p.m. slate magazine's panel on comparing watergate to today. on c-span two at noon, the 2018 savanna book festival. 9:00, in-depth fiction edition, with national book award winner colson whitehead. 2:30, the story of world war i and the legacy of president woodrow wilson. scholars explore the relationships between ronald reagan, george bush, and russian leader gorbachev. watch today on the c-span networks. >> testifying on capitol hill about the president's 2019

he defended a, trip he took to europe that was deemed a violation of administration ethics policies i the inspector general. it was announced that his chief of staff would be leaving her post as a result of the matter. this is two hours and 15 minutes.

>> the committee will come to order. good morning and thank you all for being here to discuss fiscal year 2019 budget submission. this fiscal year's budget almost 190.6 billion dollars in funding, an increase of nearly $12 billion over last year. that is a huge number. it is even more striking when you compare the growth to overall federal spending. graph in the budget presentation that illustrates

this point. since 2006, but the a budget is up 175% while overall fiscal spending increased by 54% and gdp grew only 40%. given the aggressive expansion, i appreciate the secretaries testimony emphasizing the department's core objectives and foundational services that support those objectives. the department must stay focused on their core mission to ensure resources are appropriately utilize. but the able take action on many important items in fiscal year 2019. some examples include implementation of the forever g.i. bill, and the start of what would undoubtedly be a costly and like the replacement of the ba health record, just to name a few. in the coming weeks, our subcommittees will hold hearings

on specific aspects of the budget proposal within their jurisdictions. today we will help ensure the department provides better quality and timely services to our nation's veterans. consolidating and improving ba community care. this community has heard from veterans, employees about the many obstacles that prevent the torom effectively partnering augment in-house healthcare services. another important priority is the establishment of the ba asset and infrastructure process to help the department repurpose billings, allowing dollars to be spent with a make the most impact. as we have discussed many times,

modernizing the infrastructure is a crucial prerequisite to ensure future success of the ca --va care system. it is one of the federal government's largest property holding entities. however the department's capital asset portfolio is challenging. the average building is approaching 60 years old, i know something about that number. out of the 150 million square feet of real estate, nearly 6 million are completely vacant, and many more underutilized. to determineiew how to adapt this physical footprint to meet the needs for the future. , is but certainly not least implementation of a modern electronic health record. while it is necessary it is very expensive.

the contract has a price tag of about $10 billion, and that does not include the cost of updating infrastructure to accommodate it. after visiting fairchild air force base in spokane, washington, i'm not sure you can ever turn this stuff off. it is unthinkable that va can potentially spend billions of dollars on a project that doesn't substantially increase. yet that is exactly what could happen. but of veterans affairs has a sacred mission to serve those who have served our country.

today, we are entrusted with significant resources, to carry out that mission. with substantial resources comes substantial responsibility to spend dollars wisely. yield, iote, before i would like to address a report regarding the secretary's trip to europe last year. i was disappointed in the allegations raised by this report. i was briefed on this yesterday and have instructed my staff to request additional documentation. i have gotten to know you well over the last year, actually two years, and i believe your intentions to serve and care for our nation's veterans are well and clear. you have that mission at heart. with that said, we are expected to be held to a higher standard. to take everyu step to address the findings

misreport to make any changes necessary. we have a lot of work to do on behalf of our veterans of cannot allow distractions like these keep us from doing our work. i look forward to seeing your response. while i understand many of you want to ask secretary about the findings, i ask that you keep in mind we are reviewing a budget million,f nearly $200 and that should be the focus of our discussion today. we have a responsibility to taxpayers to review that proposal as well. today the secretary will testify that this is not business as usual. i look forward to discussing how this year's the school budget request will support the transformation to a more modern and effective va. we are all eager to receive the secretaries testimony, so i will leave it there. >> thank you, chairman.

as they get started today, i our heartfeltsay thoughts, prayers, actions go out to our fellow citizens of florida in the chastity. -- tragedy. mr. secretary, i've got the opportunity to know you over many years and your intentions to help veterans is clear. the trust you have on this committee is strong, but we do need to address these allegations. you have 3.5 days to respond, which is unusual, usually longer time is given. i would like to say, before moving on to the budget, the allegations of a potential hacking of the computer system with ill intent is a serious matter. we are prepared to ask the department of justice to look

into that if you think that is appropriate, and we will follow up to see if that is an appropriate action to go on. a budget reflects the president's priorities. many of these priorities are going to agree upon. some of them are going to be contentious. we know those are there. i would note several things have happened. 12 years of war have happened. in 2003 the budget was so underfunded, that priority a veterans were asked to leave the system. the came back on in 2009, adding to that. that added cost, the chairman is exactly right, to account for every penny of that in december that is at. things, thatot of

baseline were restarted 2006 was in adequate. it is what we are getting for those dollars and the improvement of care for our veterans. several issues. last week, congress passed a bipartisan act. rebuilding hospitals and clinics. $4 million was to address significant needs and backlogs. budget proposes spending almost half of the increase on community care instead of hospitals. is after we authorized $4.2 billion in emergency funding for the program last year. community care spending will have increased 49%. this is compared to 9% increase in funding care. time and again, members of this community have raised concerns

over privatization. these numbers lend credibility to these concerns. mr. secretary, you said your intent is not to privatize the va. you're seeking to merge a congressional account that was created to provide transparency. an issue you have championed. these accounts will muddy our understanding of how the ba is delivering care to the nation's veterans. at the end of last year, the were over 31,000 provider vacancies. because of an unofficial hiring freeze. i want to know how this budget plans to fill the vacancies and if the hiring freeze will continue. i want to know how the department expects to recruit and retain the best providers and employees, when our president does not appear to value their work.

just last week he testified that your commitment to caregivers would be reflected in this budget. i did not see it. while you are willing to make astronomical request to fund care, you're not willing to do it for the caregiver community. i'm doing the best from our site. caregivers deserve no less than our commitment. expansion ishis small compared to what veterans and their families and caregivers have been forced to pay. requesteased to see the for the new health record in this budget. i would like to see update on it. here is a touchy one. i noticed budget would be scaled back during 2019, leaving them far short of the desired staffing level. additionally, the pay freeze will prevent them from hiring

investigators. it is something that i'm a chairman have championed for years together. i look forward to your testimony today, mr. chairman. our common goals are absolutely clear. our commitment to the nation's veterans are clear. i think this committee is up to the task. i yield back. morning byoined this the honorable david shall can. welcome. the secretary is joined at the table. welcome. chief financial officer of the veterans health administration. active deputy undersecretary for benefits. matthew sullivan, deputy undersecretary for the national cemetery administration.

mr. secretary, you are now recognized for as much time. >> is to chairman, i want to thank you. and thank all the members of the committee. many of you had a chance to come over to my office and spend some time talking about the issues. i know all of you are very committed to the work we are doing here today. , theve the best committee best veterans committees in the house and senate, as we work well together in a bipartisan way. thank you for keeping the focus of today on the important 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 taken the focus off of that important work. that is why i am here. of youthat is what all

are here. we care deeply about the subject. i have made the decision to reimburse the treasury. i am committed to doing what we have to do to focus on veterans and make this better. trump's about president 2019 budget and 2020 appropriations budget. it is a very strong budget. it reflects the president's commitment to veterans and their families. it provides the resources to continue modernization and respond to changing needs. greater access to care. effective management practices. modernizing the infrastructure and our legacy systems. budgetsident's 2019 requests $198.6 billion for the department.

is $88.9 billion in discretionary funding. 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. the budget also enables us to 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 increasing nearly 6% over 2018. the budget provides $1.1 billion in major construction funding as well. i am proud that this is the largest in the last five years, that will allow us to address the v.a.'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. enhance veteran accs and 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

department of defense and our community partners. the budget includes $1.2 billion to advance the implementation of this electronic health record. the 2019 budget also makes important investments and benefit services. for example, we will hire an additional 600 personnel for the various offices, and also hire an additional 225 fiduciary filled examiners to ensure protection of our most vulnerable population. this budget reflects our efforts to reform business practices in our intention to do what is right for veterans and allow our transformation of the new -- v.a.dr. shulkin: 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 wisely use taxpayer resources. we will significantly reduce the impact of certain disabilities on the lives of veterans. our goal is to get veterans better and to decrease the need for compensation. to do that, we need to modernize the rating system. more importantly, veterans and their families deserve access, choice, and control of health care. build anorking to improved integrated network for providers and employees. we call this the coordinated access and rewarding experiences in veteran care. it will allow us to simplify 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 modern, adaptable 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 president's budget supports our mission at the v.a. in the coming years, this will help maintain our commitment to our nation's veterans. mr. chairman i look forward to , working with you and the committee on doing what is right for veterans and i look forward to your questions. rep. roe: thank you, dr. shulkin. i will start by saying that, to the ranking member, that we have started a great discussion on caregivers and will continue that with a roundtable. i would like to make that roundtable bicameral, so we can get both the senators and us in a room together. i thought it was a great start the other day. i do see a pathway forward where we can do this right and get this done, hopefully this year. that would be my goal. n choice, i sent all of you this 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. i encourage you to read them. mr. secretary, you mentioned yesterday the v.a. -- most people out in the country did not realize how expensive the v.a. is. people out in the country did not realize how expensive the v.a. is. we look at the medical care and all the facets of medical care that the v.a. does, the benefit process, which we know has gotten slowed it down. we talked about that yesterday. by hiring 605 people, i'm concerned 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 who is brand-new will kick it into the appeals process, where it gets really slow down. i would encourage you to make sure that those 605 people are vetted and trained before they are turned loose. information technology,

electronic health records, they are in themselves huge projects, but all under the one umbrella of the v.a. i want to give in my time a shout out to the cemeteries. one thing that the cemetery administration does in this country, i have a national mile --erry within one mile

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

operate with dozens of different systems. or records. that is a challenge.

you authorized $2.1 billion back in december. so when we do the >> are we providing care based on the amount of money that is there? veterans putting the need first and the money follows. the money for infrastructure appears it will not be used for infrastructure will go to community care. my 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. >> you are talking about the 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. 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. based on the funds available, we could better use that funding, frankly, in community care. rep. walz: we are talking about the $20 billion in backlogs, how 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 with the digital -- and with the additional, once the deal was reached we were given an additional $500 million to be able to support that executive order. we had originally made the decision, as you know ranking member, because we thought it was the right thing to do. our focus is on suicide and we did not 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. >> i am sure that they are busy. we have worked on this a lot. the phone number down here, we would help and 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 -- then mental health care outside the walls. probably a discussion for this committee to have. i see request for this is based 2020, on the baseline, and reflects close to a 50% increase in community care. is that the norm going for it, we will increase 50% in the

community? dr. shulkin: uhh, i don't think so. i think that we have seen a significant increase as we have begun to address the axis crisis. this really was a significant crisis in 2014. we still have some axis issues. so we are getting veterans out to be seen rather than having them wait. that we've all agreed upon. i think we have essentially reached a slower growth rate of that, but we are doing what you said, we are making sure that the veterans are being cared for appropriately, then letting the money follow. i don't think 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. finally now, three years later they are understanding how to use it and that is why we saw such a big growth. rep. walz: choice is good, i've always supported it. the choice not being given is a v.a. funded with those 30,000

positions. we are making the choice that they will not get in the v.a., because in the v.a., was those appointments 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 and billion dollars say it is for infrastructure then going up, if we went through the regular , order, past and signed into law and now we have an executive order that none of us know about it, my frustration is it's becoming more and more difficult, mr. secretary, to say i'm not supporting privatization of the v.a. i 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. and not in what we are asking for the research. i still have deep concerns that this budget is going to continue that trend without the input, without the knowledge.

and i think that is the wrong approach, because veterans themselves have made it very clear they wanted the fully funded v.a. i yield back. >> i thank the gentleman for yielding. we have an announcement, the caregiver roundtable is going to be march 6. we are moving quickly with that. thank you, mr. chairman. mr. secretary, in looking at your construction budget, i think it's $1.1 billion in major construction. and $770 million in minor construction for our priority infrastructure projects and cemetery expansions. so the last four hospitals that the v.a. managed were each at least 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 to stripcongress was 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 their fingerprints on these for construction projects that were years behind schedule and millions of dollars over budget are the same people that are in charge of construction management today in the department of veterans affairs. it is unchanged. it is -- the people that have their fingerprints on this stuff are still 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.

shift thatd to responsibility as we did in my , hospital, my district to the army corps of engineers, some third party outside the v.a. because it is a waste and the abuse is incredible. could you respond to that? dr. shulkin: congressman, you have been very vocal on that and i think you have been right. there is no excuse for these past projects and we cannot continue to do business as usual. the army corps, as you know, is involved in everyone of our construction projects above $100 million, but i think we need to do a different way in the future. i think the way of the future are the public-private partnerships where the private sector helps us build, that is why we are excited about this project in omaha, nebraska, a

groundbreaking on a different model of constructing v.a. facilities. $400 million of the major construction will be seismic improvements. because we have ignored those for a long time. reorganizing and a 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 -- approach for construction and facilities and logistics. and the people that job is being recruited for, we are going to look for people with outside expertise. and we are, we think that you are pushing us in the right direction, congressman. for your comment, very quickly on your idea for introducing mandatory spending in terms of disability. sec. shulkin: yes. growth in this budget our growth , in this budget, 2006-2020 is increasing. the federal budget has increased by 52% during that same timeframe.

we cannot continue to do business as usual and think that is a sustainable structure, which we know it needs to be. we have to look at things differently. we need to focus on getting veterans back to independence and well-being and all of our efforts should be to help restore the quality of life for our veterans and we want to change the focus of our program to make sure we are doing that. we believe it is good for veterans and that will decrease the level of spending of our mandatory program. rep. coffman: on the last point, and i know this is not about the i.g. investigation, but you issued a memorandum prior to your trip to europe last summer, "essential employee travel." i will quote from the report.

"the memorandum instructed staff, before there is a request for 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 the united states, the largest of those forces does not go -- this 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 optics of this are not good and 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. >> mr. secretary, i want to echo 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 is vital that we 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. i want to ask quickly some 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 till in effect? sec. shulkin: there is no hiring freeze. rep. takano: do support of the freeze on employee pay in fy19? sec. shulkin: i'm going to take a leadership from the president. that would be across the administrations. i think it is essential for us to get the right people in v.a. so that we have competitive salaries. i would be concerned if we fall behind. we will use our ability to do that, particularly using title

30 to make sure that we are competitive. -- 38 to make sure that our salaries are competitive. rep. takano: i gather there would be some concern over a hiring freeze. how would a federal employee pay freeze affect retention in the department? sec. shulkin: we are competing, particularly in health care, but in all aspects of v.a. to get the best employees. and we know where we do not have areetitive salaries that vacancies stay open or we get the wrong people into the organization. so it is essential that we remain competitive on benefits and salary. rep. takano: with a hiring freeze, potentially in fy 19, would you be able to ask the president for a waiver if you felt that the needs of the v.a. would be affected? sec. shulkin: i would. i want to make sure we are maximizing our authorities under title 38 and title five. but if it got to the where i was

point not able to recruit the deservehat are veterans to have caring for them i would absolutely ask for a waiver. >> i am pleased to hear that. rep. takano: i am pleased to hear that. the medical center near me was having difficulty recruiting, because pay was low. housekeeping staff may not be the most glamorous position, but it 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 in danger danger patient safety? sec. shulkin: there are a number of occupational hazards in the v.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. so we are working to change the job specifications and the grades of these jobs so we can be competitive, but we have a problem hiring enough environmental workers right now, so we have to change that. rep. takano: wouldn't the 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 -- 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. work is underway right now. rep. takano: we've heard reports that the v.a. central offices

have not proceeded in improving pay for jobs. is this true? sec. shulkin: if that is true, let me make it clear right now, 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 asset. and we have to make sure we have the right people serving veterans. rep. takano: my time is up. can i ask one question's? ? failed cases, like the medical vendor program, in many cases, vacancies are directly contributed to the postponement of procedures ineffective patient care. how does this budget address vacancies? sec. shulkin: this fully funds our needs. and people should be filling those positions. and i think that you are right. that 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 resourced, without that the rest of the operation does not work. -- organization doesn't work. rep. takano: thank you. chairman: thank you for yielding. part of the problem is not the v.a., it's countrywide. at home, our hospital is having a terrible time filling nursing positions and other positions. not just hospitals, but in general. the jobs are out there, if we can find the trained people. is recognized for five minutes. rep. bost: 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 fte's will they dedicated processing legacy appeals? sec. shulkin: that's a great question. that? do you want to take >> that is a great question. thank you for that. the first thing we are doing is giving a pellets the opportunity to opt in to the new appeal process as we speak. we have gone to the pellets who have had the lungs to peel and -- longest appeal and have said, you have the first opportunity to opt in." and we are going along several thousand a week, sending letters to them and their powers of attorney and telling them that they have the opportunity. that is 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. we will have roughly 2005, i believe, the number after this. >> he is not talking about appeals, he is talking about the legacy -- >> they are making progress in this. i do not think that any of those are going to the legacy claims. but what they have done is they've implement is some thing called a new type of claim "drc" , a claim that gets this done in 38 days instead of the usual several hundred days. so they are making great progress on the claims. >> i am still concerned about this. this is across the board as we work through that committee, the concern we have is the legacy appeals, we are trying to catch up with them, but you are asking for six after more employees. five>> that is right. >> we have got the speed the

process up. is that going to speed the process up to answer these appeals and get them taken care of? jamie: absolutely. it will speed the process up. more fte to we have work appeals and we will do a blended approach toward working with those appeals, both legacy appeals and 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. >> that is right. >> and the concern that we see out there and the weight on their families, trying to get an answer. the reason for changing it was to try to straighten it up. my hope is they are aggressively on it. >> absolutely. as i indicated earlier we are , giving them the opportunity to opt into the new process. those have been waiting longest in the appeal line, if you will. rep. bost: mr. secretary, you

said you do not think any of them are going to go to the -- sec. shulkin: the 605 are going to be focused specifically on addressing the appeals, not on claims. rep. bost: ok. ok. i want to go to another quick question. you know the problems i have had in my district. right now, the president's budget has requested $172 million 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.? and second, do you need new authority to establish clear-cut qualifications for positions like h.r.?

sec. shulkin: yep, on the inspector general, my understanding, and john i will ask you to confirm this, they increased the levels last year. and this allows them to continue what they raised last year. is that correct? >> i think what happened is they had under executed their program previously and they had carryover of funding, so they hired people above their baseline funding level last year. and then so, this is tema funding for that was less than what they had hired above, so they requested an increase and they received an increase. what i would say objectively, i support this idea, working in the financial realm, but we need to look at the requirement and we have a manpower office. you cannot just have self-determined needs, it has to be validated. if you look at the line on that actually decrease. >> total budget? >> yep.

fte's, i just described how that occurred. they hired above their baseline funding. so they hired more than they had money for in one year and they requested the additional funding and received a some of it, but they still hired above their funding level. my point is the actually need should be validated. it could be more than what they say, it could be less. rep. bost: thank you. >> thank you, mr. chairman. mr. secretary, i wanted to focus a little bit on the open nominations. rep. brownley: i think there is clearly a lack of consistent leadership within the v.a., that i think is a barrier to many of the challenges that the v.a. faces. i heard,ast the last there is 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, we do not have a permanent one anyway undersecretary for , health, undersecretary of benefits. what progress are we making, in terms of finding candidates to fill leadership in the v.a.? >> i appreciate that bad wish of the same concerns. the under secretary, we had our third round of commissions -- this is the third time we have had to have a commission interview candidates. that was thursday this week. , i am inen three names the process of evaluating them and we will make history names -- maiko three names to the president if they are vetted.

i feel like we are making spec . felt toaiting for them hire and fill other important -- >> no. i share my concerns that my colleague asked, to me in terms va.hese vacancies in the is lackt of the issue of human resource personnel.

i need to hear from you, it commitment that you have a laser sharp focus filling these fill theseo they can other critical positions across the country. i agree, i would be concerned if anyone out there always there is a freeze or any desire to not staff your human resources office. i agree with both of you. i know within my visit to california and beyond, that is the primary issue. at least when i ask this, it's human resources is unable to fill the responsibilities on a timely basis.

to ask on terms of the healthve order on mental in the community. what is 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 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 -- when theplan is complete, you will presented 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. chairman: thank you. >> in the idea of flex ability and making decisions, it makes sense that we take a look at our underutilized resources. there is one 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. we 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.

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 instructor bill would change that. that's what we are supportive of that. we save the maintenance. we keep the buildings. 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 financial -- foundational services. the list includes geriatrics and other things. 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. this is -- 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. it's 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. >> thank the gentleman for yielding -- chairman: thank the gentleman for yielding. >> i want to thank you, mr. chairman, for your focus on reducing veterans -- 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 another 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 a 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 matter of 250 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 mental health building -- coming. when you look at how you'd have to staff that, that's about 1000. >> 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 pa uses a different model of primary care, -- since the 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. 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 used described is exactly our strategy around 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 means. 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.

ir -- 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 point seven increase 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 are vietnam veterans, and did not return to open arms from a nation they served. these are the same veterans that are not cure for in the caregiver program. -- cared for in their 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. 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 with christ, -- a flat request, is 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 130 five 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. 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 the current the stuff electronic 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. this is -- 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 won 30 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. >> 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 better 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, 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 have other products that are being tested on three other sites. that ford 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?

the next from the fbi. we returned to the here and now.

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 0three? sec. shulkin: this is your decision.

i am giving you my advice on this in terms of our resources. 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. 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.. -- in the that spend -- in the 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 ricky 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. americans consistently boast 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. that is a 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 goes to 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? sec. shulkin: we need to be doing more. the advances in science and

technology are incredible. you take the $727 million we are proposing for research and match it with the $1.1 billion of federal and commercial grants. you now have a very substantial amount of research dedicated to the health of veterans. we need to be doing more of that and working with the private sector and reaching out more to see what could help, particularly with ptsd and mental health issues. del. radewagen: thank you, mr. chairman. mr. chairman: i yield. five minutes. >> i want to focus on the stewardship aspect of resources, 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. how many people will this $12 billion translate into new people? sec. shulkin: i believe the budget, prior to the budget cuts deal, was an incremental 6200 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 to >> 373,000. rep rutherford: that is your biggest budget expense? sec. shulkin: yes. rep rutherford: we have to get this right. my initial introduction to the veterans administration was frustrating with respect to managing people's performance in achieving the desired outcomes.

accountability would be the core of that. that is 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? sec. shulkin: 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. the objective is to make sure we 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 some of v.a. -- of the v.a.'s 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. i am delighted we have been able to achieve a lot of bipartisan work, probably the most productive committee in congress.

35 bills passing the house. 12 will become law. we have a 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. the people back in west texas, 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. the time spent on union time is usually supported by union dues. i 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. i 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. >> mr. chairman, thank you. you have created -- asked for an increase, the largest of which is a $400 million seismic corrections fund. your 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 slush fund. let's revisit that.

in the past, the gao has raised concerns about the capital projects linking system, skipped by improperly coding projects as seismic corrections. i would like to be sure these 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? i was concerned about the same 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. this is the first time we have been able to substantially deal with some of the seismic issues that are decades old

inefficiencies. -- in deficiencies. i know the specific projects the $400 million are going for -- rep. dunn: we have the appendix that lists some of these projects, in arkansas, illinois, south carolina, earthquake zones. 44 states are involved in the seismic correction projects, plus washington dc and puerto rico. i would like to be sure these requested projects, along with $7.6 billion worth of seismic corrections, 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. rep. dunn: 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 linked back -- linked to seismic corrections, they might get priority that they otherwise wouldn't. with that, i yield back. mr. chairman: on the seismic issues, a little over 200 years ago, there was an earthquake in

the west tennessee 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 graph up here earlier. we are in the business of caring for our veterans. when we have the world war ii folks and the korea folks moving on, the population of our veterans responsible -- we are responsible for caring for is

dropping. but at the same time, i know a lot of our young men and women coming back from the middle east are greatly injured and need to be cared for. i understand all of this. but what i am looking at is a budget that has grown dramatically over the last 5, 10 greatlyick a period, outpacing the growth of the total federal government, greatly outpacing the growth of our total economy. when you have an economy that is department and a is growing at -- i don't know, x, it'ss x, five times not sustainable. i know you know this, mr. secretary because we talked

about this yesterday. our federal government is horribly in debt. debt.ly in $21 trillion to be exact. trillion, with interest rates rising, the economy picking up, there will be more and more pressure on interest rates, so the debt servicing on that debt will continue to go up. you are coming back to us, asking for another $12 billion in a budget that has gone up dramatically, continues to go up dramatically, greatly outpacing the growth of the rest of the federal government and the economy is clearly not sustainable. so, could you please just in a what are the us two or three top drivers causing this to happen and what you have to come back to us every year asking for -- in this case -- another $12 billion? yeah.hulkin: congressman, i share your exact concern. this correct.t

that is why we produced the graph. we cannot continue to do business as usual. this will eventually lead us to not being able to support our country's veterans, which will be a great error and lapse of our responsibility, so we have to do things differently. we are dealing with problems that have been essentially neglected in the v.a. for decades, putting in a financial management system that still runs on cobol programming, running 130 different versions of an electronic health record that is 35 years old where we are putting all of our money just to maintain it, dealing with old hiring practices and not having the right accountability in the past. , we are we are doing is doing everything we can, this investment, to change that. to bring us modernized systems, to decrease the rate of

increase, and my whole team knows that is our goal, to bend the cost curve and not have another graph like that for another five or 10 years. the drivers are vietnam veterans age 67 on average, getting older, requiring more services. about people who continue to return with significant needs. rising atory benefits huge growth rates, our veterans have earned those benefits. but we have to make sure that those benefits are designed to help people function -- return to functioning well-being. if ipoliquin: correct me am wrong. the goal is when a veteran comes to us with a malady, it is to get them better and have them become independent and -- ok. would you site for us -- cite for us what happens when someone comes with sleep apnea versus someone who comes to us as an amputee?

sec. shulkin: we start a process to look at all of our body systems. we are now in the process of looking at issues like sleep apnea. sleep apnea has a 50% service connection with it. we are spending billions of dollars on that. fortunately, medical advancements have helped us in being able to treat this condition. we need to diagnose this properly, treat it, management, then people can go on with their lives in a normal, healthy, functioning way. we want people to get that treatment. that is our goal at the, to get people treatment. once we get them able to function the way that they should with adequate treatment, there should be a recognition of that in our benefits program. so we are going through this process. throughd with our bso's this process. we believe a good system like this needs to evolve and change as science changes. rep. poliquin: mr. chairman, i

know my time is up, what may i please have a few more seconds to ask a question that is imperative to the staff? thank you. i know that was a lean yes. you asked to reimburse judgment claims -- will do zero out the v.a.'s liability to the judgment fund. sec. shulkin: anybody know? we have to get back to you on that. chairman roe: the gentleman's time has expired. having no further members, i for yield to mr. walls closing statements. >> i yield to the gentleman from texas. >> thank you, ranking member. i would ask for all outstanding primary care hires, to give us a number -- they gave us the number in the hundreds. apart from mental health, i want to know how many outstanding primary care provider hires they

are. many of us are getting questions at our townhomes -- i don't know who to go to. i want to know what that number is. would you get that to me and the members of the committee? i was handed what you were, primary care to 70, but that seems small. o'rourke: i think inadvertently my colleague mr. arrington has conflated two times -- official time -- we can have a reasonable debate on that. that is not union time. i think you misspoke earlier. i would like you to just for the record share that you intended to say a official time, not union time. no one is allowed 100% of their workday on union time. >> thank you for clarifying that.

for being here, mr. chairman. i want to be absolutely clear, what distinguishes this committee, i think, for many other, is our ability to focus together on the issues that matter. i am glad there was a lot of press herepress -- today. i hope they were there for the budget. no one is not taking these eryngs very, v seriously. it looks like there are allegations of criminal conduct on both sides of this thing. those need to be find out. decision toout the reimburse the federal government. the reason this committee works is we have chosen collectively here not to allow partisan natures to get into this. your predecessor took a lot of grilling because he was a democratic president's nominee there. you have a unique position of eating someone who spans both of those. i hope that everyone here

understands -- i would like to clarify one thing. i am a little bit miffed. blue wateried the navy bill. this has been a passion for me. my disagreement is not about theing this done or commitment of doing this. my disagreement is we should not be asking one group of wounded warriors to pay for another. my suggestion is to ask for 1/10 of 1% of the tax cuts of the top 1%. a biti asked perhaps facetiously, but perhaps not, if you got a deferment on vietnam, you will pay for the ones who went. the chairman is doing humans work and by presenting that, i do not disagree with that. a valid points. i hope that we are all committed to doing this right. i understand the commitment to use the coal around down. i think there are valid arguments on that, but they are

not coming from a position that we do not care about getting it done. i want to be clear on that. on the accountability act, again, 30% of the people moved come from food service and laundry. just as a thought where we are going -- perhaps training on that in? perhaps new employees? perhaps we are quick to move people before we get them in. i believe strongly in accountability. i was there to help craft of this. my intention was not to get rid of housekeepers if these are things that can be corrected with training at hr and management, if you will. i thank the gentleman for clarifying the position on official time. a really important clarification. there are tensions, i understand, around this. now we are back to the budget. i am grateful. the president sent down a budget. the constitution is very clear on this. appreciate his suggestion. congress failed job is to write the budgets. congress fell job is to find who havefrom the folks

to deliver that. there's a lot of commonality in getting there. i think the issue on budget growth, we have to have that conversation. i do not disagree. management practices, all of that. we do have to acknowledge though, i would argue, the v.a., the clinical folks especially, are doing such a fantastic. we have added 2.5 million veterans who come to the v.a. want to go there. the vietnam veterans are the rabbit through the python thing. and i would close with this. if you go to war 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 have to budget for that. yes, it does not become sustainable, but this -- i do not see this as an option or discretion of funding. this is absolute mandatory requirement to care for our veterans and we have to budget accordingly. i think the chairman for his leadership -- i thank the chairman for his leadership. i yield back.

chairman roe: thank you to the gentleman for yielding and i think the panel for being here today for the start of this discussion, the 2019 budget. , for our folks that are watching this, just what are the services that v.a. actually provides? i have been here now nine, going on 10 years, and basically, it provides quality health care for veterans.lion and whether it is inside the v.a. or outside the v.a., their commitment is to provide college -- quality care. it provides memorial benefits. veterans. andwe talked about that earliero your will. over 140,000 veterans a year who have now passed, with those benefits going to their families. pension benefits. hundreds of thousands of veterans get pension benefits. group life insurance. we don't think about that. home loans. veterans over 3 million get a

home loan from the v.a., compensation benefits over 4 million or five millions of our -- thes get huge benefit educational benefit. the montgomery g.i. bill and now the forever g.i. bill. veterans are able now -- and half, i think, of the young and -- the young men and women use that g.i. bill. one is sitting in this chair. i used that g.i. bill benefit. i want to thank the president for his focus on the v.a. i remember sitting up at night late in the evening when he gave his acceptance speech in one of the first things out of his mouth was his commitment to the nation's veterans. i very much appreciate that, and i don't think it stopped. givestime he talks about, a speech, he mentions our nation's heroes. i thank him for that.

committee, as a bipartisan way, as the ranking member mentioned, have a huge amount of work to do. we have the expansion of the choice program. we have to do that so you can move on with that. the asset review. of morewn the pathway efficient care in the neighborhoods, in the communities where our veterans live. we have the hr -- vhr modernization. alz brought up, one of my passions and want to get up the table, my blue water navy friends. we have caregivers. we have our first roundtable on that. state veteran homes. everywhere i have looked at a state veteran home, those are really quality places our veterans can go. you mention the number one health priority, suicide

prevention. we have enormous work to do one that and is it -- and there is a huge investment in this budget for reducing the amount of suicide we have in this country. and lastly, i know always when privatization comes up, it's hard to do that with a straight face. i think you said that there are gone tohe budget has 990 $8 billion. that does not look like privatizing to me. it looks like a commitment this nation is making to its veterans. and i am proud about that. when i go home -- and i live in a very conservative area of the country -- i will never apologize for the money we spend helping our nation's veterans. i don't think a person on this dais does. i think we can go home and say this entire congress -- both

republicans and democrats -- have done this. lastly, as we close, we have a number of questions for the record, and one of those i want to get out is this transition to choice. you do not have to answer it now. money that lasts until the end of may and further money was appropriated and inns until the end of the fiscal year which goes until first october, 30th of september. how do we get from 30 of september to march 19, because that is the time when your team will have this to be fully implemented? you don't have to answer that now, but i need that. will it be under the budget caps? with that said, it is unanimous consent that all members have five legislative days to revise remarks and add extraneous material. without objection, this hearing is adjourned.

[captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2018]

>> [indiscernible] [indistinct conversations]

>> now it is only after the fact -- [indiscernible] it is a moving target. it is a moving target. but, no, i think -- you know,

the question, to me, he the failures of the prior administration where they want to sweep everything under the carpet. everything is going well. how can you solve anything without a source of leadership? is there anything he could do -- >> i think, there has always been a question in my mind about what the president wanted. what the president wanted was somebody from outside the v.a. to come in -- i think he went differentike, three names who backed away. i think he kind of gave up and went for someone within the

v.a., and ultimately, i think that has been a mistake. shulkin isou think as a choice overhaul? i wonder if that is a major factor in the report by this committee today? >> we are on that path. i think we will continue on that path. we've got to let the system work. would meanhat authorizing legislation. i don't think it would. it will be debated through members of congress. v.a. spending mandatory funds through choice has a huge impact and how you have to move or respond to make sure veterans have access to care. i wonder if they can see at that high of a level could really address their ability --

i would hope the vacancy would not be there. i would hope be vacancy would not be there for long at all. >> [indiscernible] mean, certainly i would rather see somebody from the , thate who has experience number one has a military background, and number two, as a background in preferably managing a major hospital system, but brings executive experience to the v.a. be morphed going to into being part of the system, part of the culture of the v.a.. when they get in there, they become part of this. part of the culture.

this week on the communicators, we wrap up the series. a look at the latest developments and television, phones and virtual reality. >> but that is referring to is the panel technology which is different from lcds, even though the led is the same, and that it is in miss of technology. it doesn't even backlight. yet this very thin factor and you can -- it enables the curve. is showing ampany prototype of a display, that it rolls up into a storage box and

it rises out. this is a little bit of a glimpse. >> watch the communicators >> coming up next, q&a with author and journalist michael fabey. that is followed by your phone calls and a look at headlines on "washington journal. bob dole is honored with the congressional gold medal at a ceremony on capitol hill. ♪ >> this week on q&a, investigative journalist michael fabey. he discusses his book --"crashback: the power clash between the u.s. and china in the pacific."