[inaudible conversations] this morning epa administrator scott pruitt testifies before House Appropriations subcommittee on Donald Trumps fiscal year 2018 budget request for the agency. Live coverage at 11 00 am eastern on cspan3, cspan. Org and the free cspan radio apps. Next, Veterans Affairs secretary doctor David Shulkin testifies on the president s 2018 budget request for his department. The hearing also has representatives of veterans groups talking about budget proposal. This hearing is about two hours. [inaudible conversations] let me apologize for being a little late. A couple things coming down the hall, i dont want to flip up on me but stand at ease. In the air force, and for just one minute, my trusted friend, Ranking Member, will open the [inaudible conversations] [inaudible conversations] call this meeting of the Veterans Affairs committee together. I apologize again for being a little bit late but i want to make sure we are on the right track and i didnt mess anything up. I want to welcome secretary shulkin who has had a great start. I dont think anybody in this administration started better when confirmed and voting last week on accountability with extraordinary, the way we got to the decision, working together, was extraordinary and i commend the Ranking Member on his help in doing this and we have other things to do today to talk about budget wise. We have several decisions to make but we can keep the same tempo, the same commitment to make sure we know what each other knows before that happens and financing after the fact. I welcome doctor shulkin and other members of the staff that are here today and appreciate where we are going with the Veterans Administration which is upward and outward. I want to make a long statement, to say a couple things. One thing i have to brag about, the cerner decision getting our Electronic Medical records issues solved after years of unwillingness to address it. It is extraordinary. I think from what i have heard there are signs people are coming together in the past that havent been together to make sure this happened and works efficiently for our veterans and the department of defense and the promise of Veterans Affairs at the same time. Thank you, much. And thanks for having this hearing, and i think its important to say that our thoughts are with the colleagues who were the victims this morning. We wish a speedy recovery for congressman scalise and everybody else who was injured. And a, a big, big thank you to the Capitol Police officers who work every day to make sure this place is a safe place. Our thoughts are with them. Now, secretary shulkin, i want to thank you for being here with your v. A. Team. We spoke last week at some length about the future of Choice Program, and i hope i made my perspective clear the Choice Program was intended to supplement care provided directly by the v. A. , not replace it. Not now, not in the future. I worry the budget proposed by this Administration Starts us down a path of unfettered choice that will hollow out the v. A. In doing so, it proposes to increase funding by third by proposing the v. A. s own hospitals receive an increase that that is less than half the medical inflation budget. Further, the budget does nothing to address the aging infrastructure. Actually provide care for veterans while also denying them money to address the environment care concerns, we know what that outcomes going to be. Soon enough, there wont be any quality v. A. Hospitals staffed by quality providers and v. A. Care will become nothing more than a voucher plan to hunt for a doctor who has the time, capacity and knowledge to treat them. That is not what the veterans need or want to happen, and for a rural state like montana, it would truly be a disaster. Each year more and more rural hospitals are at the risk of closing, and if there are rollbacks to recent medicaid expansions, its likely these closures would accelerate. Is we cant assume the private care will work in rural commitments or where there arent sufficient networks. We know the vast majority of veterans are eligible to long wait lines not because they live too far from a v. A. Facility. Data shows rural veterans arent just choosing choices much, but they actually do depend on v. A. Care. But now, based on your quest yesterday, we may have to shift additional funds around to get the Choice Program through the fiscal year. For months weve being asking about the choice to spend rate and the amount of remaining funds. We were never provided with those answers x now were in a difficult spot. Mr. Secretary, no one wants delay in care for veterans, no one. And we will act appropriately and in a timely manner to solve this problem. But for that to happen this late in the game is a bit frustrating to me. And my frustrations compounded by a budget that cuts services that veterans rely on, makes cuts to education oversight, makes cuts to i. T. Which impacts every business. Im most concerned theyre being made in order for certain veterans to get private care. And the new policies are simply untenable. To put forward a proposal that would, without warning, top earned benefits payments to the most severely disabled vets is unacceptable. In this case, were not talking about folks milking the system for uncompensated must be that they dont money that they dont deserve. It must be determined that a veterans able to engage in work as a direct result to service to their country. More americans are having to work longer in their lives to make ends meet. And all in the name of finding more money for choice. Thats a nonstarter, and i hope we can get your commitment today to keep this important benefit in place. So i look forward to working with my colleagues on both sides of the aisle to address these concerns and look forward to hearing from you and how you intend to prioritize funding for veterans who get care and benefits directly from the v. A. And finally, i would like to wish the u. S. Army a happy birthday. I look forward to your testimony, secretary hull quinn. Sec shulkin. Secretary, welcome. We appreciate those use brought with you. Edward murray, Richard Chandler are, Deputy Assistant secretary, mark yao, james manniker, acting Principal Deputy undersecretary for benefits and matthew sullivan, finance and planning. Mr. Shulkin, secretary shulkin, the floor is yours. Well, thank you, chairman isaac soften, Ranking Member tester and other members of the committee. As you can see, i brought a big team with me because i kno youre going to have i know youre going to have lots of questions, and in particular with the Opening Statement, i really do look forward to having a meaningful discussion and getting to some solutions and some closure on some of these issues. I also did want to echo the Ranking Members concern that this is a sad day for the nation where public or servants who work as hard as i know all of you do have to worry about their personal safety. And our thought ands prayers are with the congressman if the stay and the Capitol Police as well. Thank you again for allowing us to be here today. What we want to talk about today is the 2018 president s budget and the 2019 advanced appropriations. And all of this is in way of showing support for veterans, and we appreciate the legislation that recently has been passed. As you know, you passed just within the past week the accountability bill, and that went through the house yesterday. Were looking forward to actually next tuesday bringing it for a it for the president , and for a signature for the president , and thats good news. We also appreciate your support for the veterans choice improvement act that you supported and for providing us really for the first time in a long time the full 2017 budget. Thisthis has really allowed us o make Real Progress for veterans. Were grateful for that support. Ive submitted the full written statement for the record, so let me just start by thanks you again for allowing us to participate in the hearing last week. Seems like we were just here with you. But i thought it was an excellent hearing, a good discussion on choice, and that type of discussion and dialogue is going to allow us to help get it right for veterans. When i testified before the house Veterans Affairs committee on march 7th, we had 2 billion in the choice account. Less than a month and a half later when the president signed the choice extends act into law are extension act into law, our choice account was at 1. 5 billion. Today that account is at 821 million. As we know, more veterans than ever are using choice. Weve authorized 8. 2 Million Community care appointments since january of this year, thats 2. 6 million more than be last year or a 46 increase. In fact, march, april and may were the largest months ever for choice. And, frankly, that happened because we fixed so many of the problems that weve all been working to fix with choice, and weve been increasing our use of choice. One of the reasons why is the 17 budget, as you may remember, actually had 2 billion less in Community Care, so weve been putting more through choice. Two years ago, im sure youre going to remember, in july of 2015 we had too little money in our Community Care accounts within the v. A. Which we solved with your help by accessing unused funds in the choice account. So we transferred money from choice into Community Care. We now have too little money in the choice account which were working to solve, again working with you, with the legislative authority, to replenish funds into the choice account. Is so this is the situation that weve described before where for a single purpose of providing care in the community, we have two Checking Accounts. And i tell you i wish it were easier than it is. We have to figure out how to balance these two Checking Accounts at all times and, obviously, its not a science, its an art. Were having difficulty with that once again. And thats why we need to work with you to solve it. The Veterans Care Program that we outlined for you last week will solve this recurring problem permanently by moarpdizing and consolidating all of the Community Care accounts including choice. The president s budget provides additional funds for choice, and the resources necessary to continue the ongoing modernization of v. A. 104. 3 billion in mandatory funding and 82. 1 billion in discretionary funding for a total increase of 6. 4 billion or 3. 6 over 2017. It provides 2. 9 billion in mandatory funding to continue the Choice Program in 18, plus a 7. 1 increase in discretionary funding for vha to improve Patient Access and timeliness of care. It supports the strengthening of Foundational Services as well as modernization and consolidating v. A. Community care through the veteran care Program Announced last week so veterans can make the right decisions about their care, together with their physician or provider, giving them yet another reason to choose v. A. This budget reflects the president s strong personal commitment to the nations veterans. Its also a budget we need to achieve my priorities as secretary; providing greater choice for veterans,ed modernizing our systems, focusing our resources towards whats most important for veteran, improving the timeliness of our services and suicide prevention. Were already taking steps to meet the challenges that we face. At the president s direction, weve established a v. A. Accountability office. The recent decisions made by the senate and house will help us with that. Weve recently removed two Medical Center directors and three other Senior Executive service leaders. We simply will not tolerate employees who act counter to our values or put veterans at risk. I recently announced a new fraud, waste, and abuse prevention advisory committee. Ive directed the v. A. Central office remain under a hiring freeze for administrative positions as we consolidate program offices, implement shared services and realign overhead to get more money back to the field. We now have Sameday Services for primary Care Mental Health at all of our Medical Centers. Veterans can use an on line tool to online tool to understand access and quality. No other Health System in the country has this type of transparency. Weve made it easier for veterans to fill out Online Health care applications. Since last summer weve received eight times as many online applications than the year before. Last month we were able to the process a disability claim in just three days. I said that right, a disability claim processed in three days using a new process could decisionready claims. Well be introducing decisionready claims nationally september 1st. At our regional offices, well be completely paperless for claims by mid 2018. A few months ago the Veterans Crisis line had a rollover rate of 30 , today its less than 1p. Weve launched a new tool called reach vet allowing v. A. To provide proactive support for veterans who are at higher risk for suicide. Were also launching a new initiative, getting to zero, to help us end veteran suicide. This is my top clinical priority. Weve identified over a thousand facilities that are vacant or underutilized, and were working now to move forward with 142 of those facilities, and with your help, we could do more of the same. We need congress to fund our i. T. Modernization to keep our legacy systems from failing and to replace vista with a system already in use by the department of defense. This will ultimately put all patient data on one shared system enabling seamless care between the v. A. And dod without manual and Electronic Exchange can have reconciliation of data. We also need congress to overhaul our broken appeals process. Weve worked closely with vsos and other stakeholders to draft a proposal to modernize the system, and we are pleased to see house unite behind the bill last month. Now we just need the senate to act. Most of all, we need congress to veterans are responding to our modernization efforts by choosing v. A. More than before. To keep up with those choices, we need to fully fund choice and to help us modernize v. A. Community care through the Veterans Care Program. The Veterans Care Program will coordinate care so veterans get the right care at the right time with the right provider whether in a v. A. Facility or from a high performing Community Care provider. Of we just need your help to make it happen including funding to keep up with veterans as they choose v. A. Thunk and we look forward thank you and we look forward to your questions today. Thank you, dr. Shulkin. We appreciate you attendance today. I want to start off with my questions on the appeals process. I have consistently said that any change in the process to improve it must include an acceleration of and dealing with the 470,000 veterans whose claims are pending today at the v. A. Would you agree with that in. I would like to see that happen. Im going to give you the same question once i give you a chance to make a commitment on that. If both the appeals reform and budget requests are adopted in this budget, would v. A. Be able to given accelerating decisions for those 470,000 appeals that are pending . The appeals that are in the board of veteran the board of appeals are the ones that were most concerned about. If the senate votes to move the appeals modernization forward, as i think youre saying, mr. Chairman, we will have a process to expedite those from the time that the haw the law passes moving forward. Youre asking about the legacy claims. Correct. And appeals. We do not have a plan to make Senate Progress on those. Significant progress on those. Were going to have to whittle away at them. The budget this year will add 142 more staff to the board. That will allow us to make incremental progress, but i think to deal with the backlog wed be looking at 2026 before we dealt with the backlog. The one hope that i have, mr. Chairman, rather than adding a large number of staff to deal with the backlog is that we will get current veterans who were in the appeals process the option of opting into the new process. And if they choose to opt in but its going to have to be their choice they would be able to have their appeal dealt with in the expedited fashion, in the faster fashion. So that is my hope, to be able to accelerate the backlog to encourage veterans who unfortunately right now would have to wait years to get decisions to opt into the new process. Well, first of all, let me commend you, because you just gave a patently honest answer to my question. Not that i expected anything else, but its easy for a Department Head sometimes to talk departmentese, and we think we heard one thing and we heard something else. But what i heard you say and, in fact, as far as or those legacy appeals are concerned, this really is not going to do much even if its adopted to take those legacy claims and move them forward. Which mean well still have 470,000 veterans claims out there. At least. Eventually, hell die and we