Youre not the dominant race you are excluded from the courts and education and access we as a country try to you are wrong. We are not done with the journey almost every delegation under every flag everyone marching looks like. Until the United States marches in and you see this great diversity of athletes and it reminds us again in the past ten days should remind us we are not done so to do the hard work with their own families and do that legislative work that needs to be done to make progress but lets keep going. And tell it is done my friend said to me last weekend founding documents are great we just never live them out for everybody. I cannot wait for us to continue the work in this body toward becoming a more perfect union. I yield the floor. Las americanser gettembe for us to gather together but last monday gave us an opportunity that we should take every day to pause and remember the brave americans who gave their lives in defense of our country and we honor the sacrifices they made made to keep us free. Let me start by saying that the veterans that we honored on memorial day served our country and the peaceful protest are a demonstration of the freedom of veterans serve to safeguard and protect and while we reject the defacing of our mom one monuments i would express my gratitude to the National Park service its employees and volunteers who quickly sererts restored those e service of our men and women particularly the world war ii memorial. I know this committee will further the nations pledge under liberty for all to honor those that serve that we live in the country to use this as an opportunity to pay respect to veterans who lost their lives to protect freedoms. Todays hearing is on fiscal year 2021 budget request in the supplemental appropriations in the care zach to respond to the cove in 18 outbreak we recognize secretary wilkie with the chief Financial Officer and weve done our job to socially distance despite the distance between youou and me theres nothing other than covid19 and i look forward to continue to work closely with you at severy opportunity and how we can Work Together to improve outcomes in our country. I would also like to acknowledge v. A. Personnel who lost her lives due to cove in 18 to make sure it has the loss of life during the unprecedented times also to think that the nurses and doctors and support staff workingod tirelessly for veterans during the covid19 pandemic they have executed the Fourth Mission to support the American Healthcare system during this National Emergency and this response from these Healthcare Professionals has been and continues to be ladmirable and important and necessary to devote resources veterans will rely on their needs such as education and Home Financing in Transition Services and must continue unabated. With the release of this budget to pass legislation to support federal agencies reporting to the pandemic following a supplemental request Congress Passed the care zach marc march 27th to provide 19. 6 billion for medical Services Including telehealth andt supplies through emergency room an urgent care and also two. 2 billionon for it for telework capacity i am interested how it has affected the v. A. Health services and respectively did that cares act and the prospective lead to give the shifting healthcare demands and that still has the projected needs before the emergency the fiscal 21 budget increase of 22. 8 billion of funding for theeis v. A. For a total of 200 200. 4 billion this is ang ten. 2 percent increase of active levels i look forward to hearing from you how the proposed budget increase would have Better Outcomes for our nations veterans. I am pleased to see an increase for Community Care is the v. A. Continues to implement the mission act. Many veterans especially those likecr kansas for access to timely and quality care a bipartisan effort to transform and you have been a champion to ensure the proper implementation and we all with them to get care to the v. A. Into discuss the mission act today i and another Health Priorities for the judicial request for funding for Mental Health and suicide prevention. Mr. Secretary i know you share our priority in january this committee unanimouslyna reported john scott veterans Mental Health improvement care act grants for Community Partners and improve coordination between the department of defense to quell the rates of veterans who die by suicide is my hope you will continue to work with us into law soon. As always i thank you for being here and the difficulty of your job as the administration works to find a whole government solution to hear on the fi budget and the senator from montana for his opening remarks. This is very important hearing and i do want to say more than i have ever experience but the bottom line to have an opportunity of what the veterans have given us in this country with freedom and the promise with liberty and justice for all and its appropriate as we have all said its veterans day in this country without the sacrifices what they have done over generations and i hope with all my heart that this is about liberty and justice for all. And to all the veterans out there and secretary thank you for you and your Leadership Team for being at the hearing today we get to know the details of the president s budget request and the v. A. Has changed more than 600,000 americans have died returning from moores a broad and a very different battle here at home the v. A. Is a largest integrated Healthcare System and to save as many veteran lives as possible with 12000 veterans to be diagnosed with covid19 by the v. A. And also the frontline workers and their workforce have done an incredible job and deserve more than just thank you because thats not enough. We need to make sure to keep them safe and keep them in the process this is an opportunity to take stock of where we are and where we need to be. At the outset of the response to covid19 we do need a better understanding of how v. A. Has spent the funds are they available for this next fiscal year . Yesterday to make sure that his request it with the coronavirus we have to know if the private sector providers are preparing to safely administer given the unprecedented effect on soAmerican Healthcare and then to meet those demands. And that congress that had contacted so we also see largescale psychological impacts the not to traditional access with those resources and to Mental Health care and as we have seen with the cove in 18 crisis and to shortchange the infrastructure. And unemployment on the rise critical of what programs need to support to get back to work and able to provide for their families one way is to ensure that claims are processedde timely and i am truly concerned with the backlog of claims and with those for veterans and how those delays will affect and with that budget request and i look forward to our conversation thank youth mr. Chairman thank you to the witnesses for being here today. Thank you for joining us today i appreciate our relationship close are far apartre maybe this works better for us. [laughter] im delighted you are with us. This is a hearing the Committee Members take seriously and i am pleased all the members are here i want to acknowledge the presence of senator bozemanip of the appropriations so senator bozeman thank you for joining us with the expertise and interest in before i introduce you you have been very kind and in your time with senator tester and i i cannot ask for more opportunities to have more conversations with you and your team as we explore those suggestions and ask questions that are beneficials to you. You stole the first line. And that in my experience in this institution for the Majority Office that there is no committee of authorization more collaborative are supportive of the department which is why i say with a straight face and then to pick up on what senator tester said about the events memorial day has been part of my life as long as i can remember but then to look out from the podium and then those scattered amongst the thousands and then to realize it is a different time. And on those day of days they could be in our cemetery. Those that have lost her life since the shots were fired in lexington april 1775. And then to present the largest budget it has now beenir surpassed and that trust in v. A. That did not exist six years ago that is not what you read about in 2014 today we are we dedicated to lincolns vision and the record of turnaround is something that may be unprecedented in the history of the federalal government and in just a few short years we have implemented major reforms and while some said the commission meant privatization of Veterans Affairs the number show the opposite has happened and then to put with those internal episodes and while we were doing that between june 6 and the National Emergency only 4 million veterans into theth private sector to fulfill the mission ask mandate with critical updates those of the Blue Water Navy veterans and we continue to make progress of the development of the Electronic Healthcare record those like my father will never be burdened with an 800 page record evertm again. Roud a am for the thousands of va employees who put themselves in harms way to create an indispensable resource not only for our veterans but for our nation. We continue to perform well because we took steps early on that allowed us to keep serving veterans even when there was so much uncertainty. Those steps included the immediate implementation of Emergency Management procedures in the last week of january. Expanding telehealth access and prohibiting visitors to our va Nursing Homes and spinal cord injury centers. Heres where we stand today. As of this week more than 12,000 veterans nationwide had been diagnosed with the virus. But 80 of those veterans are now at home having recovered. We are caring as we speak for 1,200 veterans with the virus, a number that has fallen in the last two weeks from 2,200. We have currently about 1,100 va employees who have tested positive. But we estimate that our infection rate with 330,000 employees and dr. Stones department to be one of the lowest infection rates of any organization on the planet. It is less than one half of 1 . And our staffing is stable because we have hired in the last seven weeks 16,000 americans who have agreed to join us and serve veterans. That means 3,300 registered nurses, 535 physicians, and 202 nursepractitioners who are with us now full time. And more importantly we have the lowest rate of infection amongst our nursing home residents. The lowest rate of infection amongst any system in the country because early on we took very difficult steps to close off our veterans sadly from their families and friends. Because of that we have 19 veterans in our Nursing Homes, 19 out of the 7,000 who are infected with the virus, and i believe we have set an example how to care for our nations most vulnerable. That stability in operations has allowed us to open our doors for the mission which is back up our Health Care System in times of crisis. We are now in 47 states and territories. By april we were accepting requests to open dozens of our hospitals to nonveterans cross the country. Our expertise in caring for nursing home residents is in the highest demand. Weve deployed 204 va staff to Nursing Homes around america. The crisis as i mentioned was not costless for us. Covid has claimed the lives of 32 of our va family. But in april april brought us irrefutable evidence that the tide at va has turned for it better. On the last day of the month we released a survey showing that a record 90 of veterans across the country now completely trust va care. That is a record high and is a record high even in a pandemic. So that is todays va. It is a learning organization filled with employees who can turn on a dime to keep veterans and nonveterans safe even during this time of incredible uncertainty. Mr. Chairman and senator tester, i again thank you for your many courtesies to me and everything you do for our nations most deserving. Mr. Secretary, thank you very much. Let me begin with a handful of questions and then turn to senator tester. Committee, we will do this by seniority not knowing the presence of every member at the moment. So well work by seniority. Mr. Secretary, can you walk us through why we are seeing a steady growth and increasing funding in both internal Va Medical Services and Community Care. Let me use this opportunity to say that i believe that whether the care is provided in the community or provided internal to the va both are va care. They are both part of the department of Veterans Affairs, and they are not separated. You indicated the hiring of 10,000 medical staff. This in my mind could lead toward a greater capability of seeing people internally within the va and maybe result in less people involved in Community Care. Youve also indicated to me and senator testing over a long period of time the increasing use of telehealth. How does that have a consanyone of the amount of veterans being seen internal and the community . I raise this question in part because we are being requested in this budget for more money in both categories. Internal va care. Let me and answer the telehealth question first. That is separate category because it rests on a priority that i gave to this committee when i had my confirmation hearing. The two communities in this country who serve the nation in higher numbers than any other communities are rural americans and nativeamericans. The two populations that are the hardest for us to reach no matter what the mission act does, what we have done with telehealth is increase our footprint in rural and native america. Ill give you an example. In april we had over 900,000 telehealth encounters. That is an increase of several hundred percent. The reason that is important is at a time of crisis when veterans cant get to our facilities or they cant get to their private sector provider we have offered them a window to help with their health conditions. I intend to expand our footprint through telehealth into rural and native america. On the Community Care side i am fully committed to expanding that choice even during this time 60 of our normal mission act Community Care appointments have been carried out. The one thing we have discovered during this crisis is that many of our veterans are not going into the private sector, and youve seen that all across the country with declining rates, not only of wellness visits but visits to the emergency rooms. So that has been the makeup of how we have reacted both to the expansion of mission but also the expansion and the confidence that people have in va, and ill let dr. Stone add some comments about the numbers and budget. Mr. Chairman, the growth in the budget reflects enhanced enrollment. Were anticipating about 30,000 more veterans to be enrolled with us, enhanced dependence on the system. As you know about 80 of the veterans that are enrolled with us have other health insurance. They dont get all of their care from us. About 20 do get all of their care, but increasing amounts of dependenceance upon us as well as the growth in referral in Community Care. A small percentage of the crease is do to mission act and the increased requirements, probably not more than 2, 2. 5 but john will correct me if im wrong on that number. But it is really dependent upon us and the enrollment, and as we come out of this pandemic we certainly are concerned that financial destabilization of the veteran population may result in even greater dependence upon us, and ill defer to correct anything i said. No corrects. I would say from the early health care projection model we used to predict cost i think the big cost driver is the reliance that more people are taking advantage of the va, so were a victim of our own success. I think there are more programs, more benefits, more access, different environment and frankly people are coming in and taking advantage of it. Is there a way to distinguish between increasing number of veterans accessing care and the cost of care in your c calculations of a budget . Trz. It gets very complicated. I belong to a commercial Health Care Plan and they sort of know im going to use their Health Care Plan. The challenge we have is we have beneficiaries who have all kinds of medicare, tricare, private insurance and the challenge for us is predicting how much of the va theyre going to use. We may see an increase in va use because of this covid pandemic, people losing their job and thats something were looking at very closely but predicting that and sort of knowing is a very difficult thing to sort through. Thank you all for your responses. Let me turn now to senator testing. Thank you, mr. Chairman and everyone there that is testifying. You guys touched on it, and im going to follow up where the chairman was at. This budget was developed long before we knew there was going to be a pandemic. And quite frankly its a boat load of money but it needs to be right sized. It doesnt need to be overly inflated and it shouldnt be less than you need. But each one of you talked a second ago about an april increase in the hundreds of percents. You talked about the fact that 80 of the folks have Health Care Insurance that use the va. I think with unemployment increasing and you guys talked about th