I wanted to make sure we were on the right track and i didnt mess anything up. Wanted to welcome secretary. I dont think anybody who had a better unanimous vote. It was extraordinary and the way we got to the decision working together and was extraordinary. I commend the Ranking Member on his help doing the same. We have some thing to talk about budget wise. We can keep the same tempo and same commitment to make sure we all know what happens before it happens and well be better off. I appreciate all they have done in our meeting to explain where they are going. It is upward and outward and further ahead all along. I will make a long statement except to say a couple of things. I dont want to make this today but one thing i have to brag about, the certainer decision in getting our electronic after years of unwillingness is extraordinary. There are signs people were coming together in the past and makes sure it happens and works for our department of defense and the department of veterans affairs. It was silly to have an agency in the same government serving the same soldiers fighting the same constitution that had two medical systems that were not n inoperable. I think it will prove to be a tremendous move economically for the va and benefit wise for our veterans. No way to do any better than that. With that instead of getting into details i will turn for an Opening Statement john tester. Thank you mr. Chairman and thanks for having this hearing. I think its parent to simportae wish a speedy recovery for congressman scalise and everybody that was injured and a big thank you to the Capitol Police officer to make sure this place is a safe place. My thoughts are with them. Secretary, thank you for being here. We spoke at some length about the future of the Choice Program. I hope i made my perspective clear. It was to supplement care not to replace it not now or into the future. I worry that the budget proposed starts us a down a path. In doing so it proposes to increase funding by a third and proposing that the vas hospitals receive an increase that is less than half of the medical inflation rate, not much. Further that the budget does absolutely nothing. If we are starving and actually provide care for veterans and denying care concerns. We know what that outcome will be. Soon enough there wont be any hospital staff by quality providers. The va care will become nothing more to send veterans to hunt for a doctor who has the time and capacity and knowledge to treat them. That is not what our veterans need or want to happen. For a rural state it would truly be a disaster. We need to be honest. Each yore more and more at the risk of closing. If there are roll backs its likely that these would accelerate. We cant assume that the private care would work in Rural Communities or where they dont have sufficient networks. We know that the vast majority of veterans are eligible to long wait lines, not because they live too far from a va facility. It shows they arent just choosing choices but they do depend on va here. But now based on your request yesterday we may have to shift add digsz additional funds around. For months we have been asking about the amount of remaining funds. We were never provide with those answers we need to make informed decisions. Now we are in a difficult spot. Mr. Secretary, no one wants delayed care for veterans, no one. We will act in a timely manner to solve this problem. For that to happen this late in the game is a bit frustrating to me. It is which impacts every business line and department operates. Im most concerned it appears these cuts are being for certain veterans to get private care. The new policies to pay for private care, to put forward a proposal that would stop earned benefits payments is unacceptable. In this case we are not talking about folks milking the system for things they dont need or dont deserve. It must be determined that a veteran is able to engage as a direct result of service to their country. President trumps budget that we stop paying at a time when more americans are having to work longer to make longer in their lives to make ends meet. It is all in the name of finding more and i hope we get your commitment today to keep this important benefit in place. I look forward to working with my colleague to address these concerns and look forward to hearing from you and how you intend to prioritize funding who get care and benefits directly from the va. I would like to wish the u. S. Army a happy birthday. With that thank you mr. Chairman. I look forward to your testimony. Welcome. Let me introduce you. We need to back you up. We appreciate them being here today too. Thank you for being here and chief Financial Officer. Richard chandler, Financial Officer of Health Administrat n administration. The floor is yours. Thank you members of the committee. As you can see, i brought the big team with me because i know you will have lots of questions and in particular with Opening Statements i look forward to getting to some solutions and some closure on some of these issues. Also wanted to echo the Ranking Members concern that this is a sad day for the nation where Public Servants who work as hard as all of you do have to wore i have about their personal safety and thoughts and prayers are with the congressmen thank you for allowing us to be here today. We want to talk about the advanced apropuations. It is in way of showing support for veterans. We appreciate the legislation that had been passed. You passed within the past week the accountability bill. It went through the house yesterday. We are looking forward to next tuesday bringing it far signature for the president. 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. It really allowed us to make Real Progress for veterans. We are grateful for that support. I submitted the full written statement for the record. So let me just start by thanking you again for allowing us to participate in the hearing last week. When i testified we had 2 billion. Last month 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. We authorized 8. 2 Million Community care appointments since january of this year. Thats 2. 6 million more than last year or 46 increase. In fact march, april and may were the largest months ever for choice. Frankly it happened because we fixed so many of the problems that we have all been working to fix and we have been increasing our use of choice. One of the reasons why is the 17 budget, as you may remember actually had 2 billion less than Community Care. We have been putting more through choice. Two years ago im sure you will remember in july of 2015 we had too little money in our Community Care accounts within the va which we solved with your help by accessing unused funds in the choice accounts. We now have too little money in the choice account which we are working to solve, again, working with you with legislative authority to replenish funds. This is the situation far single purpose we have two checking accounts. I will 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. Obviously its not a science. Its an art. We are having difficulty with that and we need to work with you to solve it. The Veterans Care Program that we outlined for you last week will solve this recuring problem permanently by modernizing and consolidating all of the care accounts includes choice. The president s budget in 2018 and 2019 provides the resources necessary to continue ongoing modernization. It requests 186. 5 billion for va, 81. 1 billion in discretionary for 3. 6 over 2017. It provides 2. 9 billion in mandatory funding to continue the Choice Program in 18 plus 7. 1 increase in discretionary funding to improve patient access. It supports the strengthening of Foundational Services as well as consolidating Community Care through the veteran care Program Announced last week. Veterans can make the right decisions together with their physician or provider giving them yet another reason to choose va. This budget reflects the president s strong personal commitment to the nations veterans. Its a budget we need to achieve as secretary providing greater clois for veterans, focusing resources towards whats most important for veterans, improving timeliness of our services and suicide prevention. We are already taking steps to meet the clal lehallenges that face. I directed the Central Office remain under a hiring freeze as we consolidate Program Offices and realign overhead to get more money back to the field. We now have same day services for primary care and Mental Health. Veterans can access wait time data using an online easy to use tool to understand access and quality. No other system has this type of transparency. We made it sooizer to fill Online Health care applications. Last month we were able to process a disability claim in just three days. I said that right. A disability claim processed in three days using a new process called decision ready claims. Well be introducing decision ready claims nationally december 1st. At our reej flgional offices wee by mid2018. A few months ago the crisis line had a rollover rate over less than 30 . We launch add new tool allowing va to provide proactive support for veterans who are at higher risk for suicide. We are launching a new initiative to help us. This is my top clinical priority. To keep moving forward we will need your help. We identified over a thousand facilities. We are working now to move forward with 142 of those facilities. With your help we could do more of the same. We need congress to fund our modernization to keep our legacy systems from failing and to replace vista with the system already in use. It will ultimately put all enabling seamless care without manual and electronic conciliation of data. We also need congress to authorize broken and failing claims appeals process. We worked with closely with stake holders to draft a proposal so modernize the system. We were pleased to cease the house last month. We need the senate to act. It is through the Veterans Care Program. The Veterans Care Program will coordinate care so veterans get the right care with the right provi provider we just need your help to make it happen. Thank you and we look forward to your questions today. Thank you. It must in dealing with claims who are pending today at the va. Would you agree with that . I would like to see that happen. I will give you the same question with a chance to make a commitment. If both appeals and budget ri quests are adopted would va be able to begin axel vating decision for those appeal that is are pending . The appeal that is are in the board of veteran the board of appeals are the ones that we are most concerned about. If the snenate votes to move it forward we will have a process to expedite those from the time the law passes moving forward. Youre asking about the legacy claims and appeals. Right. We do not have a plan to make significant progress on those. We are going to have to wid l away at them. The budget will add 142 more staff to the board that will allow us to make progress. I think to deal with the backlog we would be looking at 2026 before we deal 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 give current veterans who were in the appeals process the option of opting into the new process. 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. So that is my hope to be able to accelerate the backlog to encourage veterans who unfortunately would have to wait years to get decisions to opt into the new process. Well, first of all let me commend you. You just gave an honest answer to my question, not that i expected anything else, but its easy for a Department Head to think we heard one thing and we heard Something Else, but what i heard you say this really is not going to do much even if it is adopted so take the basic things and move forward. Well still have veterans claims out there. One of them is 25 years ole. At least. And eventually he will die but we have 269,999 more to get to. I have been told it to address the legacy appeals. Is that the plan and how long will it take . I heard your answer being yes, it will probably be very gradual and it would be 2026 before we got to it . Yes. We share that frustration. I find it really difficult to tell people who have submitted they have six years to wait on average to get a response. I have asked the question, how much more would it take to get that backlog addressed . The answer is . Im not sure you want to know. I was astounded by ou muhow muc was. Around 800 million. And everything we do as a committee will pail in comparison to the hell it will catch if it is 800 million to handle those claims before 2026. We will clean up with what this budget proposes. For the legacy appeals that sit out there they will still be out there and the anger is going to get louder and frustration deeper. So we really need you need to know the number. We need to be prepared to find some way to do that. All thats going to happen is a lot of people are going to get more and more anguish, less service and cause more problems. Thank you for being candid about that. I want all of us to be aware of what we are dealing with. We have to make the hard decision. One of the things is not let them build up in the fuchture. Now, very quickly, i thought that ought to be out on the table. When a an american citizen signs up in the United States military and commitments them to a period of service carries out that service and then meets the qualifications necessary for them to be qualified for Va Health Care in their retirement or when they leave the service then we are obligated as a nation to pay for those benefits. Is that not correct . That is correct. Anybody disagree with that . Im trying to get everybody engaged. We did choice. Senator sanders and mccain did leadership on that. We did the backlog, waiting time, things of that nature. We did good things and it brought about some problems which we have eliminated and then begun to solve. We are now in a situation and you we lieluded to it where you to find money to finish out choice in this current budget period by moving money from one part of the va budget to the other. I want to make sure im right on this. You have seven accounts that Fund Health Care benefits, is that correct . Community care. But theres seven accounts . Yes. One of those is choice and one of those kplCommunity Care. So when you asked to move that money so you have enough money youre not asking for new money to given to you, youre asking them to move existing apropuated money for Health Care Benefits from one stove pipe to another to achieve balance. Its no new apropuation, am i correct . That is correct. We have enough money to make sure all veterans will get the care that they need. We need your help to figure out the best solution about how to get more money into the choice account. And im raising this only as a good talking point for all of us on the committee to have a discussion, which im sure we will have on this. We get bogged down in words like mond mandatory and discretionary. Its for vert rans Health Care Benefits. Its not any new money. We are not raising any expenditures. We are trying to meet obligations to our veterans. Is that not correct . That would make sense to me, mr. Chairman. Thank you. Thank you for being here. You talked about and i want to kind of follow up on if questions. You talked about in your Opening Statement choice being down to 821 million abdomen t 821 million and there was a fact you wanted to transfer it. You had put out a rule i dont know what you want to call it. Directive. Thats right. A few days ago that said you wanted to go to the original intent on choice. So that would dry up a lot of how the dollars were spent. We had a great breakfast. We talked about potentially doing a fix legislatively. I was told today that another directive was put out today that reinstated that rule to go back to the initial is that correct . Let me try to be accurate about what happened. We noticed that there was an imbalance in our two checking accounts. On friday we sent out a directive saying stop spending from this account and start spending from this account. We were afraid after seeing that directive that we were going to confuse the field. So we rekrended that. Okay. We have more money in Community Care. We sent out four principals about the appropriate use of choice and appropriate use of Community Care while we are working with you to figure out the best solution about how to get the appropriate money in each of those checking accounts. And did those four principaling and i dont have a problem here. All i want is predictability. Did those four tell the folks to go back to the original use of choice . It told them to use choice for. With all due respect the directive was put back in place. By the way, i dont have a problem with the first directive. I dont have a problem with staying the way it was and in a week when we fix this it will be no again. So thats all i ask. In that uncertainty, by the way and i wont speak for everybody but i got a notion that it will be this way for everybody ton committee does not add confidence to the va moving forward. Ill just tell you. Do you get my drift . Absolutely. I would not disagree or argue with you. It