Good morning, were placed to welcome back a good friend, dr. David shulkin. She last time you appeared before our committee you were in the virginia undersecretary for health and now kicked upstairs after a nance confirmation vote and that says a lot in this political environment. So congratulations. You have a great background in the philadelphia area, just learned you were in marstown and you certainly bring lat of experience to the job and although im sure these days that the challenges are very dawning for you daunting for you. This hearing is unusual. Rather than the typical Budget Hearing we have at this time of year, were limited to a discussion of the skinny budget, the skinny budget materials the onb sent to the hill in march. They twopage entry for the va doesnt give us much to go on in terms of Program Priorities but the skinny budget gives us the administration is proposing a 4. 4 billion 6 funding increase for the agency and addition theres 2. 9 billion proposed in new mandatory funding for the virginia. You must be probably the only domestic federal agency not facing a substantial cut and so i suspect ill need a kevlar vest when talking to my fellow preparations subempty appropriations subcommittee. So when we say you full budget well be asking tough questions. The merits you propose increases when we no others bill we struggling. Despite not having a complete budget im sure the members will fine plenty of va topics to ask you about this morning. How you envision va striking balance, making Electronic Health records work for veterans as shay see more daughters how to choice. Your efforts to tackle appointment scheduling problems and approaching disability claim backlogs and appeals. Your plans to decrease veteran suicide and homelessness, your campaign to limit opioid abuse among veterans, plans to access care for rural and female veterans veterans and thats just the start. So well include your full statement in the hearing record and be pleased to hear your oral statement. But ill ask our Ranking Member if she has any opening comments to make and. So miss wasserman shiltz is recognized. Thank you, mr. Chairman, and welcoming are mr. Secretary. Its been a pleasure to talk to you and have you in any office. We appreciate you being here in your new capacity, and its an awkward situation we find ourselves in. Youre operating on a bigger stage than previously and with greating responsibility that comes with the duties of being the secretary of the va. Mr. Chairman, since fiscal yearing two the va has seen a tremendous 70 increase in accounts, the va medicare anses now 64. 4 billion and discretionary accounts increased to 74. 3 billion. Fy2018 is no different. This skippy budgets requested 78. 9 billion or 6 increase from the 2017 inactive level. The 20sel budget requests legislative authority and 3. 5 million in mandatory authority to continue the veterans Choice Program. And what is a question that arises is that this would support a program that was initially mend as a stop gap treasure fund. Mr. Secretary, while im thrilled to have you here today its up fortunate we wont be able to discuss the specific budget request and its challenging to tour on juror. Given the 70 increase over the past ten years its critical that the committee has the opportunity to app an analyze the unders and determine what the va has less than adequate okay and wait times. To it is crucial that we understand how these issues are being addressed. And once we more fully understand the issues at what point do we ask if this continued growth is unsustainable. Mr. Secretary i ask these questions with genuine concern for the future of the va. Obviously our driving concern must be to provide the best care to our veterans. We dont control costs and ennoor hat the resources the committee provides are used in an appropriate and efficient fashion. We actually hurt our ability to help veterans and deliver on our mission prove providing top quality care. Comes to mind we are providing Additional Resources were not seeing what would normally come as the commence membersat responsible from people receiving new services because of the challenges that the va is having in providing the services efficiently. Top quality care is our top priority and we need to mike sure we help you deliver on that mission. With that in mind, mr. Chairman, its imteartive we discuss a number of key issues including the Choice Program and the state of the vas Electronic Health records. How does theave envision choice . As after creating the Community Care account, 9. 4 billion in advanced fy18 appropriations why does the budget request include 3. 5 billion for the Choice Program . Additionally where is the va in implementing and improving the electron Health Records system and executing congress man dead for full interprincipal with dod systems. As we discussed a solution to this issue is long overdue. And finally, i hope you can address the significant number of vacancies the department and then the positions are expected to be filled. 11 senate confirmable positions are vehicle cant, including the undersecretary for benefit its, for health, and the undersoutheast for Memorial Affairs the general counsel, the assistant secretary for information and technology, the assistant secretary or policy and planning, the assistant secretary for management, and the chairman of the board of veterans appeals and by the way, the veterans appeals process is an absolute mess, and so for it to have no chair for as long as that has occurred is really unacceptable. And i believe that you ernestly want to reform improve the va it reflect of the confidence and its our duty to ensure you have adequate resources to do so. We have a lot to discuss today. Thank you for the opportunity to share my concerns. Id like to recognition the chair of the full committee. Thank you, chairman, and Ranking Member. First of al i want to give you a shotout for passing your bill last year, september. Thank you for that effort. You were the pace setter. I wish we could have followed your pace but i cant think of a more Important Department than the department of Veterans Affairs. Those who have served our country right now in dangerous places deserve when they get hem to get the best care possible and i know you from your time in new jersey and wonderful things you did there and for good reason you were unanimously confirmed by the senate. Not a lot of unanimity over there but im glad they focused their attention and support for you. Two areas areas of interest intt to me and i dont want to take time away from your remarks, questioning to be the appeals and benefits backlog. Its a nightmare. Ive even shared with you some of the three our four, year waiting periods for people, obviously evidence has to be checked and verified but in result its nightmarish president suspect and the confirmation of your undersecretaries might be helpful. The last area of interest is Electronic Medical records. Three years ago the then chairman rogers hosted chuck hagel, secretary of defense, and rick shen sick can i, we received a commitment from former we would have a luigs. Know that the department of defense and given the resources theyve been given, is getting up to speed but i do view your systems as sort of the weak link. So i just personally feel this is something which is enormously important in a day and age when we have so much information passing back and forth, obviously, encrypted and protected, that to not have that available to our Healthcare Providers is pretty inexcusable, but good luck and god speed and thank you, mr. Chairman. Thank you very much, and i would like to thank chairman dent and Ranking MemberWasserman Schultz for holding this important hearing and i welcome secretary shulkin today. We as members of congress and you as a secretary of Veterans Affairs, have a duty to provide the best care available to our veterans, who have sacrificed and faithfully served our nation. The va faces serious challenges in meeting their health needs. After working four years to reduce the claims backlog, it is once again increasing. And the Choice Program will soon run out of money and is in need of reform. And the va and department of defense and not significantly closer to the interoperability of Electronic Health record than years ago. We owe it to all current and former, future veterans, to tackle these challenges now, and this subcommittee is committed to achieving that goal. I must say, after reading your resume, i am so optimistic, ass was referenced before, chairman rogers and i had four hearings. We also met in closed door sessions, but we havent been able to resolve this. Now, have my own personal preference about who is to blame as we were talking about it before. But that is irrelevant now. And looking at your resume, i am so enthusiastic and i know youre going to get this done. In my own district ive worked to secure federal funding to improve rehab facilities, and ensure that veterans can receive a high quality of care. But for too many, the va is enable to provide the types of services they require. From women struggling to find care in the Health System that has traditionally served men, to veterans who were turned away from va facilities when they are most in need, the virginia has a responsibility to serve all veterans who seek the care and treatment they have earned. In light of these challenges congress awaits the details of the president s fy18 budget request. The budget lack deed tail, providing seven bullet points of vague proposals. Why you may not be able to speak to details of the Budget Proposal now i hope youll return after its released so we can fully discuss it. Mr. Secretary, i again thank you for being here today. Thank you for your commitment to improving the lives of veterans and thank you for assuming the responsibility. I look forward to hearing about all your success sooner rather than later, so we wont in a bipartisan way, continue to talk about backlogs, and the lack of records so we have confidence in you and i thank you for appearing here today. Thank you, at this timed like to recognize secretary shulkin for five minutes. Chairman, Ranking Member lowe, and Ranking MemberWasserman Schultz shut and all here today i was ceremony pressed with our Opening Statements and so many topic outside have thought about and that you care about and i know are serious issues and we trying to do things differently the va that it have a terrific Opening Statement but im willing to, mr. Chairman, actually forego it and get right into the questions unless you prefer me to go through the Opening Statement. Because i think we have so many issues and i want to use your time most valuable. Ive submitted it for the record, and id be glad to read through my oral statement but live it up to you. Youd like to hear it . Okay, good i told you its terrific. Your bridge version,. Ill try to do it quickly but thank you. Okay. So thanks to town be here today to talk about the president s 2018 budget. I also want to to for your support of the 2017 budget that really gave us for the first time our full budget from the start of the fiscal year. It really speck speaks well of the u. S. Congress and the American People that despite all these differences, and you have mentioned this several times, we can come together on this topic to support our nations veterans. I have submitted the full statement for the record. The president s 2018 budget reflects his strong personal commitment to to the nation residents veterans, provides the necessary resources to continue to ongoing moored concernized moored concernization of the system. The requests. A 6 parts increase in funding for the va. It provided 4. 6 bill more for medical care, a 7. 1 increase, and the 3. 5 billion more in mandatory Budget Authority that was mentioned to continue the veterans Choice Program. More veterans are opting for choice than ever before. Five times more in fiscal year 2016 than fiscal year 2015. And choice authorizations are still rising. We have issued 35 more authorizations in the First Quarter of fiscal year 2017 than in the same quarter of 2016. All told, including both va facilities and the community we project a 6. 6 increase in ambulatory care. I urge you to support our request in order to meet increasing demand for va services to modernize the va systems and invest in choice. I came to the virginia during a time of crisis when it was clear that veterans were not getting the timely access to high quality healthcare they deserved. I know virginias made significant progress in improving care and servicers to veterans but i also know that much more must be done if va is to continue keeping president lincolns promise. Last book i had an opportunity to meat two courageous jung americans, michael and sarah of rhode island. All michael ever wanted to do was to be a soldier, and he became a soldier serving in the armys 82nd airborne division. Then he loss a leg and part of his arm in an explosion in afghanistan. He suffered other wound as well. They told me when he sought care from the va in 2014, they did not receive the care. We cannot allow ourselves to ever again fail our american heroes like this couple. Meeting michael and sarah underscored the need for modern ization, i want to provide care, modernize systems, focus resources mow efficiently to improve the timeliness of services and Suicide Prevention among veterans. We simply cannot tolerate employees who act counter to our values or put veterans at risk. January of this year, weve authorized an estimated 6. 1 million Community Care appointments, 1. 8 million more than last year of 42 increase. We now have Sameday Services for primary care and Mental Health at all of our medical Centers Across the country. Veterans cannot access wait ten days for an easy online tool where they can see those wait times. No other Healthcare System in the country has this type of transparency. Ba is any new trends with public , private partnerships. Last month, we announced a Publicprivate Partnership of ambulatory Care Development center with a donation of roughly 30 million in omaha nebraska, thanks to mr. Thornberrys help. Veterans now have or will have a facility being built with far fewer taxpayer dollars and in the past. Finally, the va is saving lives. Our top priority is Suicide Prevention. Twenty veterans die a day by suicide. A few months ago a crisis line had a rollover rate to a backup center of more than 30 . Today that rate is less than 1 . In support of our efforts for suicides we watched new Predictive Modeling tools that allow va to provide proactive care and support for veterans for the highest risk of suicide. Recently, i announced the va will providing emergency medical Mental Health care to former. We know these veterans are at greater risk for suicide and were now caring for them as well as we can. These are just a few of the efforts that were improving the lives of veterans. We want to keep moving forward we need your help. We need congress to realign our capital infrastructure, to dispose of property we dont need and support facilities where veterans can get better serve. We need congress to fund art modernization, to keep our legacy systems for failing and Electronic Health records to be essential to any highperforming integrated Health System. We are also laying options for adopting a commercial offtheshelf alternative to our legacy systems. I scheduled the decision for this in july. If it make sense, will need some Additional Support from you as well to go the offtheshelf route. We need congress to authorize for appeals process that many of you mentioned. Working closely with veteran Service Organizations and other stakeholders, va has drafted legislation to modernize the system. We submitted a proposal to the hundred and 14th congress and we resubmitted it in this current congress. We need congress to act on this. Most of all, we need congress to ensure the continued success of choice for veterans. Extending the Trace Program past its august and eight was an absolute necessity and thank you for that. But extending the program was the next step to the modernization of the Community Care the veterans deserve. We charted a course for modernization and are already moving forward but we need your help to keep up with the Choice Programs growth, maintain momentum and make our Community Care plan a reality. In closing, let me again express my thanks to the Appropriations Committee and to this subcommittee for the support that youve shown veterans in recent years. Without that support, we could not expand the choice to Record Number of veterans who are also