have urgent needs waiting until we get enough access in the system. having said that, this flexibility will allow our medical centers to make good decisions about what's best for veterans. whether they can use this money to better support programs in the v.a. or whether it's a better decision to continue to buy care out in the community. and that's what you want an accountable management team to do. focus on their customers and in this case veterans and figure out in their market how do you best supply those services. >> you do. 49% hen you have difference in increase in growth you're clearly favoring their ability -- ms. wasserman schultz: which side of the ledger is their ability to make that choice. so the more and more resources that go into private community care and the less of an increase that we're focused on in the v.a. care the longer it

takes us -- i mean, government -- we'll turn more slowly anyway -- then the longer it takes us to ramp up to make sure that people could choose the option of getting care at the v.a. rather than private sector and frankly every -- almost every veteran i have ever spoken to and i don't know if my colleagues had the same experience, if you ask them, their preference is to go to the v.a. i yield back. >> thanks, ranking member. at this time i recognize the gentleman from california for five minutes, mr. valadao. mr. valadao: thank you, mr. chairman. thank you, mr. secretary, for being here. appreciate your time. last week the v.a. inspector general released an audit of wait time. wait time experienced by veterans seeking first-time care from v.a. doctors. the report estimated new patients waited on average about 18 days for an appointment. additionally, 36% of veterans had to wait longer than a month for an appointment despite the

v.a. scheduling system saying only 10% had waited that long. due to this inaccuracy, nearly 13,800 qualifying veterans were wrongly made ineligible for veterans choice program. have those responsible for misreporting wait times been properly dealt with and what do you plan to do to fix this serious, ongoing issue? secretary shulkin: the i.g. report i think was well done and gave us a lot to be able to start going through. there have been some immediate changes that have been made. many of the inaccuracies that were in that report were because people were inputting specific dates, our schedulers were. that's now automatically taken from the system. so that there's not the ability for individual variation. it's what's put into the system. i changed the way we record wait times to when the veteran first calls and requests an appointment.

it used to be there was this judgment in there about when did the patient want the appointment and that's where i think you had the ability to see data from the problems. now it's the data they call and ask for the appointment is the way we start recording things. we have also increased now the number of audits that are going on throughout the system to be able to make sure that these types of data are understandable and accurate. in terms of accountability decisions, v.h.a. and seeing what if any appropriate actions have to be taken there. but we have the data on the wait times today and overall for mental health and visn 15 it's 11.6 days, but for primary care it's 18 days still and it's something we are working very hard to get lower than it is because that's still too long to have to wait. mr. valadao: that's an issue i heard in my district. my constituents approached me

throughout the district with the same thing. we love the care we get once we're in the door. the struggle is getting in the door. i appreciate it. one more question, mr. secretary. as we discussed in previous hearings, since 2002, the v.a. has continued to deny claims from blue water navy veterans despite signs showing higher ates of cancer and non-hodgkins lymphoma. i brought this up in prior meeting hearings with you and you replied you are requesting additional recommendation from the v.a. on this issue. additionally, i wrote a letter to you in august to address this issue. in september, 2017, you responded to my letter and said you were going to be receiving additional subject matter -- receiving additional subject matter, expert recommendations on the matter. -- update me and my fellow so my question is nearly six months later, have you come to a decision on the blue water

navy veterans? if not, what is the status update and when can we combect a response as to whether your department intends to afford these brave americans the benefits they have fought for and deserve? secretary shulkin: well, first, i thank you and others in congress that continue to not let this issue go unanswered. i am aligned with you that these veterans have waited too long. and that this is a responsibility that this country has. as our veterans get older it's unfair. i do want to make clear that any veteran who has a disability claim such as some of the cancers you talked about is absolutely able to file that claim in an individual -- and an individual decision will be made whether there is evidence to suggest that that disability is related to their service. and we are dealing with these claims every single day. what we're talking about is a presumption. what we're talking about is a class of veterans who served that wouldn't have to go

through that type of disability process. and so i believe that it is imperative upon us to resolve this issue. i also believe that there will not be strong scientific data to help resolve this. this is going to be an obligation that we feel as a country that these veterans shouldn't be waiting any longer and i am on the side of trying to find a way to resolve this for the blue water navy veterans and we are working hard to look at offsets and other ways to be able to do that. and it is a high priority for us. mr. valadao: i appreciate that. with these types of cancers, time is of the essence. and so having that extra step that they have to take to be able to get treatment is a huge issue and they're -- so thanks again for your testimony. secretary shulkin: thank you. >> i'd like to recognize the gentleman from georgia, mr. bishop. mr. bishop: thank you very

much, mr. chairman. mr. secretary, thank you for appearing today and your continued partnership with members of this committee ensuring we support our nation's veterans. i want to also thank you for your leadership of the department both as medical director and as secretary. i along with v.s.o.'s and veterans all across the country appreciate your hard work and your commitment to veterans. i am going to ask you two questions very quickly. the first has to deal with prosthetics. f.y. 2019 budget includes $727 million in research which is above the 2018 budget. coupled with an additional $1.1 billion with other federal and private grants in support of veteran research is $1.9 billion. it's my understanding the technologies surrounding the prosthetic process for our service men and women have grown exponentially over the past years and the v.a.'s

prosthetic program may be somewhat outdated. what steps is the administration taking to ensure veterans have access of the latest prosthetics technology that's available on the market and that the v.a. stays competitive with the private sector in this regard? my second question has to due with modernization and telehealth. i represent a predominantly rural district and i am concerned about the highest qual of care they receive from the v.a. the modernizing program anywhere everywhere v.a. telehealth program, what costs are associated with expanding this program and is it included in your f.y. 2019 request? will the v.a. be providing the equipment required for telehealth of medical appointments? i know 45% of the telehealth services are for rural veterans. tell me what steps are being taken to grow that percentage in rural areas with the limited

access to broadband. and tell me whether or not you are coordinating your efforts with the department of agriculture that has primary responsibility for rural communities and in particular broadband access. and whether or not you are participating in the rural america task force that's made up of cabinet secretaries and convened by secretary perdue over at usda. secretary shulkin: ok. so thank you for both those questions. it is essential v.a. maintains the most contemporary approach to prosthetics and orthodics. this needs to be a foundational service for us. and i do believe the research funds needs to be moving us towards those contemporary technologies. i was this past week at the las vegas v.a. i asked about this. i met with their team. they are using the laser you and i e way that

talked about and that is the best practice. we are making sure we are learning what new therapies and diagnostic approaches are out there. as i mentioned we are working with 3-d printing. we have recently developed a new prosthetic arm with darpa and so it's exactly this type of focus we need to be doing and i will make sure we are using the very best technologies. but we do work with private doctors who are constantly telling us new ways to learn and we are committed to that so thank you for that on the telehealth services, as you know in fiscal year 2017 we had about 27,000 veterans using telehealth. in the rural areas it's about 300,000. just this past quarter we had 110,000 rural veterans in one quarter using telehealth. so you can see it's increasing.

that will be around 450,000 on this type of run rate. for us to reach more rural veterans and provide that type of expertise. in terms of the budget we are seeing an increase particularly for rural rural health and telehealth. it's a 12% growth in 2019. mr. bishop: you are working with the task force with rural america with regard to veterans' health, particularly with the broadband access? secretary shulkin: yes. i have attended a number of meetings with the telecommunications leaders through the white house conveners. this is a really important problem to solve and i think

you identified the reason why. without the broadband technology it's hard for us to get into veterans' homes and even into some of our own facilities. but we need to do everything we can to partner with our companies to be able to find solutions. so, yes, we will continue to work with our rural counterparts throughout the administration. mr. bishop: thank you, mr. chairman. >> thank you, mr. bishop. i yield five minutes to the gentleman from west virginia, mr. jenkins. mr. jenkins: thank you, mr. chairman. mr. secretary, thank you for meeting with us last week. couple quick things. number one, we have an opioid crisis nationally. we certainly have it in my state of west virginia. and tragically many veterans are impacted by the disease of addiction. with regard to the v.a., the data as siloed in sharing

with state pdmp's. have we broken down those barriers? do all prescribers at the v.a. have unfettered access to the state pdmp programs? and number two, is all escribing data relating to prescribing behaviors dispensing of v.a. folks put into the state pdmp's? two-way communication. ecretary shulkin: first of all you know the v.a. has focused on the opioid initiative since 2012. we have seen a 47% reduction in opioid use. what i am most proud of, it's a 90% reduction on initial starts now. we are looking and finding alternatives besides having to reach for opioids. in terms of the state prescription data monitoring program, it's a requirement that all v.a. prescribers

participate in the state monitoring program. so that is a requirement. and as far as i am aware but we are going to come back and confirm this because i think this question is something i wish we had asked and i didn't make sure this is bidirectional. if we are not getting into the state databases then how do outside prescribers know? so i believe that's the case but i will confirm that and get back with you. mr. jenkins: i think the gentleman from california raised the i.g. report and i will talk about the issues. this congress over the last couple years took great strides of the administration and secretary's request to hold people within the v.a. accountable. our goal is clear. we want the best care possible

for our veterans and if there are people who aren't committed to providing that care at the vel we expect the veterans deserve we want to hold them accountable. as i raise wud previously and i heard your comments just a moment ago talking about appropriate actions and change and i know you weren't referring specifically -- i hope not -- to the situation in west virginia but i simply want to say it's not appropriate action and not the change we are talking about where a v.a. employee in oregon accused of gaming quality of care statistics to refusing to treat certain veterans was proposed to be transferred to my state of west virginia and simply because outcry from me and others the decision was not to o that transfer. can you reassure us the day you're handling those employees at the v.a. that are not committed to the mission of the

best possible care aren't being swept under the rug, shifted to other state i don't want oregon's hand-me-downs. secretary shulkin: first, congressman, we appreciate the feedback. but this was a decision made by the health administration and the decision was made to demote the individual to a lower level of responsibility so they could get the appropriate mentorship to be able to contribute back at a higher level. this was not just a simple lateral transfer. but because of the feedback, as you know, that didn't happen and i think that's the way it should work. we have to come up with mutual decisions to find out what's best. but there was not a decision made by the health administration that this person

should be terminated. the decision was made that they were operating above their appropriate level of responsibility so a demotion was made. mr. jenkins: maybe demotion is appropriate. i don't know the facts. it's the demotion and transfer to send a problem from oregon to the veterans in west virginia. that's unacceptable. there needs to be transparency. while you acknowledge it is a factor it did not become a factor until there was awareness. and i think those in oregon probably let the folks in west virginia know you got a problem on their way. we need better transparency and not kind of that mode of communication. finally, with regard to the infrastructure. i visited all of our medical centers. i'm out of time. i understand. i'll save it for the next

round. secretary shulkin: ok. thanks. mr. dent: recognize the gentleman from virginia, mr. taylor, for five minutes. mr. taylor: thank you, mr. chairman. mr. secretary, thank you for being here today. we appreciate it. one quick thing -- as you know my district has the fastest growing veteran, women veterans and care. according to the v.a., 40% more will fall in the care. on that infrastructure note, our outpatient center on the vouth side in our area is one of 28 major v.a. major facilities that were approved by congress last year. my question is, how can we expedite these needs to get them built? because i think it will be another two years before there's groundbreaking. are we using the correct contract vehicles to be able to make that happen? secretary shulkin: it takes way too long to get this stuff done. we are following the federal

contracting rules and regulations and we're trying to do this as quickly as we can to get through the process. i do believe that the answer that probably you and i are both looking for to get this done faster is new models to work with the private sector. and allowing public-private partnerships to ahelp us achieve this. we did ask for legislative authority to use greater extended use leases. you have given us authority to do that with the homeless population. we're limited to being able to do this. if we had greater authority to be able to build your facilities with extended use leases, the private sector could do it and we lease it back and i think that's an approach we should look hard to doing. with federal contracting rules it does take years. mr. jenkins: use of those to expedite contracting? secretary shulkin: it's something i just don't know

enough to answer. i will be glad to get back with you. i don't know if my colleagues know enough about that. any ideas -- i mean, we need to get this done faster. the money has been authorized. veterans are waiting. it drives me crazy to years go bained not do this. mr. jenkins: thank you, mr. secretary. we'll get to you on that. another note, it's important to say, as there is a generational divide in terms to use the v.a. or desire to use care. and my generation tends to in general want to have private care because it's easier access. the older generations tend to like the v.a. better. so there's deaf cincinnatily a generation -- definitely a generational divide. we had the i.g. who talked about our own facilities and talked about the care being great but, of course, the

perception still amongst veterans of wait times, of not being called back is still very poor. in my area it's a one star out of your rating and that's obviously a big problem. question is as the ranking member pointed out where 9% has increased in the v.a. care but 36% in private, what are the numbers -- didn't see that -- for the folks, the veterans who are using the private care? and let me also say on the record that i agree with you and the ranking member that it's the government's responsibility and our duty to take care of our veterans and oversee that so not just be privatized. at the same time, as one who's of that generation, i think it's to get better, faster access and not have to wait which as you said, we should be able to use those facilities. but private care -- excuse me. what are the numbers and what are the veterans saying in terms of wait time in terms of being called back that are using private services? i haven't seen that. secretary shulkin: look, when you are talking about nine million veterans that use the v.a. system, this is -- this is

never going to be an everybody feels this way or everybody feels that way. that's why we're working towards giving people more choice in how they want their care. many in your generation, many in my generation increasingly want their care on their mobile phones and convenient access when you need it. that's where we really need to be moving, no doubt about it. but the difference between community care and v.a. care in terms of access is geographically variable. but in general, because i will talk across the country and i have a publication i am submitting on this, v.a. access compared to the private sector is 11.3 days less across the country. now, depending what region you are in that can vary. the satisfaction of veterans with access to care is actually improving from where it was in 2014. we are getting better but there are parts of the country and i think you come from one where

we need the private sector in order to meet the needs. so that's what we're doing. that's why you're seeing us prioritizing access. community care growing. we're trying to build capability. hire more people within the v.a. to address access. that will hopefully give veterans more choice about where they want to get their care, in the v.a. or outside the v.a. mr. jenkins: thank you. mr. dent: i'd like to recognize the gentlelady from california, ms. lee, for five minutes. ms. lee: thank you, mr. secretary, for being here. as daughter of a world war ii and korean veteran, i am really pleased to know we have a secretary dedicated to ensuring that veterans receive the quality health care. i know the v.a. intimately as a result of my dad. so thank you very much. couple things i want to mention to you. first, i have a letter that i am going to give to you regarding alameda point. this is the new outpatient clinic in my district. now it appears it will be two years now off track in terms of timing. so i'd like -- and i'm asking in this letter to give me

monthly updates on the status of this because i'm quite concerned about what's taking place. that's for the record. i'll give that to you. and then secondly, ok. now coming from california, of course, you know we have a variety of dispenseries which make marijuana available to patients and veterans who use it for ptsd or chronic pain and it works. ok. now you said that the v.a. can't recommend medical cannabis in accordance with state laws until the federal law changes. but marijuana schedule 1 status does block formal prescriptions but it does not block the ability of doctors to fill out questionnaire forms in those states. so what's the problem? what's the federal statute that blocks the v.a. from doing this and not letting physicians simply recommend cannabis to veterans who need it and it's proven that it works? secretary shulkin: filling out a questionnaire, isn't that a

step towards prescribing? somebody has to write the prescription. ms. lee: it's not a formal prescription, no. it's just a recommendation form. that's all the state requires. not a prescription. secretary shulkin: who writes the prescription? ms. lee: the physician would recommend cannabis. secretary shulkin: my understanding is v.a. federal law would not allow the physician to write the prescription. but -- so i have to understand what the questionnaire would be in order to make a recommendation but not a write prescription. ms. lee: could you show us that questionnaire? secretary shulkin: absolutely. ms. lee: it's a shame and disgrace the v.a. is preventing this type of treatment that works. so -- and we know the federal statutes and what all but this is merely a questionnaire. i'd like you to review that. secretary shulkin: i'd be glad to review. ms. lee: the tragedy that occurred in younesville. it shows the problem with guns.

secondly, veterans who need more mental health care and the pathway model where it leverages benefits from the private sector as well as the public sector and the v.a., it's really a nationwide model. and so i hope you look at what took place there and look at how we can expand the model, first of all, but also how we can prevent these tragedies from happening. i don't know, are you conducting an investigation now? secretary shulkin: we are. as you know this is a state home so that we weren't providing the security. that's up to the state to be able to do that. but we are looking at every aspect of this. before you came in i mentioned that three heroic women lost their lives. as i know you know. but one of them was a v.a. employee. we are -- we are absolutely torn up that this happens to people serving veterans. we are looking at every aspect

of this to see what we can do. we don't want our employees ever to have to go through this but also the fear when they're serving veterans they have to worry about this. so we are working very hard to look at what we can do in order to protect our staff and to protect our veterans, quite frankly. the pathway home model is a remarkable model. they were dealing with the toughest of the tough, you know, in terms of people that failed other treatments. we're not going to give up on this. that would be a failure of our acceptance of this mission, so we're going to continue to do that and we're working closely with our california counterparts. . i spoke to governor brown and we worked with the state department head of veterans' affairs there and we'll continue to work to make sure we're going to see this model continue. ms. lee: thank you very much. mr. secretary, one more

question. this military parade the president's proposing. will any part of the v.a. budget e directed toward this parade. mr. mulvaney did $10 million to $30 million. right now 1.5 million veterans live in household receive snap benefits. an increase in homelessness among veterans. are you going to pay for part of this parade rather than put money into veterans' health care, mental health, and housing? secretary shulkin: as you know, veterans day is a very important day to us. we put our resources and efforts into the recognition at our cemetery that day. we have no chance to change that. we haven't had any discussions at the white house about getting in the parade. mr. dent: i'd like to recognize the retiring gentleman from florida, our good friend, mr. rooney. mr. rooney: thank you to the retiring chairman. dr. shulkin, welcome.

thank you. aware ornow if you are not, but over the last several years congressman tim ryan and myself both served as co-chairs of the military mental health caucus. it's had a few variations of different aware or not, names. essentially we have tried to hold hearings and have meet to discuss things that would help returning war fighters and veterans deal with any mental health issues or stigmas that have arrived since, quite frankly, the last war on terror. to try to do something to address the suicide issue that has obviously been a big problem. i want to say that we appreciate everything that you have tried to do. and your willingness to send someone to participate in a lot of briefings we had for our members and staff.

and i recently read a report about the v.a. that raised some concerns about our ability to meet the mental health needs of those post-9/11 veterans. of the post 9/11 veterans who haven't gone to the v.a. for help, many reported they don't know how to apply for benefits. they don't know if they are eligible or they are not aware that the v.a. offers mental health care benefits all together. how are you working with the department of defense to improve transition assistance programs and reduce this lack of knowledge amongst veterans? how are you working to target veterans who have left the military before these type of transition programs were actually in place? and then this other question, i'll ask all my questions and let you answer. the report also suggests that the transportation issues pose challenges for many of these post-9/11 veterans. i know that this is especially

true in rural districts like mine. but i also think that it might be true in anybody's district. if you just don't want to talk to somebody face-to-face, maybe that's part of an issue. maybe it would just be easier to discuss these things over a telephone or something like that. when asked, 45% of veterans answer that they would be in favor of using the internet or telephone to receive mental health care. you recently announced the launch of a new pilot, telehealth program, for rural veterans with ptsd that will provide veterans with remote access to psycho therapy and related services. can you provide an overall -- overview of how this program works and anything you have to expand that program to include other areas? secretary shulkin: first off, thank you for your leadership in this area. as you know this is critical to us and our top priority to reduce veteran suicide.

you are correct that of the 20 veterans who take their life through suicide, 14 are not getting care in the v.a. they are in the community. we have focused extensive efforts on working with community organizations, churches, synagogues, mofpks, -- mofpks, wells -- mosques as well as not for profit organizations to get resources whether in the v.a. or outside the v.a. our veterans crisis line we have expanded to now a third center. and we're responding to well over 1,000 calls a day. you can also text into that. we're using alternative means to be able to do that. telemental health is a huge area, an opportunity. we use it extensively. close to 400,000 episodes of care delivered through telemental health. we think it's important to expand that. we now have 11 telemental health hubs where we can hire

professionals and usually metropolitan areas that can now serve in more rural areas where the shortage is -- shortages are more significant. mr. rooney: with regard to my first question. i don't think it has to be rural. i was driving around washington, d.c. it's maddening just to try to get anywhere here. a lot of -- i'm sure it's the feeling of easy access. especially at critical times when people might need it right now rather -- to access to somebody that can talk to them rather than trying to figure out how they are going to navigate whether it's a rural district or city. with regard to my first uestion, when -- in 2004 there was no transitional advice for myself and i assume the other

people that were doing the same or around that time. since i have been out and -- some might say i probably could use some help as well. i got nothing from the v.a. or anything to show, by the way, if you p.c.s. from the army or navy or any of the branches before we started doing some kind of an awareness separation briefing, and you feel like you might need some of this kind of help, this is some of the things you should do. i have never gotten that kind of phone call or letter or anything like that. what do you do for people that may have p.c.s.ed before those efforts were put in place? secretary shulkin: first all, we worked hard on our transition assistance program to make sure that before everybody gets out that they undergo a seminar on understanding how they use their benefits. too often, i think this is what you are referring to, when i

talk to veterans that find themselves transitioned out of the military, now find themselves somewhat either depressed or in their emotional issue, the last thing they want to do is figure out how do you start applying for benefits. the president's executive order that he signed on july -- january 9 of this year, asks for essentially what i call auto enrollment. my staff doesn't like when i say that because it's complex. i believe before everybody leaves that paperwork should be done. they should be automatically eligible to have access to mental health services. that we presented to the president on march 9 they report to suggest how we're doing that with this department of defense. we're implementing that as we speak so that that's essentially all the -- automatic that every service member will have that mental health benefit when they transition out. mr. rooney: talk. mr. dent: the gentleman from ohio is recognized for five

minutes. >> just to continue along the line of mr. rooney. mr. ryan: i think that's a great way to approach the transitional assistance program is to get people in. to me it doesn't sound complex at all. it sounds very straightforward. i think that's the way we need to go. we appreciate your leadership on this. until my estimation a couple major issues. some which have been brought up here on the issues of opiates and on the issues of posttraumatic stress. we have -- still have 20, 21, 22 suicides today. we have clearly some budget issues that we need to deal with in the long term. and we have to figure out how we can provide care to these veterans who are coming back or have been back for 30 or 40 years. we have talked about the little bit at our breakfast last week.

i have seen personally over the last 15 years of my career here complementary programs that are affects in evable improving the health and well-being of veterans who have been suffering for a long, long time. i have sat at the washington, d.c. v.a. in a mindful based stress reduction session for 30 minutes of mindful-based meditation techniques. and then afterwards had conversations with vietnam veterans who were in tears talking about how they wished they would have found this 40 years ago. because they had been on so many medications. they have been divorced two or three times. they have lost touch with their kids. just emotionally disconnected because of what they did. it it's the david lynch

foundation. what they are doing with meditation. it's yoga. we have had sessions on capitol hill with a veteran yoga teacher double amputee who is going out and helping to heal these vets who are going from -- i was just in a session last week with a group called project welcome home troops. they had a vietnam vet who was on 20 prescription drugs. 20. which is not common but it's not unusual, either, for people to be on 10, 12, 13 drugs. one session, five days of this complementary approach, this guy is off all his meds. and i'm just saying we have got to wake up. there are things out there that we don't need to come up with any brand new solutions. i just want to plant the seed with you to say, as you are doing the t.a.p. program, i

think it would be in the interest of the taxpayer, the veteran, and all of their family members to start figuring out how to either through the choice -- have these options. so get the people through the t.a.p. program aware of what's going on. let's start studying these. i don't know why this stuff works. i have no clue. has something to do with your nervous system and biochemistry. the mind-body connection that we're learning more and more about. when we have vets going from 20 prescription drugs, and we do the math on that for the next 30 years, we do on the appropriations committee and the budget committee, and then we do the math of that person maybe getting a treatment for 500 bucks for five or six days, and it transforms their lives, that's something that we need to look into. i don't care what it is. i don't care how it works. what i would just recommend is

that -- i know tracy is doing an amazing job with the patient center of care. when these young men and women come back, that they are at least made aware of these programs and where they may be in their community. if we can begin to set up some pilot programs where whether through the choice program or something else, we give them 500 bucks. i would much rather, the people i represent, and the veterans, and everyone else, let's give them the 500 bucks to try this thing out. see if it works instead of immediately start doling out prescriptions. i would love to work with you on that. i think it's critically important. time is of the essence. there is a real sense of urgency here. secretary shulkin: congressman ryan, i'm all in. i think you are absolutely correct. it's why we have had a 90% reduction on new starts in opioids because we're using different approach. 93% of our v.a. medical centers

offer complementary care. the choice program does pay for complementary care. we had 47,000 authors this is past year for acupuncture. 70 thousand -- 70,000 for other are. we have to continue to reach forward on this. tracy with the whole health program is rolling this out across the country. mr. ryan: there is science behind a lot of this. the literature on this stuff has grown exponentially in the last 10, 15 years. i appreciate that. yield back. mr. dent: i'd like to recognize the vice chairman of the subcommittee, mr. fortenberry, nebraska. mr. fortenberry: thank you, mr. chairman. thanks so much for joining us today. we have great news in nebraska and harder news. i think you are well aware of it. it would be important to discuss publicly. he slogan, private-public, pub

lish-private partnersships has been used exhaustively. yet at the same time actually making this a reality can sometimes be harder, but we're doing it back home. in omaha, getting ready to break ground based upon the new piece of legislation when it was passed. fairly recently, on a new ambulatory care center. taking the money which was setaside for years and years and years struggling to become big enough to actually rehabilitate or rebuild a new hospital, just was never going to happen. so the community has stepped forward in partnership with public dollars and your leadership are putting up $30 million to build out this care center. a huge first step in terms of a new way of thinking for the v.a. we're very proud of that. back to modeling and using this as a scaleable template for the rest of the country, i would like to hear your perspective on

that. secondly, the harder news, the lincoln v.a. clinicic we're we have a historic structure. the center of our city. redevelopment agreement reached with the city. all things ready to go. then the process collapses. you have been very generous in trying to shepherd and watch this. i think it would be helpful as well if you could give commentary on the new timeline which we're going to receive rebids or the build out of the new clinic there. particularly given it was just some type of internal technical bureaucratic snafu that has delayed us. the opportunity cost of delays are huge. another year or two gone by which we're not providing the best type of progressive leading-edge care. secretary shulkin: first off i guess it's better to focus on the good news. the private-public partnership in omaha we hope to a-v a

groundbreaking ceremony in may. -- a hope to have a groundbreaking ceremony in may. that model which congress has authorized us to do five times across the contry, omaha will be the first, called the chip-in act, is a model we hope to replicate. we're actively now in communities looking for the other partners. this is a major priority for us to replicate what you are doing in omaha. mr. fortenberry: is this a vision you anticipate catching on? secretary shulkin: we have interest from at least 18 communities. the great thing about the american public is is that you ask for their help when it comes to helping veterans and they step up. mr. foreenbergry: exactly. secretary shulkin: thanks again to -- mr. fortenberry: exactly. secretary shulkin: thanks again to omaha. we believe we'll have all five soon. in terms of lincoln, this is a

contractor that was awarded that unfortunately was not able to be able to complete the work. that starts us back in the process. i think as congressman taylor said, we know this stuff takes too long. -- in 2019 al starting with construction in 2020. it's not the result of veterans that the contracting process didn't work for them. i asked our team to go back. that's unacceptable. they are looking to carve about eight months off that process. we're still 18 months away from being tible do the work that eeds to be done. from being able to do the work that needs to be done. mr. fortenberry: we're where we're in lincoln. i know you are doing this -- to expedite this is necessary. in the meanwhile, people at home

putting plans on hold, veterans eager for this new unfolding dynamic have to be told that there was some internal mistakes. anything you can do to expedite this would be helpful. again not having this in place, a huge opportunity cost. but i know you are on it. i just thought it was important to have the conversation. i yield back. mr. dent: thank you. before we go on the second round, i would like to recognize the distinguished ranking member of the full committee, mrs. lowey, for five minutes. mrs. lowey: thank you, mr. chairman. it's been a busy morning. i'm delighted to be here. i know you are proceeding. a pleasure to see you, mr. secretary. i do want to apologize to you as well. we have multiple hearings this morning and i didn't bring my roller skates so i'm moving

along. i know that important questions on investments and oversight and veterans health and benefits have been discussed. i'd like to raise a few specific items. number one, the waiting time for substance abuse treatment. i don't think that's been used as yet. last year i heard from a local veterans health care provider that veterans facing substance abuse who had the courage to seek treatment can face an average wait time of 10 days before a spot treatment becomes available. nationally the average wait time is even worse at 21 days. delays as you know can prevent a veteran who may be ready to confront addiction from actually seeking treatment, and that doesn't honor our end of the bargain to provide care for our veterans. this is really shocking to me. what's the cause for these delays? is it the availability of funding, staffing, or other structural issues?

and more importantly, what is the v.a. doing to make in-patient treatment for substance abuse available as soon as possible? secretary shulkin: this is critical to the debate that's going on right now about opioids and suicide and the homelessness problem. these all intersect. too often -- even our veterans justice issue, our jails and are still places where we're putting people with substance abuse disorders. the v.a. has a responsibility to increase its fast it for substance abuse, particularly as we're learning more about medication assisted treatments and other affected treatments. as you know, the substance abuse programs are filled with people who have recycled with recidivism. the more that we can find more evidence-based treatments that help people essentially get back on track, find jobs, and get back to their life the way that they should be living, it's

important. we do recognize our responsibility to increase capacity, we're looking to hire additional mental health and substance abuse experts. there are shortages of them. as you recognized and i appreciate you doing it, the private sector is struggling with this as well. while even there is longer waits, my concern in the private sector is if you don't have the right type of insurance or enough cash, you don't have access to programs at all. so the v.a. is doing -- much easier equity and access to these programs, but we need to expand them faster. mrs. lowey: thank you. i hope we can work together so you get the resources you need. the national septre for posttraumatic stress disorder conducts important research to access and treat ptsd with approximately 11 to 20 of every 100 veterans returning from operation iraqi freedom and enduring freedom with ptsd, the

center's work is not only critical, but as you know it increases the likelihood of discovering effective treatments. even potential cures. if you can share with us the research informing the v.a. about the assessment and treatments of ptsd. and how will the v.a. continue to support the center and its essential work? secretary shulkin: when i looked into this, the law that requested the v.a. do a study on the evidence-based treatments coming out of the national center, was actually never enacted. so that that's something that we like to make sure because we have been asked about when is the study going to be done? i don't believe that law's been enacted. our national center is moving ahead and doing the study anyway. i don't have a specific date when that's going to be done.

these studies often take a while to do well. i'll get back to you when that study will be done. i think there was an expectation that we had gone beyond that. that's going to begin this spring. then we need to get the timeline. this is a critical area for our national center to be looking at. that's why we're moving ahead with this now. mrs. lowey: thank you. lastly, concerning female veterans care, i am very concerned that the v.a. is not adequately addressing the health needs of female veterans. including obstetrics, gine go logical care, treatment for gender specific conditions and diseases. according to v.a.'s recent report, suicide rates among female veterans increase more an 60% from 2001 to 2014 compared to 29% among their male counterparts. the v.a. also found the risk of suicide among female veterans

with 250% higher in comparison o u.s. civilian adult women. frankly these statistics were shocking to me. if you have any explanation about the disproportionate rate of suicide impacting veterans, i would appreciate it. how will the v.a. ensure that female veterans' physical and mental health needs are met? secretary shulkin: in the president's budget we have requested a 6% increase in women veterans dollars to help support this. mrs. lowey: is that sufficient? secretary shulkin: i think on top of what we have been adding each year, this is what our field has asked for. we just trained an additional 332 women health providers in our certification course. we're very aggressively expanding our women's clinics, women's services, and the dollars are appropriate to flow

with that. the issue of women's suicide. these are really disturbing statistics, as you said. there is no doubt that the overall incidents among women veterans is higher than the general population. what we do know is this, in the last 15 years we have been studying this comprehensive database of suicides. if you were a woman veteran who got care in the v.a. over the last 15 years, your rate of suicide decreased by 2.6%. if you are a woman veteran not seeking care in the v.a., during those 15 years it went up 81.6%. i always say to people if you had a drug that -- where one worked by decreasing the other didn't, everybody would be using the drug that worked and not the other one. so we have to connect women -- this is why your question is so important. we have to have access to

services. we have to have women feel comfortable in the environment they seek care in a sensitive way. and our culture has not always been that in the v.a. we have to continue to change that. we can absolutely save lives by getting women connected with care. the reasons why women suicide among veterans is high is something that we don't totally understand. i think that we need to do more research into that, but right now we're focused on getting women the help that they need. mrs. lowey: thank you, mr. chairman. i appreciate you giving me the time. i do hope we can follow up on this because as we know you call it the president's budget, i call it mr. mulvaney's budget. this is a really important committee. members that do work in a bipartisan way. i was just shocked by these statistics. i hope we can address it as best as we can with your

recommendation. thank you, mr. chairman. mr. dent: thank you, mrs. lowey, for that line of questioning. at this time we're going to move into the second round of questions. for those who are here. with that i recognize myself for five minutes. on the same day last week as the release of the unfavorable i.g. report about the d.c. v.a. hospital, you announced sweeping plans to reorganize d.h.a. from top to bottom for the central office reorganization due by may 1. nationwide reorganization plan for your regional hospitals by july 1. could you quickly just touch on the situation of the d.c. v.a. hospital? what led you to set in motion such significant changes? have your market assessments different -- health care markets reveal systemic problems, are you considering delayering the d.h.a. and getting red of the

visn level? secretary shulkin: first of all very briefly just update you on the washington, d.c. situation. back in april, 2017, the inspector general called me in an unusual step and said i want to till about what we're finding cure this review. the results were so concerning to me that day i removed the medical center director. we ended up having to remove him twice because the court made us bring him back. we had new leadership in place. since april, 2017, i think this is a very much better environment for our veterans. 26% of veteran -- we have had an increase in veteran satisfaction to recommend that hospital by 26%. just since april of 2017. which is a big, big number move. in terms of consult we had 11,000 consult for prosthetics, greater than 30 days. today that number would be zero. we're seeing dramatic

improvements in the care there. but what we learned from it was, it was a failure at every level of our organization. it should have never gotten to that point. when things are failing at the facility level, the vissin should know about it. -- visn should know about it. when things aren't addressed there, the central office needs to know. i will tell you i was not aware of those types of problems. what i did in this restructuring move was we took three vizzins that i think think there was consistent evidence there was not the proper flow of information. we no longer have visn directors there. we're trying them out where there is direct exhibit to the vaco office. what i want is a plan submitted to me by july 1 for the entire country about how we look at what the role of the visn should be, if there should be a visn, and how do we get more direct accountability over performance? i have asked for a quicker plan for the central office by may 1.

i met with the team this morning to go over what that plan needs to look like where we would delayer at the central office as well. because too much information's being passed up one level and nothing's being done about t we need to be fixing these problems -- about it. we need to be fixing these problems and the washington, d.c. should be a wake-up call that a 59% vacancy rate of a splay chain people in the hospital should never exist. you can't run a hospital with a 59% vacancy rate. i believe that we're now taking the appropriate actions in place to restructure this across the country. mr. dent: thank you, mr. secretary. i want to get to the health record interoperability. the v.a.'s electronic health record not only tends to be inoperative with the d.o.t. but also the private sector. we understand a big challenge with inoperability to the private sector is private health

networks hold data for consecutive advantage and snevers wond required to change the behavior. what snevers can you bring to the table to modify the behavior? secretary shulkin: we have said to the corporation that we're not going to sign the contract that's going to allow proprietary protection and information blocking to continue. we will not allow that for veterans. the corporation has been extraordinary in working with us to respond to that. i believe we'll soon be at a contract that will be groundbreaking for new rules and interoperability. this is going to mean that the corporation is not going to hold intellectual proprietary rights to open a.p.i.'s. they are the key to having free flow of information. as well as adhering to industry standards. these are called fire standards.

that again, that we're going to build into this contract. when you have opening a.p.i.'s without intellectual property protection, you allow people be able to develop them on behalf of veterans and use industry standards. you are now breaking open interoperability in a way that's not been done before and we'll do that. we have gotten 11 major hospital systems to sign on to a pledge that they will adhere to open a.p.i.'s and industry standards. more and more health systems who want to work with veterans. i know all across the country there is a commitment to this, are going to be working with us on this pledge. we're going to change care not only for veterans but across the country for all americans by working with industry. by working with leading health systems to get this done. and we're working with c.m.s. and the office of the national coordinator and federal government to get this done. mr. dent: at this time i recognize the ranking member of the subcommittee, ms. wasserman schultz. ms. wasserman schultz: thank you, mr. chairman.

just adding on to -- on the chairman's question on h.r. process. what is a little troubling to e, i know you find it exciting that they are going to release their proprietary hold on their product. the risk there is that you would have it lead to increased customization. it's a very vast network. you have already had some trouble with getting buy-in and you have physicians and hospitals who like your own proprietary system. there is a great deal of pride there. but it's an old system and it's the 21st century. what oversight mechanisms are you putting in place to ensure

the v.a. has sufficient understanding of existing business processes so that you avoidp while are you going to have a bunch of open a.p.i.'s, aavoid costly customization that means essentially you don't have an interoperable system that's seamless. secretary shulkin: i think what you are bringing up appropriately is -- this is a very, very risky, complex implementation. and you're absolutely correct that a lot of things could go wrong. but this is not so much about the technology as about how we manage change management across the system. we're going to go from 130 instances to a single virtual instance in the v.a. that's going to require the type of standardization that you are walking about. and that is really very complex. in order to do that, we're standing up a project management

office. the project management office's job will be the oversight of that exact process of the change management process. and that needs to be clinician-led and driven in the way that you're exactly right about where this could go wrong if we don't include our clinicians in this process. the open a.p.i. process, i believe in conjunction with these fire standards will eliminate some of the risk of everybody doing their own thing. if you do it with open standards and we're going to publish our model instance so the whole world can see what we're developing and what the data points are, that's going to allow us, i think, to avoid some of this proprietary customization that's going on in the market right now. ms. wasserman schultz: i know we had spoken, not sure which meeting or conversation, but there has been an ongoing concern over whether interoperability would extend to the private sector.

and mitre's review, i know at least took a look at that, had those concerns about interoperability with the private sector and to be able to share with the v.a. have those been alleviated? over all, are you following the recommendations of i'm not sure i'm pronouncing the acronym right. secretary shulkin: you are. that was the total purpose of the pause and review that we brought in mitre who brought in experts around the country. they generated 51 recommendations. we're now building in all 51 recommendations. and in addition to that, we have sought additional expertise even beyond mitre because we know we have one shot at this time. -- at this. as you said this is an expensive investment and long investment.

if we don't get it right in the beginning, i don't think we're going to have a chance to go back and do it over. we're taking extraordinary lengths to get the expertise around the country to give us their input. we absolutely did build in the mitre recommendations and we're still looking to do a few more reviews before we say we're ready to move forward. hopefully that will be soon. ms. wasserman schultz: just 1 1/2 more questions then i'm done. i mentioned in my opening remarks to you in our closed door meetings about the concern and the difference between what our budget agreement was, which was to spend the increase in the budget through the infrastructure investment, and as our ranking member said the mulvaney budget has abandoned that principle and put it into v.a. choice and community care. that's on top of the $4.2

billion in the emergency supplemental. can you explain why the additional funds were not used for infrastructure? are we on the same page now that that's where the funds should go? secretary shulkin: i can't explain where the disconnect was. i think the chairman said it well which is that there maybe was some informal communications that didn't -- your intent may not have been understood the way that they are. we understand that this is your decision. we will be looking in 2018 for $2 billion investment in our recurring maintenance, which i think is desperately needed and we greatly appreciate that. in 2019, the money was suggested to be moved into our choice and community care funding which is also needed. on top of the president's budget that requested an unprecedented increase ins infrastructure and

major and minor construction. we think that the budget balance is appropriate at this point to make sure that we're addressing veterans' needs. as well as the investment in the infrastructure. i don't know if there is anything you want to add to that. >> i would just say when we look at the requirement, as dr. shulkin expressed, we're suggested maybe $2 billion in 2018. we also have in the omnibus a potential, of 2.1 billion wean maintenance and construction. a request in 2019 is pretty substantial. we felt between those three that would probably adequately address this now for infrastructure needs. we do have a need in choice. it seemed like a balanced approach. we would have enough for infrastructure and still meet the needs for care. ms. wasserman schultz: my leftover half a question here -- piggy backing on our ranking member's and your response in

the lopsided difference between the increase in size of the female suicide rate in private care versus the v.a. care. that underscores the point about ot going in the direction of privatization and investing more than a 9% increase in your needs on that side in the v.a. side of the house. but what you didn't answer in the last round for me was has this administration or anyone pushed you to move the v.a. in the direction of privatization? secretary shulkin: first off i think your observations are absolutely correct. it's the reason why i'm not in favor of privatization because you can't take 9.1 million veterans getting care in the v.a. system. 60% that carry a mental health diagnosis.

ms. wasserman schultz: wait longer now. secretary shulkin: right. just release them into the general public and think we're going to honor our commitment to our veterans. it couldn't work by turning on a switch and privatizing it. the president is very, very committed to improving services for veterans. there is no pressure to privatize. there is pressure to fix the system. the way that we're going to fix this system is by investing in v.a. where it needs to be improved. the way that you're pushing us to, as well as by working with the private sector where they can do it better or they have better access than we have it. that's really the only pressure to get this system working bet earn not to have to continue problems we have been seeing for decades. ms. wasserman schultz: look forward to continuing to work with you. thank you so much. mr. dent: at this time i'd like to recognize the gentleman from virginia, mr. taylor. mr. taylor: thank you, mr.

chairman. one quick thing before suicide. on request for $2 billion in fiscal year 2019 and substantial request in 2019 for infrastructure. i understand there are infrastructure needs. real quick, i know earlier on in the year we had a hearing talked about the underutilized office space. where are we at in temples progress with that? that sounds like a significant savings. secretary shulkin: we have to date disposed of -- when i say 2017,e, since february of disposed of 131 of those facilities. 83% of the remaining facilities have historic preservation status. which just makes it a longer process. but we maintain the commitment to get out of all 435 of the vacant buildings. the rest that are underutilized, another 700 or so, we're working

to make sure that we adhere to not investing resources in places where veterans aren't getting advantage of it. we're continuing to work on that list. we nufe this would be challenging -- we knew this would be challenging but we're making progress. mr. taylor: following up on something that congressman rooney and congressman ryan. i believe some veterans have been overprescribed drugs or money thrown at the problem. even on the veterans side there have been folks that have taken advantage to get benefits and not seek treatment. veterans, we have to look ourselves in the mirror and be responsible. if someone does that you are taking away from someone else. on that note, the $190 million spent on outreach with b.f.o.'s and hotlines, congressman brought up a great point in terms of veterans who are out there. we know suicide, a lot over the age of 50.

how or are we also sending out letters to the folks that are in the database known veterans to say not just looking for them or faith-based organizations, but directly to the veterans. are you having these problems. come see us. are we doing that? if not are we going to? secretary shulkin: we're trying a number of things. that's why this is our top priority. we're going to continue to try new approaches here. we do have a community outreach program, public certificate vase message. tom hanks is our national spokesperson, hash tag be there or be there for veterans.com. we will continue to try to get the message out there. in addition we're using big data analytics. mr. taylor: soarry. but directly to the veterans. to his point he hasn't gotten anything. i haven't gotten anything saying that. is there something -- secretary shulkin: what we're

using is identifying those that are at the highest risk. we're doing direct outreach calls to them asking them to come in. every medical center is involved in this. those that we know that can use the benefit the most. proactively reaching out. we're adding suicide spreengs coordinators in each of our medical centers. these are people whose job it is to outreach specifically to veterans. if you have additional ones we should be reaching out, we're opened to new ideas. mr. taylor: you mentioned prevention which is extremely important. there is a verifiable gap. you have heard me say this before. especially in special forces where they do a great job on active duty, these are the populations going back and forth in combat over and over again. they do a good job on active duty to prevent suicide. they get out. we're certainly part of that group, 14 that never receive care from the v.a. or hotline.

there is a gap there. has v.a. coordinated with d.o.d. in terms of prevention? pilot programs speaking about the best practices in these units that know they have issues they do a good job of preventing suicide on active duty. has v.a. coordinated with them to figure out what the best practice are. perhaps baselines with units more susceptible to c.t.e. and blasts to figure out you have a base line which is something we're implementing in naval special warfare. it sounds like something that could be a partnership with the v.a. and d.o.d. to prevent it saving lives. and costs as well. secretary shulkin: i think you're right. first of all i should say secretary mattis has been extraordinary to work with. many of the barriers that existed in the past between d.o.d. and v.a. have just gone away and we're working much closer together. i did what i thought the very best thing to do was get that

closer working relationship is we took the head of suicide prevention from the d.o.d. and moved her over to v.a. on the detail. we have now singular leadership who understands exactly what you are saying about d.o.d. and v.a. who are directing our efforts. dr. franklin, she's bringing us much closer together on these efforts. met with admiral lane, the heads of the services of each -- the leadership to be able to talk about what we know, what we can work better together on. mr. taylor: is there anything we can do as members of congress to help? secretary shulkin: i could tell you i don't see anything standing in the way right now. we're all focused on this issue. it seems like we're making more progress now than we have in years. mr. at this clor: -- mr. taylor: thank you. mr. dent: mr. bishop. mr. bishop: thank you very much, mr. chairman. i would like to return for a moment to the issue of

construction. i think it was touched upon earlier. one of the priorities you laid out is to focus resources more effectively. you allocate nearly $2 billion for major and minor construction. can you discuss with me what the v.a. is doing to ensure that construction is done in the most efficient and cost-effective manner? i ask this because i long awaited construction on the columbus, georgia community based health clinic to begin. and also waiting word from the v.a. on the recipient of the award for the contract. moreover, there have been issues that have been brought to my attention that have arisen with the v.a.'s construction process. one specific project is the emergency room expansion at the v.a. north health care septre in dallas, texas. i'm told that this particular

project experienced numerous concerns such as extraordinarily slow implementation of contracts which resulted in extension of an 18-month project by 16 months. improper direction from the contracting officer. suggesting that the contractor should submit the obligation for payment although v.a. hadn't obtained funding for change order in the works. -- vaurous other contractor various other contractor problems. what is the v.a. doing to really manage this construction process and make sure that the contractors are performing or allowed to perform and that the contracting officers are really adequately and efficiently managed in the contracts.

secretary shulkin: i think that facts of the past and history suggests that we should have a lot of reason to be concerned about our ability to construct on time and on budget. this is clearly a work in progress. as you know we have been asked to bring in the army corps of engineers on our major construction projects for great greater oversight. in templets way that we operate internally, we're now in the process of a reorganization of our construction and facilities program. that will be reporting directly up to our deputy secretary to provide greater department oversight and visibility into these processes. we do know that there is significant risk in dollars in not doing this right. the specifics on the dallas facility i have to get back to you with further information.

we know there are enough examples like that that suggest we have to be organized differently in order to be better stewards of taxpayer resources. this is something that the deputy secretary is taking on irectly. inaudible] mr. bishop: to enhance the quality of care provided to veteran patients within the d.h. a. health care system of the one of our major concerns has been the relationships with the historically black colleges and university medical schools. can you elaborate on v.a.'s partnerships with historical

black colleges and universities and what the v.a. can do to increase targeting training programs at the minority serving institutions and what plans the department has to expand the relationships with these institutions. secretary shulkin: we have reached out to these leading organizations around the country. and we want to do more. we think that v.a. office tremendous training opportunities and, frankly, it's in our interest to train these students so that they will look at v.a. as a potential future career. just this week i received a letter from the dean of marahi medical college and morehouse medical college reinstating their commitment to work with us on this. and asking that my office be directly involved in making sure that we continue the progress. our previous chief of staff had

the lead in this, since she left the organization we want to make sure there is not a gap or drop in that commitment. which we're extremely to and they are committed to. we're going to continue to work very closely with them to get more educational opportunities for their students and to our organizations. mr. bishop: thank you, mr. chairman. hank you, mr. secretary. mr. dent: thank you, mr. secretary. anybody with additional questions? secretary, aid like to thank you for your invitation and great to be with you again. thanks for the great work you are doing at the v.a. pleasure to work with you. with that this meeting is adjourned. second hearing to be announced. next hearing will be on april 10.

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>> as this hearing comes to a close, if you missed any of what was said during the hearing, see it on our website, c-span.org. "politico" reporting today, president trump may be itching to fire him but veterans' affairs secretary david shulkin has the support of g.o.p. lawmakers and veterans. the lack of a preferred successor may keep him at the agency's helm for now. trump's consternation with the v.a. secretary shulkin bubbled

over on monday as he was meeting with energy secretary rick perry and planning rex tillerson's out ofer from the state department. president trump didn't offer mr. perry the job, nor did he ask if he wanted it. but the events prompted speculation that a major cabinet shakeup was in the works. you can read more about that in "politico" today. u.s. house is about to gavel in. members will be working on financial regulations bills. and we'll have live coverage of the house when members return here on c-span.

>> the u.s. house is about to gavel in to start work on two bills dealing with regulation of banks that have been designated system matically important institutions. banks that might trigger financial crisis if they went bankrupt. also today the house expected to finish up work on a bill to

create the new government office to hear complaints from banks against the body that sets standards for supervision of financial institutions. legislative business about to get under way here in the house. live coverage on c-span. the speaker pro tempore: the house will be in order. the prayer will be offered by the guest chap larne reverenddom elias m. carr, all saints gional catholic church, glen cove, new york. reverend carr: source of light, sustainer of life, significance of liberty, we come before you with hearts filled with wonder, we thank you for every gift you send for blessings without number and mercies without end. turn to us as we lift our hearts upon you honoring and adoring

you our good and gracious lord. hear us god accepting the love we bring we may serve you our unimaginable king. look kind upon these representatives and their staffs, showering upon them wisdom, charity and justice and whether our tomes be filled with good or ill, let us triumph through our sorrows and rise to bless you still. let your glory in your ways make of yful duty, a sacrifice praise. the speaker pro tempore: the chair has examined the jourm of the last day's proceedings and announces to the house its approval thereof. pursuant to clause 1 of rule 1, the journal stands approved. the pledge of allegiance will be led by the gentleman from new york.

mr. suozzi: i pledge allegiance to the flag of the united states of america and to the republic for which it stands, one nation under god, indivisible with . berty and justice for all. the speaker pro tempore: without objection, the gentleman from new york, mr. suzy, is recognized for one minute. mr. suozzi: thank you, madam speaker. i'm here to welcome father elias here to the chamber and from my hometown from the city of glen could have. he is a canon regular. and he and three of his colleagues have been assigned to my parish, st. rocco's since 2011 and he is joined here by his parents as well as his brother who is also a priest, father richard from virginia and i just wanted to say we are so honored to have him here today.

he has made a dramatic difference in our community along with his colleagues, ambroseaniel and father and we are grateful to you for your service, to our community and to your faith. and to our faith. and for making such a difference in our lives. thank you, madam speaker. for what purpose does the gentleman from michigan seek recognition? >> madam speaker, request unanimous to trem. the speaker pro tempore: without objection, the gentleman is recognized for one minute. >> madam speaker, as i travel to each corner of my district, i hear from workers and families who are optimistic about the new tax cut law and what it means for their pocketbooks. there is a momentum in our economy and the latest jobs report from february is another

piece of positive news. last month the economy added 313,000 jobs, far exceeding expectations. the unemployment rate remained at a 17-year low for the fifth consecutive month. and labor force participation increased by more than 800,000 workers, the biggest surge in 15 years. mr. walberg: earlier this week the national federation of independent businesses released a survey that found small business owners confidence in the economy is soaring and they are prepared to hire and raise wages without a government mandate. imagine that. madam speaker, these are encouraging signs that our policies of reducing excessive red tape and cutting taxes are working. let's build on these results and continue to advance solutions that improve the lives of the people we represent. i yield back. the speaker pro tempore: for what purpose does the gentleman rom new york seek recognition?

without objection. the gentleman is recognized for one minute. >> mr. speaker, this weekend i wish americans will celebrate st. patrick's at this with parades and parties of every level of exuberance, including my hometown of buffalo, new york. mr. higgins: buffalo st. patrick's at this celebration is one of the most spirited in america. this year a special celebration as it marks the 20-year anniversary of peace in northern ireland. the 199 good friday agreement brought peace to catholics and protestants after 700 years of armed conflict. this peace belongs to the people of northern ire lapd and to the world. sinn fein leaders along with democratic union parties took a courageous step no one believed was possible 20 years ago. they denounced violence. and committed themselves to peaceful power sharing and reconciliation to live in peace together.

mr. speaker, let this st. pat tribbling's day and 20th anniversary of the good friday agreement stand as a shining lights of hope for a gentler america and more peaceful world. yield back. the speaker pro tempore: for what purpose does the the gentlewoman from indiana seek recognition? mrs. brooks: yield back. the speaker pro tempore: for what purpose does the madam spe ask unanimous consent to trem. the speaker pro tempore: without objection, the gentlewoman is recognized for one minute. mrs. brooks: madam speaker, i rise today to shine light on the ongoing tragedy in syria. today marks seven years of civil war in syria. seven years of indiscriminate killing of women and children. seven years of intermittant hemical attacks on civilians by the assad by the assad regime. seven years of bombing, of people thrown out of their homes, of children whose youth ave been stolen from them. the ongoing tragedy in eastern guda is just the most recent of horrific events perpetrated by the the ongoing assad regime anti-iranian-backed militia. it is reported that 800

civilians have been killed in the past two weeks and the assad regime continues to pound the rebel held area despite the humanitarian cease-fire. the blatant disregard they have for civilian life is nothing short of despicable. we must continue to be engaged in efforts to support the syrian democratic forces and other allies who believe in a free democratic and independent syria. without u.s. leadership, the carnage will continue and we will be left with meaningless resolutions. we must stand with our allies to stop this devastating carnage that is tearing apart families and ruining countless lives. i yield back. the speaker pro tempore: for what purpose does the gentleman om north carolina seek recognition. >> permission to address the house for one minute. the speaker pro tempore: without objection, the gentleman is recognized for one minute. mr. butterfield: recognition. >> madam speaker, it is with sadness that i rise today to honor the life and work of a young 24-year-old deputy sheriff who was

tragically killed during a traffic stop in his community on sunday, march 11, 2018. deputy david lee lee sean manning lost his life when his patrol vehicle crashed while engaged in the traffic stop. the elected share of the county, my friend, informed me that this loss has resulted in tremendous sadness for the manning family and entire law enforcement community. an emotion that we all certainly understand. on behalf of the united states house of representatives and the 750,000 citizens of north carolina's first congressional district, we honor the life and service of deputy david lesean manning. may god continue to embrace david's biological family, embrace his law enforcement family in the weeks and months to come and give them the solace that they need to

continue with their lives. thank you, madam speaker. i yield back. the speaker pro tempore: for what purpose does the gentleman from new jersey seek recognition? without objection. the gentleman is recognized for ne minute. mr. lance: madam speaker, i rise in honor of public schools week to recognize the incredible work in public education done every day in every state in our union. i have the honor of representing some of the finest public schools in the nation. this did not happen by accidents. our public schools lead the country because of the tremendous work of our public educators. i attended public schools. i respect our teachers. and i proudly support our public schools here in congress. i know the work of educators can be difficult. but the life of a teacher is a vocation not an occupation. educators give their lives in service to future generations of leaders, thinkers, writers, doctors, scientists, and

visionaries. we need teachers and we need the public education system to remain strong in the united states. public schools are where our students realize their talents and their potential. we need good educators to continue offering encouragement and advice and to be champions and mentors. let us celebrate this public schools week by thanking the teachers and educators in our lives. i yield back the balance of my time. the speaker pro tempore: for what purpose does the gentleman from rhode island seek recognition? mr. cicilline: i ask unanimous consent to address the house for one minute. the speaker pro tempore: without objection. mr. cicilline: many pension plans across america are on the brink of failure and threatened by massive cuts. if nothing is done 200 multiemployer plans are projected to fail, many within the next 10 years and the impacts will be felt by americans in every state in our country. cuts to these pensions would be economically testify stating for 1.5 million people who have earned their living as carpenters, truck drivers, iron

and steel workers, brick layers and painters. they paid into these plans after a lifetime of hard work they deserve to be retire with dignity and peace of mind. in these plans fail, taxpayers could have to pay billions of dollars into federal government's pension benefit guarantee corporation fails. that's why democrats have proposed a better deal to save our pension that is provides financing to put failing pension plans back on solid ground to ensure that they can meet their commitments to retirees today and workers for decades to come. prevent a single dollar of cuts to benefits who have retired, benefits they have earned. they put safeguards in place so that pension plans remain strong in order to be there today for tate's workers when they retire. -- for today's workers when they retire. we need to bring these proposals to the floor so we can work together to protect the pensions american workers have earned. i yield back. the speaker pro tempore: for what purpose does the gentlewoman from indiana seek recognition? >> madam speaker, i ask unanimous consent to address the house for one minute. revise and extend my remarks.

the speaker pro tempore: without objection, the gentlewoman is recognized for one minute. mrs. walorski: thank you, madam speaker. i rise today to celebrate barnes and hoover hardware which has been a fixture in the community for more than 125 years. the success and longevity of this family-owned business lies in the family's dedication to serving their neighbors and providing high quality products with a friendly smile. small businesses like this are the backbone of the american economy and its a privilege to represent a family so devoted to the prosperity of their community for so many years. to honor them is to honor what it means to achieve the american dream. with ownership now being passed down to the fifth generation family member, nathan miller, i'm grateful to be able to recognize such a pivotal moment in the history of this hoosier family a, their small business, and the community that they serve. madam speaker, i ask my colleagues to join me in congratulating barnes and hoover hardware and wishing them the best in all the years to come. i yield back. the speaker pro tempore: for what purpose does the gentleman

from california seek recognition? >> unanimous consent to address the house for one minute. the speaker pro tempore: without objection, the gentleman is recognized for one minute. >> mr. speaker, i rise in honor of a remarkable member of my stave and remarkable member of my community, bob, who passed away suddenly last week. bob spent over 30 years working for the people of orange county before joining my team he also worked for my predecessor, congresswoman loretta sanchez. bob had deep roots in our community. he grew up in a small family farm and was a long time member of the orange county political environment. bob worked for less fortunate throughout his community and he was a friend to everybody he met. bob was also the first native american candidate to run for congress in orange county in 1992 and he came close to winning and he changed orange county politics forever. i'm saddened by his passing. he devoted his life to making

orange county a better place for everybody to live. we'll all miss him. and we'll never forget him. thank you, mr. speaker. -- madam speaker, i yield back the balance of my time. the speaker pro tempore: for what purpose does the gentleman from montana seek recognition? mr. gianforte: unanimous consent to address the house for one minute. revise and extend. the speaker pro tempore: without objection, the gentleman is recognized for one minute. mr. gianforte: madam speaker, i rise today to congratulate the university of montana men's basketball team for an outstanding season. and to wish them success in the 2018 ncaa tournament. the grizzlies were regular season champions of the big sky conference going 16-2 in conference play. last weekend the squad won the big sky tournament. they begin their journey in the ncaa tournament tonight with a first round game in wichita, kansas. the grizzlies will be strong contenders. their defense is relentless,

leading the big sky conference this year, every player on the floor contributes to their offense. they represent the spirit of montana. congratulations also to montana head coach travis, who was named coach of the year in the big sky conference. in his fourth season at the helm, he guided the grizzlies to a 26-7 record and their first ncaa tournament appearance since 2013. . up with montana. thank you, madam speaker. and i yield back. the speaker pro tempore: for what purpose does the gentleman from illinois seek recognition? >> request unanimous consent to address the house for one minute. the speaker pro tempore: without objection. the gentleman is recognized for one minute. snidesnide yesterday -- mr. schneider: yesterday marked one month that tragedies that have become so common that the

response of this congress is practically routine. moments of silence held and then we move on with no specific action on gun violence. madam speaker, this is not enough. we need to heed the call of thousands of students who organized walkouts and events with a simple message for us, it's time to act. we have to look at these students and saying we are doing everything we can to protect you. but this institution has refused to do that. we are not passing background checks or banning high assault rifles or lifting the ban preventing our government from researching gun staste solutions. yesterday, we did pass a bill with important resources for school safety including a bipartisan provision i introduced to help schools install panic buttons. that is an important first step. but protecting our children

isn't possible without reducing gun violence. listen to the young people and find the courage to pass sensible gun safety laws and to save lives. the speaker pro tempore: for what purpose does the gentleman from north carolina seek recognition? without objection. the gentleman is recognized for one minute. >> i rise in memory of the homer vaughn wagner junior, a veteran of world war ii on left this world on november 29 having satisfied his life's ambitions in the death notice provided for him. he served our country fighting his way across france, belgium, holland and he is one of the debatest members of generation pushed back. he continued in private business helping to build a post-world war ii economy as an engineer. he invented radio and tv equipment and items for naval

ships and aircraft applications. , his sixbehind darlene children, 11 grandchildren. his grandson followed his grandfather's example. he now serves as an outstanding member of the charlotte city council. please join me in expressing condolences. thank you and i yield back. the speaker pro tempore: for what purpose does the gentlewoman from california seek recognition? >> permission to address the house for one minute. the speaker pro tempore: without objection. mrs. davis: president trump was in my hometown of san diego this week and went to inspect prototypes for his proposed border wall, a wall california doesn't want, doesn't need and overly simplistic approach to a complex issue. the president was in san diego

for just a few hours and missed a real opportunity to hear from locals about what americans in california actually need. had he taken the time to actually listen, he might have learned how connecting mexico and the united states are and how important the cross-border economy is to our region. he might have learned about our infrastructure needs, about the contributions of our immigrant communities or the environmental issues facing our region. instead, he flew 3,000 miles on the taxpayers' dime for a photo op for his political base that achieved very little. something is wrong when a president doesn't listen to the american people. i yield back. the speaker pro tempore: for what purpose does the gentleman from new jersey seek recognition? >> ask unanimous consent to address the house for one minute and revise and extend. the speaker pro tempore: without objection. the gentleman is recognized for one minute. mr. payne: thank you, madam

speaker, madam speaker, today begins the best time of the year , march madness is in full effect as of noon today. and i am here to support a team that i have followed for 50 years in college basketball, the seton hall pirates. 30 years ago, madam speaker, they played for the championship of the final four against a michigan team and lost by one point. today, we have another team that has the potential of going all the way. so i would just like to acknowledge the seton hall pirates as they start their journey for a national championship against north carolina state wolf pack and ask and as onor seniors

they start their trek. go pirates. i yield back. the speaker pro tempore: for what purpose does the gentlewoman from texas seek recognition? ms. jackson lee: permission to address the house for one minute. the speaker pro tempore: without objection. the gentlewoman is recognized for one minute. ms. jackson lee: madam speaker, it is eight months since hurricane harvey devastated parts of the state of texas and the united states. we are engaged in an assessment and i will tell you after 88 people died, people are still in hotels, houses are still in disrepair and we are still in need. we are strong state, resilient city, great leaders who work very hard, but i think it is important that as we try to recover that we work to

restructure fema as we are assessing right now in a hearing so that we can address the questions that 300-plus of my constituents in cashmere gardens asked the question, why were there so many denials and see four inches of rain in your house and it was four feet. how can we allow people to get out of hotels and get into housing. this is a holistic approach. we need to reform fema and structure fema and the rescue part and recovery part and we need answers and my constituents need answers now regarding the many, many denials that have stopped them from proceeding with their life. the speaker pro tempore: for what purpose does the gentleman from minnesota seek recognition? permission to address the house the house for one minute.

the speaker pro tempore: without objection. mr. paulsen: i rise today to congratulate the hockey team on winning the minnesota state championship, first one in school history. win came under alexandria. orono took the lead in the first but the advantage was very short lived. they came back and tied it up. despite outshooting the orono made the winning shot all that more exciting. madam speaker, the student athletes brought home more than just a statewide trophy. they set the example for their classmates because of their work in the classroom and managing other activities. congratulations to the coaches, the players and the parents and ll the fans of the boys' orono hockey team. the speaker pro tempore: the chair lays before the house an enrolled bill.

e clerk: h.r. 1177 an act to direct the secretary of agriculture to relies on behalf of the united states a condition that certain lands conveyed to the city of old town, maine be used for a municipal airport and for other purposes. the speaker pro tempore: for what purpose does the gentleman from colorado seek recognition? mr. buck: by direction of the committee on rules i call up house resolution 780 and ask for its immediate consideration. the clerk: house resolution 780, resolved, that upon adoption of this resolution it shall be in order to consider in the house the bill h.r. 4061, to amend the financial stability act of 2010 to improve the transparency of the financial stability oversight council, to improve the sifi designation process, and for other purposes. all points of order against consideration of the bill are waived. an amendment in the nature of a substitute consisting of the

text of rules committee print 115- 64, modified by the amendment printed in part a of the report of the committee on rules accompanying this resolution, shall be considered as adopted. the bill, as amended, shall be considered as read. all points of order against provisions in the bill, as amended, are waived. the previous question shall be considered as ordered on the bill, as amended, and on any further amendment thereto, to final passage without intervening motion except, one, one hour of debate equally divided and controlled by the chair and ranking minority member of the committee on financial services, and two, one motion to recommit with or without instructions. section 2. upon adoption of this resolution it shall be in order to consider in the house the bill h.r. 4293, to reform the comprehensive capital analysis and review process, the dodd-frank act stress test process, and for other purposes. all points of order against consideration of the bill are

waived. in lieu of the amendment in the nature of a substitute recommended by the committee on financial services now printed in the bill, an amendment in the nature of a substitute consisting of the text of rules committee print 115-63, modified by the amendment printed in part b of the report of the committee on rules accompanying this resolution, shall be considered as adopted. the bill, as amended, shall be considered as read. all points of order against provisions in the bill, as amended, are waived. the previous question shall be considered as ordered on the bill, as amended, and on any further amendment thereto, to final passage without intervening motion except, one, one hour of debate equally divided and controlled by the chair and ranking minority member of the committee on financial services, and two, one motion to recommit with or ithout instructions. the speaker pro tempore: the gentleman from colorado is recognized for one hour. mr. buck: for the purposes of

debate only i yield the customary 30 minutes to the gentleman from florida, mr. hastings, pending myself such time as i may consume. during consideration of this is all time yielded is for purpose of debate only. i ask unanimous consent that all members may have five legislative days to revise and extend their remarks. the speaker pro tempore: without objection. mr. buck: i rise today in support of the rule and the underlying legislation. the rule makes in order two bills reported favorably by the committee on financial services. they were the subject of multiple hearings. each bill was reported favorably by a bipartisan majority without amendment. the rule adopts the only two amendments that were offered to these bills. madam speaker, yesterday, i had the privilege of being here on the floor debating three financial services bills and i'm back with two more today. the senate took a significant step in producing a banking reform bill. the negative impacts of

dodd-frank are enough to overcome the senate's inesh yeah. last year we reformed our banking system and regulate financial institutions. our small town and community lenders have been hamstrung by regulations intended for large wall street banks. as is usually the case, washington did not regulate in a manner that focused on bad actors or differentiated between diverse financing institutions. instead federal regulateors stamped out one size fits all at have had negative reactions. we correct this approach by forcing regulateors to take into account smaller institutions. the financial choice act ensures the security of our financial

institutions without creating a too big to fail government support system and encouraging local banks and credit unions to invest in our communities. over the past few months, we have put various components of the financial choice act on the floor in order to demonstrate to the senate there is a bipartisan pathway forward on many of our proposals. we continue that effort today. the first bill that is made in order by this rule is h.r. 4601, the financial stability oversight council improvement act. this bill enhances transparency and procedural equity of the nonbank important financial institution designation process. under dodd-frank, important institutions were intended to be large banks whose collapse brought financial upheefl. certain insurance companies and asset managers were designated

as systemically important. this was not congress' intent to designate them as systemically important. this will not roll back to determine that a large bank financial institution is systemically important but will ensure the process by designating the nonbank as transparent and forces regulateors to fix before designating a nonbank as systemically important. what does this mean for americans? in 2014, the life insurer metlife was designated as a systemically important financial institution. by 2016, it prevailed in court and had their designation overturned. what was revealed how arbitrary and ca appreciateous the designation process seemed to be. they never clarified what level

of risk would be acceptable nor did they identify particular types of financial products or business activities that will result in too much risk. being designated would not only increase compliance cost and consume resources that could not be invested into the business, it would have forced the financial company to limit the options made available to their customers. we see the vicious cycle of overregulation played out again. fortunately in the case referenced above the court halted the arly and process. however we have the opportunity now to bring about reforms to the designation process that protect americans from losing h process. access to financial products that serve them well. hen we talk about washington picking winners and losers, look no further than dodd-frank and the systematically important financial institution designation. picking winners to these opaque regulatory decisions let's put an end and

allow light to shine on financial regulators. madam speaker, the second bill that this rule makes in order is h.r. 4293, the stressed test improvement act. the federal reserve determines the ability of bank holding companies to withstand certain types of economic turmoil. these determinations have been known as stress tests. these stress tests have become notorious for their vague rules and secrecy by which the regulators conduct the test. bank compliance officers are often stuck trying to figure on what exactly their bank is going to be examined. banks not only to not know what they are going to be tested on, they often never know what they are tested on after the stress test is conducted. frankly, techno contract regulators playing hide the ball from americans that they are regulating seems like a system of government wholly unlike our own. a professor from columbia university testified before the committee on financial services that, i quote t. hard to believe the stress test current

structure could occur in a country like the united states which prizes the rule of law and adherence to due process. former senator phil graham testified before a senate panel and said the following, i quote, what does the stress test test? know, but s no one the know, but the regulators see that as a virtue. the feds' vice chairman has stated giving banks a clear road map for compliance might make it easier to game the test. but isn't the fact that compliance is easier when you know what the law says the whole point of the rule of law? the stress test improvement act inserts much needed transparency into the testing process. it alters current regulations to make sure the -- the internal company-run test an annual exercise. it streamlines the number of scenarios which aback may be tested while ensuring banks are still tested on whether they are able to withstand a seriously adverse scenario. ed to-k