Transcripts For CSPAN Key Capitol Hill Hearings 20240622

Did you have a sense at all of whether the cabinet secretaries were speaking to the whole house in their briefing, or maybe just to the concerns of a crosssection of democrats who would be the ones to protect the white house . It was a classified discussion of a very important treaty. I dont see any other motives except to exploited in the way that would encourage us to vote for. Was there any part of the briefing that was contentious or disrespectful . One of your colleagues says john kerry was in respectful. I did not see that at all. All i can tell you is that if we pass this treaty, you can count on the fact that the United States will not be supporting the democratic elements in iran, who are the real solution to the threat to world peace. This goes on boy back to the time when the president first was president and he had all these demonstrators in the street in iran, asking, what side are you one . And our president didnt speak up. If we pass this treaty, that will be held over our head. You are going to undermine the treaty if you help the Young Students there are more kurds in iran then there are in iraq. Plus, the treaty does not cover iran it would not prevent iran from getting a Nuclear Weapon on their own somewhere else. It is not a good agreement. It will not work in the long term, or for the benefit of peace. It will kick the can down the road. [indiscernible] i dont know how much i can speak to that. Even when they Say Something we didnt know beforehand people can disagree. I respect secretary kerry and i think that he came here and opened himself up to questions in front of everybody in the congress. He did not make his case to me because i am just not looking about the agreement, i am trying to figure out what in pact we are going to see in the years ahead in terms of Regional Peace and stability as well on who has their hands on this particular Nuclear Weapon. Thank you all very much. I just wanted to briefly comment. My name is dan kildee from michigan. I rep percent one of the americans being held in prison in iran. I made the point inside that while i think it is completely acceptable that we evaluate the agreement on its merit and the text itself in the context meeting the path that would ensue if this agreement is not enacted for many of us, one additional factor that may not be entirely determine it is the factor we have to consider is a rons behavior, specifically whether iran demonstrates in some seriousness and legitimacy by releasing the americans that they hold, providing any information they have, specifically by releasing the innocent americans that they currently hold in prison. Amir will have been imprisoned for four years next month, his only crime being that he is up iranian descent serving and the american military. I wanted to make sure that folks listening that for many for a good number of congress, what they do about the status of these americans will be a factor in how they do the agreement so. Thank you. How are the questions . I did not think it was combative. It was generally quite collegial. Some members have formulated opinions on the agreement. Some apparently had formulated opinions before they had a chance to review it. I think secretary kerry has done a good job of walking through the specific elements in the most important point that i think continues to be the overarching point is that we have to consider not only the agreement but consider what the logical path forward might be without an agreement. I am still evaluating i have a general view of diplomatic efforts as opposed to others. I am still looking at the texan obviously i will also consider irans treatment of the americans is one of the determinants. Thank you all very much. Have you made a pure mind on the deal, and can you tell us about where you are whether the briefing helped . I am still in the process of understanding a complicated agreement. What happened today was i think kerry and other secretaries keep a strong defensive deal. They are very deliberately and smartly asking that we look not at the deal in and of itself. But look at where we were when iran was a Nuclear Threshold state before this began and consider where the deal puts it into contrast with where we were in consider the question that it is frankly difficult to answer which is, imagine not doing it. On those two fronts, they are making a lot of headway. Are you convinced that . If you are a representative it is incumbent on you to hear from everybody. There is still a process to be undertaken. From my standpoint, the burden given what i have heard so far is on opponents to explain why this is a bad deal relative to where we were and where we will be. One of your colleagues can that an express concerns over what was said versus ideals and the iaea. Is that a concern for you . It is a concern but that is the way the iaea has always operated, to have the confidence of the Member States not to disclose everything publicly and to negotiate on a bilateral basis. What we like to know everything they are doing . Maybe so. That is not and has never been the way the iaea operates. We will have more this morning at a hearing of the Senate Foreign relations committee. Live coverage begins at 10 00 a. M. s eastern time on cspan 3. Next on cspan, Veterans Affairs secretary Robert Mcdonald testifies. President candidate walker campaigns in iowa, followed by washington journal with your phone calls. On todays washington journal, we will talk to congressman Carlos Cabello about the recent thaw in u. S. Cuban relations. Also, congressman brad sherman a member of the Financial Services committee on the fifth anniversary of the dodd frank financial regulations. And, dr. Deborah howard with a recent cdc report on heroin use that found increases in heroinrelated deaths. Live with your phone calls at 7 00 a. M. Eastern time on cspan. Considered underrated by many first lady historians, Caroline Harrison was an accomplished artist who took up china painting and carried that interest to the white house establishing its china collection. She was interested in womens issues and helped raise funds for Johns Hopkins university on the condition that it admit women and was the first general of the daughters of the American Revolution until she died in the white house from tuberculosis. Caroline harrison, this sunday night on cspans original series first ladies. From Martha Washington to michelle obama, sundays at 8 00 p. M. Eastern on American History tv on cspan 3. At a house hearing today Robert Mcdonald pose questions about his departments 2. 5 billion budget shortfall, which he said was caused by greater demand for the a health care. This is two hours and 45 minutes. Good morning, everybody. I appreciate your attendance. We are again gathered to discuss the v. A. Budget execution for this fiscal year. Less than three weeks ago, we heard sloan gibson testify regarding a budget shortfall at the department of Veterans Affairs. Everybody may be asking why we are here again on the same topic. I intend to explain in just a minute but as we all know, the stakes have been raised considerably since the deputy secretaries testimony on june 25. At that hearing, secretary gibson was asked the following question. I quote, if congress doesnt act on the fiscal year 2015 budget shortfall, what is it going to look like in the v. A. In july and august and on october 1 . The deputy secretary responded that we get into dire circumstances the longer we go but, quote, before we get to the end of august, we are in a situation where we are going to have to start denying care to veterans because we dont have the resources to be able to pay for it,. , end quote. Imagine my surprise when on july 13 i received a letter from the deputy secretary that in the absence of providing the flexibility, the v. A. Is seeking to plug the shortfall with choice money, that v. A. Hospital operations would shut down in august. Nonthe a care authorize asians wouldv. A. Care authorizations would stop at the end of july. This is unprecedented. Never can i recall or other individuals i can talk to recall or any agency for that matter completely exhausting its operational funds prior to the end of the fiscal year with the consequences for the a being cessation of hospitalization. Never can i recall in issue of such enormous magnitude evading the direct attention of the president. Until recently, you and i speaking about it, mr. Secretary. This is not flying under the radar. I feel that it is exactly how the v. A. And the president have treated it in an effort to avoid responsibility of what is going on. So that everybody understands where i am coming from, let me start by reviewing how we have arrived at this point. The first issue came as a result of a briefing for the v. A. On june 4, on a separate topic. At the conclusion of the briefing, Committee Staff noted that there appeared to be a 23 billion dollar difference between the projected template 1 billion obligation rate for care in the community compared with the funding that v. A. Budget. The v. A. Official agreed with the discrepancy did but stated that just because they were on pace to spend 10. 1 billion, it did not mean that the money to address the discrepancy was found or available. That assertion was repeated upon further questioning, leaving it to staff to read between the lines what was meant. At the same time, during a june 8 visit to the cincinnati the a Medical Center, i began to hear rumors of an impending financial issue, consistent with the cryptic warning that have been provided by officials in the staff briefing. As a result, on june 10, i called the deputy secretary to testify on the state of the v. A. Budget. As a consequence of my calling this hearing staff received a briefing at our request on june 18. It was at this briefing that, for the first time publicly revealed, v. A. Revealed a 2. 5 billion shortfall in funding. Notwithstanding this briefing, there was no mention of the hospital shut down. On june 23, we received a letter from the secretary citing the shortfall of 2. 5 billion and requesting a transfer of funding from the medical facility to the medical services account. There was still no mention of a Hospital System wide shut down. Finally, at the hearing on june 25 there was no mention of a Hospital System shutdown coming in august. I am disappointed about the slow painstaking revelation of this crisis by the department. I understand their excuses as to why we are in this position. However, somebody took their eye off the ball. Just as congress established a cap on spending for the denver project, Congress Also provided a budget for ba four 2015 which the president signed into law and it too the v. A. Has Left Congress with very little time to react to a crisis created by the v. A. s management decisions. The days when v. A. Can come to congress and say, cut us a check , are gone. Asking for flexibility without supporting information is not enough. Similar to the way a Large Corporation board of directors sets the budget and the Corporate Management implements that budget, the president , 535 members of your board of directors set a budget expecting you and your staff to carry out the mission, that is, to manage the taxpayers resources in a fiscally responsible manner. Just as emerging circumstances and the private sector might cause a ceo to go to the board armed with information supporting a request for resources, we have the same expectation. Despite unsupported hints of a problem by the department as supporting information was not provided until extraordinarily late, we have already passed legislation to take the a out of managing Major Construction programs. Perhaps we need to bring in an outside entity to manage finances. I hope not. I recognize brown for opening statement. Thank you for calling this hearing to discuss the v. A. Budget shortfall and the possibility that v. A. May have to close hospitals. Mr. Chairman, i know everybody in this room agrees that this committee is committed to providing the resources that the v. A. Needs to take care of our veterans. We all need straight answers to our questions. How much is needed and why . We are supportive to make sure our veterans get the care they need. But yet again, we are faced with an 11th hour budget crisis. We must all Work Together, v. A. And congress, in order to properly anticipate the resources needed. The v. A. Must do a better job it is important that the v. A. Starts planning and anticipating what our veterans will need and where they will need it. We have been hearing that this shortfall is due to the increase of veterans coming to get medical care, resulting in more veterans being treated outside the the a. I also think it takes care of the veterans with hepatitis c many of whom are Vietnam Veterans who we recently honored in a celebration in the capital. I wonder if this shortfall is due to a lack of planning. Today, lets figure out what we need to do to ensure our veterans get the health care they have earned and begin to see what steps we need to take to prevent any more 11th hour budget crises. In february, the secretary asked this committee for more flexibility to move money between accounts that would enable him to run his administration more like a business. Let me repeat that. And february, and again in march, the secretary came right here and asked us to give him the flexibility to run the v. A. Like a business so he could care for veterans. We have over 60 additional accounts that the v. A. Has to decide whether or not to allow flexibility. As we track support, allowing the secretary access to funding i want to present, for the record, the v. A. Productivity is up 8. 5 and it gives the account of every category that we are Service Veterans for fiscal 2015 and the increased i want to submit that to the record. In addition to that, i want to submit for the record a letter from each of the Service Organizations indicating that they support the secretary having the flexibility to move this money around. When we did the choice act, the purpose of the choice act was to provide services to the veterans. We did not say what Services Just services to the veterans. And the secretary needs the flexibility and able to provide those services. With that, i yield back the balance of my time. Without objection i will accept those letters. And i do appreciate you submitting those letters of support and remind my colleagues that all of the veterans Service Organizations support my accountability bill. As we meet later this week, i hope we will keep that in mind. I will remind the members that this committee and the senate rejected a bipartisan basis, an attempt to go into the choice fund to fix the budget shortfall at the old aurora hospital. I think we need to focus rightly so forecasting and getting a better grasp on what is going on with the dollars that are appropriated to the department of Veterans Affairs. That is why we have asked the secretary to be here. I appreciate you changing your schedule. Without question, the secretary said i will be there along with dr. Tuchschmidt. You are recognized for your opening statement. I know you have charts with you. Secretay mcdonald if i may, i would like to start and i know you would agree with this i honoring our five Service Members who are senselessly killed in chattanooga. On behalf of all veterans, i extend my deepest condolences to their families, fellow servicemembers, and the friends who grieve their loss. We will never forget their service to our and the freedom that we so cherish. Thanks to the chairman and the Ranking Member for joining your Senate Counterparts at our recent meeting at Va Central Office pete i appreciate office. I appreciate continuing the dialogue so all americans could understand these issues. Representing veterans are Senior Leaders of some of the most orton partners in military organizations. I want to thank them for being here as well. A year ago today at my Senate Confirmation hearing, i was charged to ensure their va the focus on providing veterans with the highest Quality Service that may have earned. I welcome that opportunity. Last year i was working with a great and growing team of excellent people to fulfill that sacred duty. Since my swearing in, nine of the seven teen top leaders in va are all new. We have to get the right people on the us. We have to get them the right seats on the bus. Because of their hardware, va has increased veteran access to care. 2. 5 million within va and 4. 5 million in the community. 7 million total more than last year. 4. 5 million in the community. 2. 5 million inside va pit we have increased va care inside va. We have increased va care. 900,000 more authorizations than the previous year. Choice has been a small proportion of that 4. 5 million years it is on the rise. Utilization has doubled in the last month. Today because of growth and access, the department of struggling to meet veterans needs through the end of the fiscal year. We need your help. You have appropriated funds to meet these needs. You havent given the flexibility or the authority to use them. Without books ability, we will have no option at the end of july, but to defer not choice nonchoice until october. Provide staff with notices and notify vendors as we shut down hospitals and clinics across the country. These are unfortunate conclusions to an otherwise forget the fear of progress. We have doubled the capacity that we got was required to meet last years demand by focusing on four pillars staffing, space, productivity, and va Community Care. We sometimes call choice care. We have more people serving veterans beauty april 2014, we have increased staffing over 12,000, including over 1000 new positions. You hard over 3000 we have hired many in staff. That increase the number of primary care exam rooms so providers could care for more veterans each and every day. We are more per death. Identifying unused capacities optimizing scheduling, and stopping late appointment tends lazy nations and extending click hours at night and on the weekends. Were using technology to secure messaging and he counsels to reach more veterans. Output has increased 8. 5 while our Health Care Budget has increased 2. 8 . Were using care in the community. The Choice Program in our care initiative. His veteran options for care in the community. We have provided va care authorizations for 36 more people that we did over the same period last year. In short, putting the needs and expectations of veterans and beneficiaries first and empowering employees to deliver Excellent Customer Service and proving or and shaping more inductive internal operations. That is maybe a. A top priority to bring the a into the 21st century. Our strategy is paying dividends for veterans. The increased va care authorizations, including choice by 44 . That is 900,000 more authorizations than the devious year. In end of june last year and make, we have completed 56. 2 million of ointment. In 4 increase over the last year. 1. 5 million encounters during extended hours. A 10 increase. That is important to our women veterans. We have completed 97 percent of appointments within 30 days. And the percent within 14 days. 80 within seven days. Any 2 sameday appointments. 22 sameday appointments. Primary care cup wait times are down to an average of four days. We have an average of about three days for Mental Health care. We are making verifiable progress for veterans. Va could be the best Customer Service in total government. Important challenges remain. There will be more in the future as veterans demographics evolve. The crisis in 2014 was a matter of get mismatch of some fibers demand. It was exacerbated by greater numbers of veterans in services. That in balance predicts failure in any business, of the gore private compass especially when we promised Veterans Benefits without the flexibility to fulfill obligations. The fundamental problem budgets are static. Requirements are fluid. Changes in veterans needs and preferences for care far outpaced the federal budget cycle. Example, last year on average we added to do 1000 veterans each month. This year the average monthly of new release has been 131,000. That is what hundred 47 in. We welcome them all. Im sure you do as well. We cannot miss that today enrolled veterans rely on the a for 34 of their care. What percentage growth increases kospi 184 billion dollars it increases costs by 184 billion. 1 increase in reliance increases costs by 1. 4 billion. We are working hard to best serve more veterans. Without its ability, we can provide what they need the what you have directed it. We have reached the Decision Point Congress Good shape a different than if its profile for veterans or give va the fox ability money for entitlements. My Worst Nightmare is that veterans are going without care says there is money put in the wrong pockets. I compared the influx ability we face to having when Checking Account or gasoline in your household and when Checking Account for groceries. The price of gasoline falls in half. You cant move money from the gasoline account to the food or grocery account. The influx ability we are talking about today is even worse than that. It is even more puzzling. I cannot move money from the food account to another food account. Altogether, we have items of budget that are not flexible. We need flexibility to move money from line item to line item. When effects ability to move money from the a Community Care to choice and from choice to va Community Care. Both are care in the community. We need flexibility depending on demand. We will not be able to predict the demands exactly. We only to veterans and ourselves to be more agile 15 years into the 21st century. It was february when asked for flexibility to move resources. It was made when we asked for flexibility to provide care in the community. Im asking again for the simple flexibility to serve veterans with the money you have appropriated so we could resource the capacity that we have grown. More stability go far toward meeting veteran care and increasing access across the country. Money for the Denver Replacement Medical Center will be completed in early over. Work on the project will cease unless we receive congressional authorization for the full cost of the project and flexibility in its fullyear 2016 to transfer millions of our existing resources to the Major Construction account. We have presented several plans to congress. We havent a date shortly. We will have a date shortly. If we receive full authorization and the flexibility that we seek. To improve Community Care, we need to streamline and allocated a variety of programs that provide the Community Care for veterans i have Trouble Holding this up at talking at the same time, but you have this at your table. The debris of seven different programs for writing Community Care. Each one has its own exclusion. Each one has its own payment options. It is incredibly confusing. We have traditional va care. Choice. Patient centers. Community care. Two separate plans. Something called arch. Tribal health programs. It is all difficult to understand. Our employees dont get it. I could tell you members of congress dont understand it completely. We need a single system to get the providers we need on board. Providers chair pick the program to get the highest reimbursement rate. We sent to our proposals. Need a bill to make medical improvements and give up the flexibility to provide timely care to veterans. We need reasonable costs. Lex ability with respect to choice is central to resolving the budget shortfall and entering veterans continue receiving timely care as we strive to meet the 30 day access goal. On top of va care we provide congress has new entitlements for veterans. There are many programs that the act doesnt cover. Because authorizations and Community Care authorizations are different rockets, we have a shortfall in spite of the fact that both types of care our Community Care. Are Community Care. We expect it will cost an additional 2. 5 alien dollars. New hepatitis c drugs for veterans will cost an additional 500 million. Always seek is flexibility. Lex ability through limited authority to use money for Community Care to the extent exceeds our fiscal year 2015 budget. To meet this growing requirements next year, va needs Adequate Funding of the president s budget request provides. The house proposed 1. 4 billion reduction. Meaning as many as 70,000 veterans may not receive care. Further, it means no funding for four Major Construction project and six cemetery projects in 17,000 veterans and family members may not receive va honors. Distraction the construction budget was cut. The increase in requirements we are seeing anticipate greater challenges ahead. Services and benefits peak years after complex end. Remember i talked about the fact that we are now seeing the peak years of the vietnam crisis even though the vietnam war ended the day years ago. The health care requirements and the demand for benefits increased as veterans age and exit the work force. Full funding of the 2016 budget request is a critical first step in meeting these challenges. We had to look much further ahead. In 1975 just 40 years ago, the our graduate from west and, only 2. 2 American Veterans were 65 years old or older. By 2017, we expect 9. 8 million will be 65 years or older. What does that mean . Va provides the best Hearing Aid Technology anywhere. Medicare doesnt cover hearing aids. Most insurance lands and limited coverage at best. Choosing va for hrearing aid saves money. More veterans are going to come to the va because they want to because it makes financial sense. The cost of the filling our commitments will grow for the for seeable future. It bears repeating that the 2014 crisis was in part a vietnam debt. Not a debt of afghanistan or iraq where Service Members still serve. We cannot to be shortsighted. We have to respond today with a longterm view that underlines a commitment to va transformation. The military drawdown continues. Service members are also watching. Young men and women who might choose to serve are watching us. Expect us to fill our obligations the same dignity of which the but their lives on the line where our nation. If we choose to shut down, we fail all of them. I know we will honor all of obligations. Thank you very much. We look forward to your questions. Think you. You talk about thank you. We talk about additional royalties. Enrollees. Its that including those that die . Or is this just new enrollees . How many folks die . I dont have the number of how many died. There are many more receive appointments. There are a lot more alive than dead. For clarity purposes he will get you that number and the number of people who died and the number enrolled. The simple question we need to talk about today i know you wanted to talk about the appropriations process which is still ongoing, i hope the senate will move a piece of legislation so we can get the budget passed. I think it is critical that we get that done. If we didnt have the Choice Program to fall back on today. How would this problem be solved . Grexit we agree with you. We very much favor the choice roca. It is the shock absorb or that has allowed us to care for veterans at a time when more veterans are entering the system and when that is necessary. It allocated 10 billion for care over three years. The idea that has been propagated in the media that somehow we are against the Choice Program is as newly absolutely wrong. Community care is essential. I think the issue is the hepatitis c drug or whatever the number is for hepatitis see is part of the issue. I dont think anyone of us thinks it we should not be providing that drug did you know budget session that i could recall is it discussed about that. Hoping that somebody will talk about forecasting that someone was looking at the approval of that drug. The did come on, it was going to cause a significant issue as it relates to the nonva care line item of 6 billion which is gone now. Never gone before. All of a sudden this year it has disappeared. It we didnt have the cost of money that you are looking at right now to solve this crisis, how would be solved the crisis . Based on the laws that congress has passed, theyre certain benefits we have to get to veterans. The budget has to match that. Without the choice act, the object wouldnt match the laws that we have provided veterans. Only by third of veterans are using the system. Were talking about 1. 5 billion. I think the point you make is a really important one. I talked about the length of budget cycles in the federal government. We started the appropriation sometime around 2013. These drugs were invented between any 13 and 2015. They could not have been anticipated. We had two more drugs come out. How do we Work Together to create the stability in the budget cycle so we could deal with the demand of veterans and new special causes like new drugs . That is what we are proposing to Work Together with you on. They have taken a number of steps, including revised died in and halting all nonessential hires, purchase, and travel. One area that i see that hasnt been done is the issue of bonuses. What is sacred about the bonus pot that would event you from accessing that money . If you need but stability, we would like to give you flexibility. We do not look at every crevice . You probably recall the meeting we had to give in the steps we have taken within v. A. One of the steps is nobody is receiving a bonus for 2014. Also, the relative ranking, no one in the Veterans Health administration received an outstanding rating. I would defy you as a different day to compare our relative performance ratings versus the reading of the other departments. We were falling and symbols of the best companies in the private sector. I appreciate the information you provided is my time is expired. Nobody is getting a bonus . Yes, sir. There is a very distinct difference chewing executive and align employee. I just wanted to make that clear. Thank you. It was a uniform service that you had here in the capital for the Vietnam Veterans. That is very nice. They deserve it. What they also deserve i participated in every choice meeting. The purpose of the choice was that Veterans Services can you expound more on the flexibilities that you need . I think about it, i think about the g. I. Hill. Veterans can look at any school that they want to. The money all of the veterans. Could you expound on that but stability both in oh been and in private . Both openly and privately . Yes maam. As we have said, there are about 23 million veterans in this country. Only 9 million are signed up for a Health Care System. There is an opportunity for every veteran to use the health system. In order for that to happen, we have got to have the flexibility to deal with an influx of veterans as we improve care. One of the things you are aware of is if you get your knee replaced with medicare, it will cost you roughly 5,000. If youre a veteran and get your knee replaced, you say 5,000. To the degree we improve access to our system, more veterans will enter the system. Every percentage point of veterans who enter the system is going to add another 1. 5 billion. With 70 plus line items of ajit where we could not use money from one item to another of the budget where we could not use money from one item to another, it causes situations like the one we find ourselves in today. The purpose was to get veterans care in the community. What were talking that is a shortfall in care in the community. It defies my logic to understand why we cannot use choice care money for care in the Community Since that is a reason it was appropriated. It is sitting there. As more come into the system, we went to care for them. You talked about knee replacement. Someone goes into one of the Choice Programs and the doctors determine that both the needs knees need to be replaced, you can i do with how choice is working right now . I know it is getting technical. Can you explain to me why . I think at the veteran needs replaced, under a Choice Program a could get both replaced. I think that challenge is really that the chairman asked what could we do if we werent in a situation where we have choice funds . We probably would have done managed to ajit. But we didnt do that this year. That requirement was that no veteran would wait more than 30 days for care. We have worked very hard. A lot of our care we are buying it through mechanisms outside the Choice Program. We are doing it so that no veteran with more than 30 days for care and accessing the resources to be able to pay for that is i think our challenge today. Those Community Programs we have been working with her years, universities and other stakeholders, what is happening to those programs . We have cut the uses of some of those programs because of the shortfall. We have curtail the use of the program. Our interest is actually making choice the premier program to make that program the predominant way that we get care. We have worked very hard with both health net and try west to get the 87,000 providers that we have used in the past. Some academic affiliates to sign up to be providers under the Choice Program. For academic affiliates, we offer them indirect and direct medical education overhead expenses that they have negotiated. Thank you. Thank you for having this important hearing. You have come in here physically demanding 3 billion. Im amazed we are in this position. Do you and your Leadership Team at the v. A. Have any accountability or any responsibility at all for this happening . If so, how much . Of course we do. As was laid out in the last hearing on the same subject just a few weeks ago, there are many reasons that we are where we are. I think we all share some of the response ability. We have a new program called the Choice Program. We have seven different ways of providing in the community. Im sorry. Did you want to interrupt . My time is limited. You have described with the layout of the land is. Is going to show you what accountability we half. Ok. Do you have any role in this . One of the things you learn is to have no excuses. One of the things that baffles me this case is we are dealing with a Computer System that is over 30 years old call the fms system. It is written in a language i wrote in 1973. We have got to change the Management System of the financial of this enterprise. Our i. T. Budget is about 50 of what a Health Care System i. T. Budget is. We have got to fix that. At the same time, we have got to improve our management of the financial systems. Were going to work harder to do that. At the same time, it would help if we had flexibility rather than line items we cannot move around. Every time one of these issues comes up on an almost weekly basis, we year please for more money or more flexibility or some like that, we never get to the bottom of what causes it in the first race. That is what were trying to get to the bottom of. I thought is pretty clear in what caused it. They are giving them too much care. When Congress Passes a law here is my real problem here. You said there is no other option except for an emergency supplemental by congress. He will start closing down operating rooms and hospitals all over this country and with a 60 billion healthcare budget theres no other way for you go around this problem than to tell them they cannot come into the operation room after a certain date . What i taught about was using part of the 10 billion that has been appropriate i congress for care in the community to pay for care in the community. You are appropriated money for care in the community. I yield back. Thank you, mr. Chairman. Thank you, mr. Secretary, for your continued leadership to write the ship. I appreciate it. I do think that stability is part of the solution. It is not the panacea, but it is heart of the solution. Clearly we need to be more enabled to serve veterans and to serve them appropriately and in the way that they deserve it. Closing hospitals is not a choice as far as im concerned. We have an i. T. System that cannot track spending and cannot reconcile a budget in a timely way. I think you have alluded to this in your testimony. I would argue that there has been an increase in demand from our veterans. They also argued that the v. A. Is pushing more resources out the door than they have in the past. That is a good thing. It needs more veterans are being served really. You have mentioned areas that we need to improve upon. You have mentioned i. T. Better management of checks and balances. I think before we move forward in any way shape, or form, we need assurances that these kinds of things will get. Will get next. We cannot hope and pray the next time that we will be at her off. We need assurances that these will be fixed and we will know in a timely way where we are. We will know exactly where we are in terms of money that is spent and what the balances are. Share with us the specifics and when you think these things will be fixed so we dont approach another school year with the same kind of calamity that we are facing today. Thank you. I want to reiterate that we do own these problems. We want to fix these problems. I dont want to give any different kind of impression. The starts of getting the right in place. We have our assistant secretary for the office of information and technology. She was the i. T. Leader. I have been working to recruit her for many months in almost the day i was confirmed. We have got to get the right leaders in lace. I think we have them. We need benchmark operations which we are doing. We have got to replace it. Until we do, have got to take root force effort to make sure we do a better job of keeping track of our budgets and keeping you in warmed of them. One of the issues here was when you passed the choice act, you demanded that we account for care the community and the different ways that we were doing it previously. You asked us to centralize that. Im sure you get in order to keep the chill of that money and make we werent spending it for something else. That exacerbated the situation. We tried brute force to try to keep that accounting will so we could understand what was going on. There is no question we have got to do a at her job. Better job. That is part of the solution. I dont have a lot of confidence having served on this committee for 2. 5 years that the va you have asked us for additional money for an i. T. System yet. I assume that will potentially come. It provides the tools necessary that we would need to be able to have a timely thats timely data. Is there something that you are working ons the city . This is a hype your before us high priority for us. We have got to Work Together to go to one with paper the community and making the i. T. System would be easier. Thank you. I yield back. Thank you, mr. Chairman. Thank you for being here this morning. I think you have a ready sisi history of what was going on here. I thank you for the history of what was going on here. I completely agree with that. What im most concerned about is the fact that you didnt do more about the situation in till two weeks ago . All of a sudden it is like a crisis. From my perspective, i was hoping you have a plan to reform the v. A. And make it all good. I havent really seen you about the reform process going on. Im disappointed with the shortfall. Why didnt we know more about this in advance . What is the story with that . I want to draw your attention to this. This i gave you on june 5. This was about placing the denver facility. At that it was important at the time we publish this to give you a heads up on the work were doing to transform va. If you turn to the back this book, the last 56 pages are all about the transformation of the the a. We sat down those members of congress who are interested and went into the detail. We would love to take you through the details. It includes some of the most outstanding ceos in the country that are helping us. If he is going to the largest transformation in its history. Every member on the committee has 56 pages of what is going on. Were happy to spend more time with you. We would like to be a part of it. We like to have hearings of what were doing to transform in the future. Our first knowledge of it was in the middle of may. At the time we had a meeting with both the senate and house appropriations. We mentioned three issues that are emerging. When was hepatitis c. One was denver. The third was the cost of hearing in a community. At that time it that we could solve the problem by putting more veterans into the Choice Program and therefore not as much on our internal community budget. We also thought we could use unspent money from previous years to do it. We couldnt solve the problem. Anytime you have budget line items where you are inflexible and moving items from one item to another, you have unspent money. When we to be the government of that money is to allow flexibility between accounts. In prior years, the last five years sitting on treasury and as those obligations are expensed the obligations and funds they get you obligated i think for the last years there is about i had another question. I heard there is an issue. It is not what it should be. Could you give me a situation of eight with that . Our collections this year are up significantly. I havent refreshed that figure in my head. I would say it is not 7 higher than we had anticipated. Were working hard to improve collections. A lot our patients who have insurance are at a gap coverage. Explanation of benefits. We are not a medicare provider. We are working hard to collect every penny that we can. Out of time apparently. Thank you. A lot of that money that is left was used quite late to a for the continuation of the denver project, wasnt it . I document the money in the treasury . That money is in the treasury. It is not available to us. We cannot use that money. We thought we could. It is money that essentially becomes the obligated as expenses come in. Sometimes there are new expenses for whatever might have happened in 2014 and that money is used in that year. That was not available to us. We had hoped it would be. I was a staff person who had that cryptic conversation in june. We thought we had a plan. We are a victim of our success. We have gotten many more veterans care. Where did you find that money for denver . The money for the denver project we talk about for this year came from the current year budget and not from the previous years budget. Facebook. That is where you also listed a possible solution of taking that 1 across the board cut. It is not a good idea. Apparently at that time you thought you could. That is correct. There is a lot of gnashing and hair pulling today. We cannot let hospitals close. We have to look for some kind of flexibility. Over the difference between care in the Community Programs that have not been consolidated and choice come it seems to me there is little difference in those aside from contract is and some naming. They are really about. The community. Is that accurate . That means it is not that big of a problem . Yes it your statement is accurate and sensible. In execution, it is incredibly complex. What youll find is that with seven different programs. There are different Payment Methods and different exclusion amounts. I was traveling with a senator who brought in dividers about me about every program we had except for one. I knew the reimbursement rate for that program was higher. Because we have different reimbursement rates, we have different providers encouraging one program over another. With we proposed is to bring all of those together under one program. Make it easier for the veteran and that the a employee. Doesnt that mean that the flexibility that you need from the Choice Program to that consolidated community would it sense . Yes, maam. Lets am trying to help you here. Thats exactly right. There is one very were to point. Our Community Care programs are used to call purchase care. There are a lot of in those programs now that are not covered by choice and will require statutory change to fix that. The longterm care is not covered by choice right now. Can you work with us to look for them . Absolutely. Were working on 13 things that we think need to be changed and have made a commitment to sit down with the staff to make sure that we can address those. One last thing. I notice you are all looking that means veterans and sit at the table drive four hours into los angeles will drive eight or 10 hours to separate cisco . San francisco . This is something we are very concerned about. Thank you. Where are trying to simplify it. We want to make sure it gets that are for veterans and not worse. Thank you. Is there lingers that could combine all of this . Were not yet provided the consolidated language. Thank you. The nonva care money is of a discussion of the department of Veterans Affairs where the choices at the discretion of veterans. Thank you, mr. Chairman. I appreciate the topic of consideration day. This is a difficult discussion for me. I had great hope that we would move forward. The most massive shortfall in the a history. When did you know that we had the shortfall . What i said was around the middle of may. If i understand the items ultimately to percent over the budget amount . We have got it problem. Is that a normal manner . It is not coming to attention a list it is 50 over budget . Your essay tried to resolve the issue as quickly as you can. There is a 10 billion source of funds. What were talking about is i do know that. I would like to know why you lowballed the estimates. New gaming projected theyd be 25 you came in and projected theyd be 25 less. They are actually coming in as 1. 5 dollars over. 1. 5 billion dollars over. Let me give you these figures that you provided. This will 2014, actual spending. He said really need 1. 9 . You are surprised to come in. You will spend more than your spending and 2014 . You come here later and say not only to be cut, we are going to add. That is what i dont understand. [talking over each other] wycoff information as quickly as we could. We are here today. Cracks and would like an explanation of why the project to a reduction in this line item , but now youre saying you want an increase over last year . Im not familiar with information you have. I would be happy to look at it. Here is my concern. You said that you do support va choice. We hear from others in the department that you have many employees were not supportive of choice. Somehow it came in well under budget. What you want the next years budget you decided not do that. You decided to come in and request what we wouldnt do for you earlier. I dont know if they lowballed purposely were created a severe mistake. That is what i dont understand. You are wrong on that. That is what you put in the legit. Budget. We would hope it would offset some of that. Out of the 3 billion that is 80 . That is not the numbers you provided to the committee. One last thing, for everybody here that has never happened. You know that is not true. I want to know for the record how many employees have actually been fired . Is it only to . I think we have seen over the weeks that we have made progress. To our retired. We have got over 100 investigations. Lastly, we saw an announcement that the fbi has indicted someone. These investigations do take time. The good news is that they are coming to fruition. I think over 1300 people have been terminated. We take this very seriously. That is why we night of our 17 members and new Leadership Teams at our Medical Centers. The leadership is changing. I hope we have a change in culture and performance. That is why we had 7 million more appointments this year than last year. Thank you. We do have an outstanding question in regards to the people you say have been terminated. How many were probationary . Are still waiting. We will get you the answers as could the as we can. Unfortunately our systems are selected the financial systems. Thank you very much. I appreciate being with us here today. I will try to focus on issues that i think may be causing some confusion in the question of Community Care. They had redefined what has been viewed as nonv. A. Care to include other programs. Community nursing homes. Home health care. I just want to be realistic given the age of demographics. Betsy to 5000 Vietnam Veterans. Just so that we understand Going Forward. Longterm if we are making a commitment to shorten the time frame for waiting to provide reader access and to hire more professionals, i want to understand the exact we but it is, this umbrella of Community Care, and how we expect to meet this need in pay for the need Going Forward. Going forward. So we, under the legislation, were required to centralize all these programs under the chief Business Office and to centralize those fundings. Required by whom . By the choice legislation. So we did that and when we did i mean, we always called them purchased care, really, when i came into it years ago it was pcare. But we were calling it nonv. A. Community care and we said when 20 of our care on a cost basis is out in the community its not nonv. A. Care anymore, it is v. A. Care so we call it v. A. Community care. Were trying to change how we talk about it and the mindset in the organization about what were trying to accomplish so you are correct. That bucket of things includes both outpatient and inpatient care that you normally think of as the purchase care stuff that we do. It also includes our nursing home care, our state home care, home care, camp v. A. Those list of things are this and im happy to get you the detailed list of those and the breakout financially of whats being spent in each of those. Is it the your proposal Going Forward that we would consolidate all of those into one program that we on capitol hill referred to as choice, but it could also be referred to as community . We have all these programs and we also have, as the secretary said, seven different ways of acquiring those services through sharing agreements through contracts, p. C. 3 arch, all these things. I think our proposal and we really want to sit down with the staff and jointly hammer out what a future state might look like. I think that the Choice Program is a good program. I think that if we can figure out how to make that model work across all of these Community Care benefits so that we have a more unified and structured way where we have one billing system, one way to authorize the care one way to get information back, the same kinds of providers that can provide those services, then i think we would be much better off because we could actually explain it not only to other people but to ourselves. And then let me understand when that was consolidated under the choice act to a central, presumably here in washington . Or is it located somewhere else . The c. B. O. , the chief Business Officer is here but we have pieces of that office in atlanta and denver and so when that was consolidated it sounds like there was an inadvertent result in that you no longer had the information that is very regional. I know in our area these are individual decisions and as the secretary mentioned, the reimbursement rates, whether a particular clinic, a particular nursing home, a particular Home Care Program is going to accept this rate, enter into a contract, have we is it fair to say that inadvertent congress wrote it that way, is it fair to say thats created a problem . I think you hit the nail on the head. So i think that these programs typically most of the outpatient care, the bulge of it, the nursing care, state homes, all that stuff was managed locally by a Medical Center, they had a budget for it and clunky Information Systems but they were able to keep track on it. When we centralized that, maybe we should have anticipated some of the problems but we didnt and i think that we lost a lot of intelligence about the obligations that were being made and because you have the authorizations in one system and you have the obligations in a different system and at a time, quite frankly, when we have unprecedented volume of care that were buying in the community so maybe we should have anticipated those things but i think it was an unintended consequence and we did not expect this to happen. So and i appreciate your candor and this is something that we also have it own on our side of the table, having drafted the legislation that way. I think we were probably anticipating a better data system which clearly we have a problem with but this is not unique to the v. A. , that the federal government makes authorizations and obligations and then ends up having to pay the piper. So our balance here as members of this committee is meeting the needs of the v. A. And the veterans all across our districts in every corner from el paso to about pittsburgh, my northern most town in New Hampshire on the Canadian Border but the question becomes Going Forward how do we reintegrate that vital local information and my time is well up. I apologize, mr. Chair. I apologize. I was watching his clock and i thought i was on the way down, i was on the way back up. Excuse me. Was there a question that needed to be answered . Mr. Chairman, i think the answer is, were going to work with you to develop that legislation that integrates all the different ways of Community Care. Ms. Brown has a statement. I just want a follow up to that question because once we pass the choice and we move how we have the counter system, youall caught the problem because when youall reviewed it and you was looking at the requisitions coming in, it wasnt adding up so thats when youall went in and do an individual audit. Can you explain that. Yes thats exactly correct. So back when the First Quarter ended, we were it was clear that we had about a 40something percent increase in the authorizations but we were on plan with our 7. 6 billion dollar expenditures for purchased care in the community. When we sat down and said somehow this doesnt make sense i could think of a lot of reasons why it might actually make sense but we didnt really know and we felt like we needed to look at this so we did, in january and february, look at that. It took us a while to understand exactly what the problem was going through this system. And then once we did that we had to sit town and reconcile millions of authorizations by hand to understand the magnitude of the problem, and it wasnt until really late april that we understood that, the magnitude of that problem. We put a plan together which we thought was going to resolve the situation. And as i said, the pillars of that plan started getting pulled out kind of from underneath us and it wasnt really until may the middle of may, when we said, look, the plan is not viable and we dont really know thou fix this problem without driving more of the care really through choice and accessing choice dollars for their intended purpose which is to buy care in the community. Thank you. I do think its important to note that just prior to folks finding out that this was an issue, we swept somebodys got a cell phone on that needs to be turned off. We got 150 million that we swept out of the v. A. To give to denver, is that correct . I believe so. I dont know for sure. So you anyhow that there was a shortfall coming but you thought it was critical that you go take 150 million and give to denver rather than allocate it to the shortfall . Mr. Chairman, i wouldnt have sequenced it that way. I think the action on denver predated this understanding that was discussed. I mean please understand that every every tool was being pulled out of the tool box to do away with even to the point where we had Medical Center directors voluntarily reducing their salary budgets, their compensation budgets. We had employees willing to give up compensation in order to meet this need of veterans in the community. Maybe some bonuses, too. Mr. Secretary, good to see you. Thanks for being here today. The problem that i dont understand with this, this is what i dont get, is that it seems like it keeps coming back to this issue of perception. You come today, you talk you have all your stats, your tables and your graphs and those kinds of things and we over here want solutions as badly as everybody else is because were fighting for veterans in our district and fighting in a bipartisan manner and doing everything we can legally through a legislative process but what we have been up to since you were here scholastmultiple thargs go on every other day in this place weve looked at to continue whistleblower retaliation systematic failures, management in philadelphia and Oakland Denver cost overruns, waste fraud and abuse and i have been involved and every time your i. T. Chief has been here and we talked about this, as well earlier, getting answers from the i. T. Department, do you need any money to upgrade what you have . Nelson mandela no, we dont. Do you have what you need and what you have needed to keep up . Yes, we do. Do you have, you know, domain issue thats been encrypted . No, we dont. So thats what we have been up to and what the American People have been up to is we have been sitting here asking questions since the last time we met personally in a body like this and i think the issue of trust and this issue of verify becomes dominant in my mind because my fear is that, you know, i love the issue of flexibility. I sit with another member im on the Armed Services committee. We did that with the d. O. D. They needed to move funds. We understood that but there was also a history we could track that was very transparent, very open and the American People saw it, as well, that there was a verifiable need. My concern is back to some of the other points folks made is what will be the guarantee today when we leave here and were going to continue our pursuit of all this oversight of Everything Else that goes on in the v. A. That the American People hear about, as well, and i sit here today shocked thinking we just heard about this crisis and is there anything other, number one, than the threat of shutting down medical facilities to take care of our veterans, is there anything else that can be done number one and number two if the flexibility of funds is the answer, where is the guarantee . Are we going to be looking for a marker that can you say in six months heres what youre going to see and i guarantee it, i put the power of my Office Behind it . I think the only guarantee i can give you is one that were putting the right leaders in place and that those leaders are leaders who are trustworthy and we have to earn your trust. I think thats the strongest guarantee i can give you. I understand and i appreciate that and with all due respect, i accept that as your answer. I guess the problem is this, that we have been at this longer than youve been at the table and we are still celebrating the day that you came. I apologize for everything that happened this morning. And your confirmation was a year ago and i think in some areas youve been incredibly helpful but i guess my concern is this, when we talk about being flexible and moving funds and we dont see and were the eyes and the ears for a quarter of a Million People each of us, thats what we hear and see and when we still get the information back and we still sit here in hearings and dont have the verification on 1300 people whether theyre probationary, whether theyre full employees, we dont see the shake, rattling and rolling of your side and those are the kind of things that i want to see, you know. It wasnt too long ago that veterans were dying because of intolerable kinds of instances that were exposed here in this place through media about what was happening to our veterans. I wanted to see people go to prison. There were people that died that will never be accounted for again and the gross abnormalities were happening at the hands of the administrators and i would think that with the 1300 people terminated the f. B. I. Investigations and those kinds of things that maybe we wouldnt have as many hearings as weve had but we still have instances of offense against wilvet blowers, i. T. Issues that the American People shake their head at, billions of dollars spent, no reforms, nothing is working and we still sit here today and i feel bad. I wouldnt say nothings working. More than a year ago we had virtually 300,000 people on wait lists. Today we have seven million more completed appointments. We have wait times on an average that are five days for specialty, four days for primary care, three days for Mental Health. I defy you to find another medical system in the country that has that. I mean, we are here and we are all for shining light on what were doing because we think it makes us better. And we appreciate your partnership to do that. Just like we appreciate your i dont want to make light here today of the fact that this is an easy decision and i dont want the American People to think, in the state of indiana where i live, 2. 5 billion is more than real money its shocking money and we toss that around like were asking for a little amount of money but im asking for a guarantee and for somebody someplace to stand up and say never again on my watch, never again on the secretary of defenses watch or anybody elses or this president will we tolerate whats happened and i want a guarantee that says heres what history says, were still having hearings on massive amount of issues. Thats what history says. I want a guarantee Going Forward that this will stop and the final question i have for you is when did the president know there was a crisis in the v. A. . I think the president s been working on a crisis in the v. A. For a long time. When did the president know about this budget crisis . First discussion i had with the president was the crisis that we have. When did our president know about this hearing were having today that were 2. 5 billion. Did you tell the president . Of course. I told chief of staff, sure. When did you do that . In june . I dont remember. May, when it started happening . Ok. I knew about the middle may so it was probably around that time. I appreciate it. Thank you mr. Chairman. I do have information, mr. Secretary, that your office did provide to us regarding terminations and i have 958 were probationary perminations out of that number. Mr. Orourke. Thank you, mr. Chairman. Thank you mr. Secretary dr. Tuchschmidt, for your answer, your testimony and service to the country. I had a town hall meeting this saturday and as with almost every town hall that i have, it was dominated by concerns about access to the v. A. And primarily Mental Healthcare access which seems to reflect your own recent rankings as of july 1, out of 141 Mental Healthcare systems within the v. A. , el paso ranks 141st, were dead last. One of the veterans who came up, wonderful young man, incredibly patient and polite, said that that friday, the day before, hed had a Mental Healthcare appointment that had been scheduled for some time at 9 00 a. M. At 7 30 a. M. He was called to inform him that his provider would not be available and somebody would call him back to reschedule that appointment. No one called him back so he came to the town hall to let me know. I immediately called gail graham, interim director, and she got him an appointment this week and hes going to be seen but i tell you that anecdote because even though were ranked the worst in the country for access, you show us at about 17 days. When i asked the veterans in my community and we did a statistically valid survey of veterans in el paso about access with margin of error under 4 , they tell me that it takes about 64 days on average to see someone so i just want to register this note of concern especially given the wait time scandal we had last year that i dont think v. A. Statistics and reporting on wait times reflect what veterans actually experience and when i asked veterans as opposed to the v. A. I get a very different number. And so i just want to register that with you and i want to thank you for your commitment to turning the situation around in el paso. It could not be a graver crisis. Mr. Secretary, you said your Worst Nightmare is a veteran not able to get access to healthcare because we havent provided flexibility. I think the Worst Nightmare for veterans and theyre currently experiencing that in el paso is despite record funding theyre unable to get access to see somebody and fully 34 of the veterans we surveyed could not see a provider at all for Mental Healthcare access whether it was 16 days, 60 days 34 accounted accounted could not get in at all so i want to be sure we look at the numbers and make sure they reflect reality as veterans are experiencing. I would suggest we do that. Lets get your numbers and our numbers together and understand the basis of your research and basis of our numbers and see if we can sort through it. Obviously we have work to do in el paso. You and i and others have been working on that and we know that. Weve submitted a proposal, pilot project, to you and i thank you for reviewing it so quickly, would love to work with you Going Forward to implement that or a better idea if youve got one but we have been at the bottom of the barrel and that translates into care deferred care denied, suffering on the part of veterans and veteran suicides in my community. Ive met with too many surviving families of veteran suicides. This cannot go on. I dont mean to be parochial but ive got to tell you were in crisis and really need your help so whether its our plan that we propose to you or your plan, lets turn this around. Id like to you to talk about i dont disagree with your request for flexibility. I think it makes sense. And i dont know that i would have a problem long term if i knew you were going to be the v. A. Secretary for the next five or 10 years to carry this out. But in thinking about a policy and a set of rules that we played laid down for future secretaries and the v. A. To follow Going Forward, how do we not create a moral hazard in the aurora funding, in the 3 billion shortfall in, future requests from the v. A. That whatever happens at the v. A. And Additional Resources are needed congress will provide them without necessarily getting accountability or safeguards Going Forward that we wont need to plug additional gaps to the tune of billions of dollars. We want to help with that as we put together this proposed legislation we would like to put in the safeguards and restrictions that we think would be necessary regardless of whos in office. We think thats a part of it. I said that in my prepared remarks. The thing weve got to work on is find a better way to predict demand. I talked earlier about the 34 of veterans accessing care and 1 difference being another billion and a half dollars. Weve got to get a handle on that and weve got to Work Together on forecasting what that will be and building that system because remember as i said 2014, the crisis was because of the vietnam era veterans. It was not because of iraq and afghanistan. If we dont get ready for iraq and afghanistan veterans today we wont be ready for them 20, 30 40 years from now as they age. Id like to ask you to consider an idea not my original idea, it was brought by the Summers Family at a hearing we had on survivors of veterans who committed suicide because of lack of access for problems within the v. A. And that suggestion on their part was, as you are referring care out and you said you had a 36 increase in Community Care last year, their suggestion which i think holds a lot of sense is why not refer that care out that is comparable to what the civilian population would need . I use the example of diabetes or the flu or dental care and for those signature disabilities and conditions related to service in combat posttraumatic stress disorder sexual trauma, the v. A. Becomes a center of access for quality of care and outcomes. Any quick thoughts on that suggestion . Patients like to go through the same medical doctor so if you have a primary care physician, you want that primary care physician connected to the specialty physicians. One of the things im trying to work given we are doing Community Care is im trying to improve the understanding of the military culture amongst private sector doctors. We have been working with secretary burwell on this and if somehow weve got to do that because the primary care physician in the private sector has to ask the person, you know, have you served, have you been in the military, because theres a different culture and a different set of questions that need to be canada if asked if they have so we are working on that. I think we agree with your position. I think coordination of care issues says we need to provide as much as the services as we can but there are some things, Mental Health is one of them, that you cannot readily buy in the community and we have to be the center of excels. We have to be able to provide the infrastructure to support those services for veterans. Id like to use this basis for agreement to prototype this in el paso if possible somewhere in the country to see if that works. Why el paso . It comes to mind. I wish a happy birthday to dr. Rowe who is now recognized for his five minutes. Thank you mr. Chairman. And a couple of things. Obviously, mr. Secretary, you are here for the same reasons were here, to provide the highest quality care for veterans that we can provide in this country as they have earned. I think one of the frustrations that ive had on this committee is that we have, as a committee i have been here 6 1 2 years and we keep providing more and more and more money and then we have the v. A. Come back for more money and we see things like thing about in aurora. We beat that horse to death. Moves that cost hundreds of thousands of dollars. I think of a billion dollars goes wasted at aurora that could have provided v. A. Veterans healthcare. I dont know where it went. We had a failed system between d. O. D. And v. A. That spent 1 billion trying to get way before you got here, to try to integrate two healthcare records, vanished, the moneys gone. Thats a waste that i see and no way on this earth would you have allowed that to happen at your shop when you were in no way would i have allowed that to happen when i was the mayor of johnson city, tennessee, where i was or in my own practice, i couldnt have survived doing that and whats happened is that both sides of the aisle want to provide for the care and we feel like were caught in this trap and the chairman mentioned bonuses, all these other things we see, when we go home and talk to our veterans and to mr. Orourkes point, ive got to tell you in johnson city tennessee, these numbers at the Mountain Home v. A. Hospital and they do a fine job, as a matter of fact, i get veterans all the time that tell me how much they appreciate the care they get there. But theres no way on this earth that the primary care is four days and Mental Health is three days and the Specialty Care is five days. I dont know where that information came from. It doesnt exist at our shop, i can tell you and mr. Orourke pointed that out. Not to beat a dead horse but that is a fairytale where i live. I would love to get the information from you as to the veteran, the name, the date, where you believe thats not true because we really do need to make sure that our data is has integrity and the only way we can solve that problem is if we Work Together to make sure we have the right data but we cant anecdotes are helpful but we really need names and dates so we can dig into it. I have a long thick stack of names and dates of people that cant get in. I think thats amazing that you could if this is true, i certainly couldnt do this in my own private practice, i can tell you that, i couldnt meet that criteria an average clinic appointment four days or 5 days. Most doctors are booked up for weeks ahead or at least a month ahead so anyway enough on that. The other thing i wanted to bring up and i think the Choice Program as i understand it, as we envisioned it was was to help get rid of the backlog, not the v. A. Care currently but eliminate backlog. If that program is to continue and it is sunsetted, i think youre right. There ought to be one system in taking a v. A. To outsourced care. It ought to be easy and i talked to several veterans and ill be delighted to let you talk to one of the Veterans Service officers in hawkin county, tennessee that cannot make sense of the Choice Program to this day. His comment was its a joke. I put that in the record, his letter to us and he certainly doesnt mind using his name. The other issue, i think, that disturbed me was when the veterans Choice Program came out, the first 500 million that was spent and we had a hearing on that, 300 million was administration. I dont understand that. I dont understand why 60 of the money went to the bureaucracy and 200 million actually went to get veterans in to see me as a doctor. Maybe that was needed, i dont know. But that seemed excessive to me. That was the amount required to set up the network. Nevertheless, were trying to maximize the use of that network as much as we can to provide more care to veterans. I think the other thing i would look into and certainly flexibilitys been talked about. Any c. E. O. Needs that to operate their shop. I agree with that. The other thing i want to comment in the last few seconds that i have is morale at v. A. Hospitals is down. Those folks feel beat down and i think there needs to be an evaluation of the morale of the physicians and so forth. The other thing im going to do is bring a bill up very soon as a trial process and a lot of people have done this, when you go to your doctor anymore, not only does the assistant come into the room but another person shows up and that person is the scribe and because of Electronic Health records, a lot of doctors use the scribe to enter the data so they can see more patients. I would like to do a Pilot Program in the v. A. And let scribes come in and see if the physicians that are there, providers, are not more productive. I guarantee you they will be. Ive had friends who work at the v. A. Tell me they could see 25 30 more people. This is a big issue you raise about the scribe. We are piloting a program with scribes. Its uneven right now but were in the process of systematizing. Morale also is a big issue. As ive said earlier, 91 of our Medical Centers with new Medical Center directors, new Leadership Teams. We had a lot of people leave for various reasons and morale is a big issue and v. A. People, a third of which who are veterans, dont want to be called out as somehow different and failing to perform. They really care about veterans and theyre working hard every single day. Yield back. Thank you ms. Rice, youre recognized. Thank you mr. Chairman. Mr. Secretary, i want to make sure i heard you correctly. You said you found out about the extent the shortfall in may. So i believe that you were given information, this committee was given information that the shortfall was actually discovered as far back as either february or actually i think it goes back to even december. Can you explain that discrepancy . No, i cant. I havent heard that. I dont think we knew there was a shortfall. I think what we knew in february that was there was a difference between the increase in authorizations that were up substantially and the obligations for that care which were on plan. So all the data we had in february in february suggested we were on path for our 7. 6 billion estimated expenditures for the year. We questioned that data. Right . Does it make sense why you would have 40 more authorizations, but the obligation rate is not up. That is what we knew in february. It was at that time we sat down and said we have to figure this out. Maybe there is a good estimation, maybe it all makes sense. But it wasnt until april that we understood the problem, and the magnitude of that problem. That sounds like semantics to me. In what way . Sounds like you just dont want to say that word shortfall. Did you have a solution . What i said is i thought we had a solution and told the middle of may. That solution fell apart as we worked the mr. Secretary, if you can put it in 30 words or less the reason for the shortfall, tell me, hep c, just give me an idea. The easiest description is more are coming for care. 7 million more appointments than a year ago. Thats the reason . Thats the reason . Thats the reason. I kind of feel like this is have you seen the movie groundhog day. Once again the committee is , sitting in front of you with members of the va talking. Talking about a crisis in the v. A. , that is a recurring theme. Another request for yet more money. And the most disturbing point to me is a complete and utter lack of accountability. I dont agree with you obviously. Remember, this money is already appropriated. What were asking you to do is to spend money for care in the community. How are you going to pay for care in the Community Next year . What we are asking for is a part of the choice budget. What we have talked about is lets put together an integrated way of doing care in the community. One way to do it, not the seven we have today. Members of the community said they dont understand, our employees have trouble actually executing. So where is the accountability is what i am asking for . There is no part of the shortfall that is related to misuse of funds or potential fraud. Or anything like that . There has been no misuse of funds or fraud. You have done an audit . Have you had somebody do an audit, yes or no . We have had an internal reconciliation. Is that a yes or no . I am not sure that is a good idea. We had 34 for more authorizations in the community. You asked us to make sure no veteran was waiting no more than 30 days for care. We have done that. What i think is disgraceful i , have about 20 seconds left. What i think is disgraceful is for you to insinuate by not giving money nobody on this committee cares about veterans. Hold i am so sick and tired of that insinuation. And i yield back my time, mr. Chairman. Just to be clear, we didnt insinuate that. We all think you care for veterans dramatically. What we are faced with you pass , the laws to give Veterans Benefits. You pass the budget to pay for those benefits, and we have to execute that. When there is a mismatch between the laws in the budget, it is a difficult opposition. I get letters from all of you every single day trying to give more benefits to more veterans. But we have to have the money to do it. The law also says the secretary must manage within available resources. But the choice act is not a resource that is available to