Focused on the future and how we can Work Together to create a better, brighter healthier one for the Healthcare System rather than on rehashing the mistakes we made long ago. As we begin to move forward, we must not lose sight of where we started. Years ago, next month in this very room, the Committee Heard testimony from a veteran named barry coates who spoke about waiting almost a year for care at the department of Veterans Affairs facility of south carolina. He was finally seen long after he should have been. He was diagnosed for colon cancer that had spread to his liver and to his lungs. He passed away in january last year. It was garys story and accompanying allegations that 40 veteran patients had died while waiting to receive care for the Va Medical Center in phoenix arizona that kicked off a nationwide access and accountability scandal the likes of which the da had never seen. It also led directly to the creation of the Choice Program and to the allocation of billions more taxpayer dollars to increase access to care for veterans nations and the three years since then, more than 2 million authorizations for care had been approved and over 1 million veterans have been able to get care that otherwise might not have been readily available. However,all of us around this dais youre from veterans day after day , experiencing lengthy and frustrating delays when attempting to schedule an appointment through the va using choice. In fact a couple weeks ago, i was contacted by a veteran with a story much better. This veteran was diagnosed with cancer last fall and refused treatment. While im relieved to say he is now receiving the care that he needs from the provider of his choice, he suffered through weeks of doubt through a series of mishaps and miscommunication between the da, thirdparty administrative managing choice in this particular region and the Community Providers who had agreed to treat him. It appears that three years after various testimony, a lot had changed but too much had stayed the same. Whats more, the recent work proforma to be a Inspector General antigovernment Accountability Office illustrates clearly that choice is not fed up to succeed at its primary mission. Providing timely care to veterans who cannot access that care within the va because its either not offered, unavailable or a reasonable amount of time or would entail travel to make visible. Gol testified this evening that veterans could potentially wait at the 81 calendar days before receiving care due to the burdensome bureaucratic process they imposed on choice. That is unacceptable to me and im sure everyone in this room. I ran a practice for over 30 years and i assure you it does not have to be this complicated. It should not and should most certainly not take this long. Luckily, choice is not the same program today as it was before the da in the ig last year and its certainly not the program that was first created. For a series of four legislative changes in 70 contract modifications in county, the choice has been continually improved upon and made stronger. What remains far from perfect, far too many cases have failed the veterans it was created to serve. Im working diligently with the Ranking Member walt, the secretary and his Senior Leaders and what are Senate Colleagues were our Veterans ServiceOrganization Partners in to chart a path forward for choice, all the care and the Community Programs in short order. We all have draft language that we shared in the coming weeks and have the va healthcare reform bill on the president s death this year. However, the first step is to reform choice is making sure theres a smooth transition to lead the way. This is why its critical this committee tomorrow markup hr 369, a bill i introduced earlier this year to move for a sunset date from Choice Programs. Acid legislation, the choice will begin shutting down in just a matter of weeks and will end completely in five short months from today. That setting off a key access at a time when veterans are seeking care in the community more than ever before. And critically at a time when va nonjewish Community Care account is unable to absorb additional demands for care. Va has already faced a 3. 4 billion deficit in the Community Care next fiscal year and va leaders have told the committee about the required additional address. And by removing the sunset Choice Program, we are not enforcing the program in its current state but we are ensuring that emergency funds the congress made available for critical veteran care are used for that purpose until theyare expended. Community care performances have increased by 61 percent overall in choice. And the defense choice was created and the last year, 30 percent of all va appointments were held in the community rather than through va medical facilities. That is what i am committing to once again this evening. With that i will now yielded to Ranking Member walz for any statement that he may have. Thank you chairman crowley to support hearing and a special thank you to senator mccain. Always a champion for veterans and its a pleasure to have you over here. A special thank you to secretary shulkin. That sounds very good and we appreciate you being here. Also had Inspector General and the gao as well as the Committee Members were here, those who sit behind any American Public all who have the same mission, the same goal, buys quality care, the most timely manner for veterans. Im grateful to each and everyone of you. Last congress we heard from both experts at va including secretary shulkin. Our Veterans Service organizations, independent assessments Blue Ribbon Panel and the commission on care about how we should shape the deity of the future. Now its time to get to Work Together to make some decisions, passed legislation to ensure our veterans receive the health care they deserve. What of this committee size players to ensure veterans receive the highest quality healthcare in a timely manner in a safe environment. This includes care at the va medical facilities and through Community Health care providers. Can all agree care must be utilized so veterans do not have to wait too long or travel too far to receive care. However from listening to our veterans and constituents are still waiting too long to receive care we need to make changes. Our witnesses, the Inspector General and the gao will testify to survey and audit data that back up with her constituents have been telling us. Veterans are still waiting too long, and in many cases have been forced to mince care on their own. As dr. Rose that it should never take 80 days to get an appointment in the committee. Veterans in need of Mental Health care and her elder veteran should not be struggling to make their own appointment and coordinate complex care. Care decision should be made between the doctor and the veteran. The va should be there to make sure the veteran gets the time appointment to make sure a doctor has a health care record to treat the veteran and make sure the veteran isnt stuck with a huge medical bills addressing that doctor. As the moves forward, i hope we can take some of the lessons we learned from choice we need strong leadership at the va hospitals are committed to putting a plan in place. Our facilities are responsible for filling in inadequate Communication Networks under choice and providing the staff to support vista program. They should be involved in this new committee care Program Every step of the way. We need technology to support our providers at the va and documentary providers treating veterans. This requires va to the modern Electronic Health record and an ib system to reduce the time it takes the va to coordinate care and process claims. Va current ib system or lack of to support care coordination are contributing to delays and increasing workload for staff for manually processing them. To get this plan right this will cost a significant amount of money. Our presiden present as it is cd to increasing funding for veterans but this does not mean to be a gets a blank check to continue programs that are not working or that this money should all go to Community Care when veterans need to Specialty Care and coordination that only the va can and should provide. This means the va must be able to better forecast the resources and staff it to provide better and secure the facilities through its network of committee providers. Tomorrow will be marking up legislation that will allow for the rain Choice Program finds to spent. I think we come to a bipartisan agreement that va should be built first before a veterans bill for receiving committee care and that providers should have access to veterans medical records. This is a bipartisan agreement working with experts and i applaud dr. Roe and his folks for making this happen. I hope we can continue working together and make decisions that move forward to improve health care for our veterans and good stewards of our taxpayer dollars. Thank you chairman roe and i yield back. Thank yothank you very much. Its my pleasure to welcome a fellow veteran, American Hero and recalling from across the capital the honorable john mccain. Senator from the great state from arizona. Both in uniform and in the senate on the health of our service members, veterans and their families. I appreciate your willingness to be with us as we need to talk about a topic i know is a very personal and passionate one for you and for all of us. You are now recognized for five minutes here. I thank you very much, chairman roe and Ranking Member walz and thank you for your kind words, mr. Chairman. Im one of those whose number of landings does not match the number of takeoffs. [laughing] and i thank you for allowing me to be here. Id like to submit my full statement for the record, and i will try to be brief since its past my bedtime. [laughing] without objection. I would also like to comment on my strong support for dr. Shulkin as the head of the va and i think all of us have Great Respect for his work. Mr. Chairman, yesterday the front page of the Arizona Republic reported that there was a 2. 5 million settlement to individual named steve cooper, an army veteran of 18 years. Steve waited for almost two years before seeing a doctor at the phoenix va. By the time he received care is routine neurology appointment had turned into a diagnosis of terminal cancer. Everyone in this room has heard a similar story. Its not acceptable. It needs to be stopped and i want to thank every member of this committee for the dedication to our veterans and to make sure that never again there is another steve cooper who served his country with honor and then because of the failure to get an appointment is terminally ill. He wasnt alone in his date for care. In 2014 our country was shocked to learn that steve was one of 15,000 veterans stand in line for care in phoenix, 3300 of whom were urology patients. This disgrace served as a catalyst for the veterans access choice accountability act particularly the veterans Choice Program which is enabled veterans to seek providers in the community for the healthcare needs. More than 7 trillion appointment with committee providers for everything from diagnostic tests and urology screening to lifesaving heart and cancer treatments has been a result. Theres been significant progress in improving Veterans Health care. Were a long way to go to change the status quo plaguing the va and thats why i know none of us will abandon our effort to provide choice and flexibility in Veterans Health care and one must consider the hard work of refining and improving the veterans care Choice Program. We need as you mention, mr. Chairman, reauthorized veterans Choice Program which is set to expire in a few short months. He would at the Program Lapse hundreds of thousands of veterans will lose their ability to visit a community provider. The va system once again become overwhelmed. I come from a rural state. Members of the committee come from large and small states. I dont want to have a veteran to drive for 50 miles or 40 miles in order to go to the va when he can go to a local healthcare provider. It isnt more complicated than that. But i say that choice authorization expiration is approaching. I understand that va already has begun limiting care under the veterans Choice Program for veterans whose treatments would extend on august 7, 2017. I think that lends urgency to your action. I am concerned that veterans nationwide may encounter significant lapses in care if we dont act quickly. The outcome is not only affordable but it is unacceptable and we in Congress Must ask. Today i was pleased in the senate side the place with the snobs reside and we took a critical step forward by joining senate Veterans AffairsCommittee Chairman johnny isakson, Ranking Member tester, senator jerry grant and others to introduce the veterans Choice Program improvement act. Let me be clear. No one is advocating that we privatize the va. Many veterans are satisfied with the va, known for providing superior specialized treatment in the areas of Mental Health, posttraumatic stress disorder and traumatic brain injury. At the same time we cant afford to go back to the pre scandal days when it va bureaucrats as the final say on where and when a veteran received care. Such thinking was what resulted in nearly 15,000 veterans stand in line for care in phoenix. I know this committee agrees as does secretary shulkin, and i look forward to working with all of you and my colleagues in the senate to extend the veterans Choice Program and continue to keep faith with our nations veterans. My dear friends, the world is in turmoil. And i believe that well be sending our young men and women into harms way in a lot of places in the world for years to come and they will be veterans and they will come home someday. And i believe that the work that you are doing is the lords work. Because you are committed as all americans are to giving the veterans that care that they need and deserve and they earn i defending this nation. I thank you for allowing me to appear before you. God bless. [applause] i was going to think senator mccain but he got out of here too quick. Didnt get a chance to do it. I will now invite a second home to the witness table where i am honored to welcome the newest secretary of Veterans Affairs who will be testifying for the first time in his new role, dr. David shulkin. I so enjoyed with the Ranking Member being at the white house during your swearingin with your lovely family. Thank you for being here and congratulations once again on your confirmation. 100 to zip i might add. I look looked very much forward to working with you, beginning with two nights hearing. The secretary is accompanied tonight by dr. Baligh yehia, the deputy under secretary for health, to medicare. Thank you for being here. Also finally w also joined by te honorable michael missal va Inspector General and randy williamson, healthcare director for the government Accountability Office. Thank you for joining us tonight. Secretary shulkin, we will begin with you. You are recognized for five minutes. Greedy chairman roe, Ranking Member walz, members of the committee. Thanks for being here so late and thank you for this opportunity to discuss communique. I also didnt want to thank centered in the game but he ran out so quick for his leadership. I couldnt agree more with him that we have to act now to ensure our veterans have time access to the care that they need. I also just want to offer my condolences tonight to the film dr. Thomas stars oconnor World War Ii Navy veteran and the father of modern transplantation who work in the va and with veterans for over 50 years and conducted the very first liver transplant at va in 1963. As you know va has provided Community Care to veterans for over 70 years. Since august 2014 we have also provided care through the veterans Choice Program and we appreciate your support providing this legislation of funding to better serve our veterans. As directed in the lobby implemented this program in 90 days nationwide. Thats unprecedented for a program of the scope and complexity. Because of the design of law and its quick implementation we did run into challenges, many of which will be identified tonight in the evaluations by the gao and the va Inspector General