May 1st of 1961, an Incredible Program for young people. He started with the alliance for progress. And he engaged in the space race. For our complete American History tv schedule, go to cspan. Org. Veterans Affairs SecretaryDavid Shulkin testified recently on his departments operations. He addressed several efforts to better serve veterans who seek and receive care, including full implementation of choice 2. 0, wait time reduction, and improving and modernizing the departments i. T. Systems and Veterans Crisis line. This is two hours and 20 minutes. Good morning. Today were pleased to welcome back a good friend, dr. David shulkin, the new secretary of the department of Veterans Affairs. The last time you appeared before our committee, you were va undersecretary for health, now youve been kicked upstairs in a unanimous vote, that says a lot in this contention environment. I know youve got a great background in the philadelphia area. I just learned you were in morristown, in chairman frelinghuysens district for some time. You certainly bring a lot of experience for the job. Im sure these days the challenges are very daunting for you. We realize this hearing is a little bit unusual. Rather than the typical Budget Hearing we usually have at this time of year, were limited to a discussion of the skinny budget materials that the omb sent to the hill in march. The twopage entry for the advancemeva doesnt give us much to go on but does give us one remarkable bit of news for the va. Apparently the administration is proposing a 4. 4 billion or 6 funding increase for the agency. In addition, there is a 2. 9 billion proposed in new mandatory funding for the va. You must be youre probably the only domestic federal agency not facing any substantial consult. So i suspect im going to need a kevlar vest when talking to my fellow appropriations subcommittee chairman. So when we see your full budget later this month, well be asking some tough questions about the merits of the increases while others are struggling. Despite not having a complete budget, im sure members will find plenty of va topics to ask you about this morning. How you envision va striking a balance between dare acare and visits, making the Electronic Health records work for veterans especially as they see more doctors through choice, your efforts to tackle appointment scheduling programs, how you plan to approach 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. Thats probably just a start. Theyll think of other things, im sure, the members. Mr. Secretary, well include your full Statement Today in the hearing record and well be pleased to hear your oral statement. But before you begin, ill ask our Ranking Member, ms. Wassermann schultz, if she has any opening comments she wants to make, and after that, the chair of the full committee. Thank you, mr. Chairman. And welcome, mr. Secretary. Its been a pleasure to talk with you over the last few weeks and good to have you in my office yesterday. We do appreciate you being here in your new capacity. I echo the chairmans comments, particularly given that its an awkward situation we find ourselves in. Youre operating on a bigger stage than you were previously, with greater responsibility that comes with the duties of being the secretary of the va. Mr. Chairman, since fiscal year 2008, the va has seen a tremendous 70 increase in pva accounts through the medical accounts, grown to 6464 billion and the overall discretionary accounts have increased. In fy 2018 is no different. The president s skinny budget even requesting 78. 9 billion or a 6 increase from the 2016 enacted level. The 2018 budget also requests legislative authority and 3. 5 billion 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 meant as a stopgap temporary fund. Mr. Secretary, while i am certainly thrilled to have you here today, its unfortunate that we wont be able to discuss the specifics of the va budget request. And the lack of detail makes it extremely challenging for the committee to properly do our job. Moreover, given this 70 increase over the past ten years, its critical that this committee has the opportunity to analyze these numbers and know more as to why the va continues to have mismanagement, wait times, and less than adequate care. It is crucial we understand how these issues are being addressed. Once we fully understand those 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. However, we dont control costs and ensure the resources this committee provides are used in an appropriate and efficient fashion. We actually hurt our ability to help veterans and deliver top quality care. It comes to mind while we are providing additional resources, were not seeing what would normally come as the commensurate response from the people who are receiving the services, because of the challenges that the va is having in providing those services efficiently. Top quality care is really our top priority. And we need to make sure that we help you deliver on that mission. With that in mind, mr. Chairman, its imperative we discuss a number of key issues including the Choice Program and the state of the vas Electronic Health records. After creating the Community Care account, which includes 9. 4 billion in advanced fy 18 appropriations, why does the budget request also include 3. 5 billion for the Choice Program . Additionally, where is the va in executing congresss mandate for full interoperability with full dod systems . As we discussed this past monday in my office, mr. Secretary, a solution to this issue is long overdue. Finally, i hope you can address the significant number of vacancies at the department and when these positions are expected to be filled. Currently 11 senate confirmable positions remain vacant including the undersecretary for benefits, the undersecretary for health, the undersecretary for memorial affairs, the general counsel, the assistant secretary for information technology, the assistant secretary for policy and planning, the assistant secretary for management, and the chairman of the board of veterans appeal. 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. From our discussions, i believe you honestly want to reform and improve the va. It is reflected in the confidence that was placed with you in the unanimous vote for your confirmation in the United States senate. Its our duty i believe to ensure that you have adequate resources to do so and the proper oversight is in place to guard against abuses and mismanagement. As you can see, we have a lot to discuss today. Mr. Chairman, thank you for the opportunity to share my concerns. I yield back. I thank the Ranking Member. The chairman of the full committee, mr. Frelinghuysen of new jersey. Thank you, chairman, and ms. Wassermann schultz. Thank you for the bill last year, thank you for that effort. You were the pace setters. I wish we could have followed your pace, in reality we didnt. I cant think of a more Important Department than the department of Veterans Affairs. Those who serve our country and serve our country right now in dangerous places deserve when they get home to get the best care possible. And i know you from your time in new jersey and wonderful things you did there. For good reason, you were unanimously confirmed by the senate. Theres not a lot of unanimity over there. Im glad if they focused their attention and support for you. Two areas of particular interest to me, i dont want to take time away from your remarks or questions. Continuing the appeals and benefit backlog, its a nightmare. Ive even shared with you some of the three or fouryear waiting periods for people. Obviously evidence has to be collected and verified but in reality its a pretty nightmarish prospect. Certainly the confirmation of your undersecretaries might be helpful in that regard, hopefully that will happen. Whats been of continual interest to me is Electronic Medical records. I think three years ago, thenchairman rogers hosted chuck hagel, secretary of defense, and rick shinseki, one of your predecessors. We received a commitment from former general shinseki that we would have a solution. I know the department of defense, and given the resources theyve been given, is getting up to speed. I do view your systems as sort of the weak link. So i just personally feel that 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, to not have that available to our Health Care Providers is pretty inexcusable. Good luck and god speed, and thank you, mr. Chairman. Ms. Lowey, i would like to recognize you. Thank you very much. And i would like to thank chairman dent and Ranking MemberWassermann Schultz for holding this important hearing. And i welcome secretary shulkin today. We as members of congress, and you as the 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 are not significantly closer to the interoperability of Electronic Health records than they were 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, as was referenced before, chairman rogers and i had i think four hearings, right, chairman frelinghuysen . We also met in closed door sessions. We hadnt been able to resolve this. Now, i have my own personal preference as to whos to blame, as we were talking about before. But thats irrelevant now. In looking at your resume, i am so enthusiastic, i know youre going to get this done. In my own district, i worked to secure federal funding for rehab facilities to ensure that veterans can receive a high quality of care. For too many, the va is unable to provide the types of services they require. From women struggling to find care in a Health System that has traditionally served men, to veterans who are turned away from va facilities when they are most in need, the va 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 fy 18 budget request. The budget framework requests an increase of 6 for the va, but lacks detail, providing just seven bullet points of vague proposals. While you may not be able to speak to details of the Budget Proposal now, i hope you will return after its release 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, mrs. Lowey. At this time i would like to recognize secretary shulkin for five minutes. Maybe thats better. Okay. Chairman frelinghuysen, chairman dent, Ranking Member lowey, Ranking MemberWassermann Schultz, and all of you who are here today, i was so impressed with your Opening Statements on so many topics that youve thought about and that you care about and i know are serious issues. And were trying to do things differently at the va, that i have a terrific opening statement, but im willing to, mr. Chairman, to actually forego it and get right into your questions, unless you would prefer me to go through the opening state, because i think we have so many issues and i want to use your team most valuable. Ive submitted it for the record. I would be glad to read through it, read through my oral statement, but ill leave it up to you. You would like to hear it . Good. Okay. I told you, its terrific. The abridged version, about five minutes worth. Ill try to do it quickly, but thank you. Thanks for the opportunity to be here today to talk about the president s 2018 budget. I also want to thank you all 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 speaks well of the u. S. Congress and really of the American People that despite all these differences, and youve mentioned this several times, that 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 our nations veterans, provides the necessary resources to continue the ongoing modernization of the va system. The budget requests 78. 9 billion in discretionary funding for the va. It provides 4. 6 billion more for medical care, a 7. 1 increase, and 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. Weve issued 35 more authorizations in the First Quarter of fiscal year 2017 than in the same quarter of 2016. All told, including both care va facilities and in the community, we project a 6. 6 increase in ambulatory care for 2018 over 2016. I urge you to support and fully fund our 2018 request to enable va to meet increasing demands for va services, to modernize the va systems, and to invest in choice. As you know, i came to va during a time of crisis when it was clear that veterans were not getting the timely access to High Quality Health Care that they deserved. I know the va has made significant progress in delivering care and services to veterans. But i know more has to be done. Last week i had an opportunity to meet two courageous young americans, michael and sarah verado of rhode island. All he wanted to do was become a soldier and he served in the armys 82nd asia borirborne div. They told me when he sought care from the va in 2014, they did not receive the care. We cannot allow ourselves to fail american heroes like the verados. My priorities as secretary are to modernize our systems, focus our resources more efficiently, to improve the timeliness of our services, and Suicide Prevention among veterans. We are already taking bold steps towards achieving each of these priorities. Two weeks ago the president signed the reauthorization of the veterans choice act ensuring veterans can continue to get care from community providers. Just last week, the president ordered the establishment of a Va Accountability Office and were moving as quickly as we can within the limits of the law to remove bad employees. Va has removed Medical Center directors in san juan, sleeves po shrevesport, louisiana, due to misconduct or poor performance. We simply cannot tolerate employees who act counter to our values or put veterans at risk. Since january of this year, weve authorized an estimated 6. 1 million Community Care appointments, 1. 8 million more than last year, a 42 increase. We now have same day services for primary care and Mental Health at all of our Medical Centers across the country. Veterans can now access wait time data for their local va facilities by using the easy online tool where they can see those wait times. No other Health Care System in the country has this type of transparency. Last month we announced a Public Private partnership of ambulatory Care Development center with a donation of roughly 30 million in omaha, nebraska, thanks to mr. Fortenberrys help there. Veterans now have or will have a facility thats being built with far fewer taxpayer dollars than in the past. Finally, the va is saving lives. My top clinical priority is Suicide Prevention. On average, 20 veterans a day die by suicide. A few months ago, the Veterans 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 to reduce suicides, weve launched new predictive modelling tools that allow va to provide proactive care and support for veterans who are at the highest risk of suicide and ive recently announced that va will be providing emergency Mental Health care to former Service Members with ot