Transcripts For CSPAN3 Veterans Affairs Budget 20180215

So that leads to my next question. Youre tracking that particular amount of money, if you will, and where its going, its going strictly to new infrastructure . To modernization . What is the plan there . Right. Well, currently today, if we exit a property, that money gets returned to the u. S. Treasury. Were not able to reinvest that. The infrastructure bill would change that. So thats why were very supportive of that. What we do save are the recurring savings, the maintenance. So we dont heat the buildings, we dont have to repair them if we get rid of them. That remains in our general what we call our nrn budgets, our recurring maintenance budgets. Do you think there will be a way to, in some way, get an idea of how its converted directly or indirectly to care or. Yes. Services. Yes. And what we would plan on diagnosis is reinvesting that money back into probably nrn or minor construction projects. Okay. We could track that. Thank you. Another question i have is one of the things that budget talks about is Foundational Services and Service Connected zakt disabilities, but then the list includes geriatrics, primary care all part of the mission. I guess im trying to understand what we consider Foundational Services, services connected, if you give me some clarity on that. Yeah. Weve spent a lot of time on this, congressman, and clearly this is about making sure that those things that the va needs to do well for its for the people who have served, were doing in a world class way. And so theres no doubt things like spinal cord injury and blind rehabilitation and post Traumatic Stress and focusing on the suicide issue and other things clearly are Foundational Services. But as part of the va definition of health, how we do this, we do believe a system of strong, primary care, geriatrics care as a primary care specialty of older people, womens health, as well as Mental Health is the foundation of what a strong, integrated system needs to have. We dont need to be doing everything and we cant do everything well. Weve learned that in the past. But these services, every va Facility Needs to be focused on do in a world class way. Thanks for that clarity. And i would tend to agree because something that may be clearly Service Connected cant be treated as efficiently if you dont have proper primary care. So i think thats what youre saying. Yes. Thank you. And i yield back. Tut gentleman for yielding. Thank you, mr. Chairman. Mr. Secretary, i wanted to begin by thanking you for your focus on reducing veteran suicide. You are the first va secretary, to my knowledge, to make this such a high profile issue. And im convinced that as we acknowledge the problem that we have and by your estimate it is 20 veterans a day every single day are taking their lives, we know that for those veterans who have other than honorable discharge, hundred of thousands have other than honorable discharge. Tens of thousands of them were diagnosed with post Traumatic Stress disorder or traumatic brain injury or other conditions unique and caused by their service who are effectively denied access to va healthcare. I know youve worked with congressman coffman and myself and others to try to expand access and there by save more lives in el paso. We know theres a correlation between the number of Mental Healthcare providers and access to Mental Health help and suicide. We went from 68 fulltime Mental Health care staff to today 122. More transare gettiveterans are and theyre waiting less time to get there. So, to that point, if there are 30,000 authorized appropriate eighted for, unfilled clinical positions, how many of those 30,000 positions are psychiatrists and psychologists, therapists, neurologists, others who will help with the unique conditions connected to service, the unique conditions that are too often connected to veteran suicide . Yeah. Last year we hired 763 psychiatrists and psychologists. Unfortunately, it was only a net of about 260 because retirements and people sometimes choose to find other places to work. So we have a need right now for at least a thousand new Mental Health professionals in this fiscal year. And we focused on trying to hire them. The budget allows us with an increase of close to 500 million in Mental Health funding to fund for an afishl 652,000 Mental Health visits. When you look at how would have to staff that, thats about a thousand Mental Health professionals. How many of the 30,000 unfilled clinical positions are primary care providers . I dont have i dont have an exact number, but my guess is, is that we probably are when you say primary care providers, im going to talk about advanced Practice Nurses too as well as Family Doctors and i attorneyists. Internists. Let me do this because both answers are important to me. Im going to happening out until the end of the hearing. Have your team thats watching this get you a number. Lets do that. Lets understand what the delta and is what were all going to do to bridge that gap in the hiring and the resources, prioritizing for those hires. Do you think that a veterans primary care provider should be in the va . I think that my preference would be that we have since va uses a different model of primary care, in the outpatient environment where im a primary care provider in the private sector, patients are usually seen about every 15 or 20 minutes. The va gives a longer period for more comprehensive evaluation. And our definition includes Behavioral Health integration, it looks at military issues in a broader way. So i believe primary care providers need to have a military competence when they see so is that a yes we want vet traps because or they need to be trains well if theyre in the private sector. Let me make the case and i hope i can get to you agree if we make the va central to the veterans care, we understand they may need to be referred out if theres not capacity or essentialzation within a given va. But if we make the va central to that veteranss care, that va provider will know the signs to look for for suicidal ideation, they have taken care of other service members, that theyre going to have a higher proficiency and a greater level of experience taking care of those veterans. And i think those veterans are going to get Better Outcomes as a result. So i would just request that that be, if it is not today and it sounds like its unclear, i think that needs to be va policy and a va priority. And i would add that i think for those treatments that are unique to service in combat, post Traumatic Stress disorder, traumatic brain injury, traumatic amputation, spinal cord injuries, that has to be within the va. I would ask you to prioritize your hiring for those specialty specialists and primary care providers to ensure that care for the veteran is anchored within the va. I share some of the concerns that others have raised, including veterans who come to our town halls, that there is a move to privatize care. I want that care centered in the va. So im going to wait for answers that i asked for hiring. Hopefully you can get those to you at the end of the meeting. I agree, its better to have good numbers. What you just described is, and you did it much better than did i so thank you, is exactly our strategy around Foundational Services. You focus on the things that veterans need us to be good at. Absolutely, i agree with your description. Gentlemans times expired. I would argue also that a va primary care physician whos never served wouldnt be as well prepared as a veteran like myself whos a military doctor who retired from the military would understand also. So there are people on the outside who can provide those services, like dr. Wenstrup, myself, and others who served in the military certainly understand those needs. Mr. Higgins, youre recognized for five minutes. Thank you, mir chairman. And i thank the secretary for appearing today. I thank you for your continued dedicated leadership, sir. I will remind those present, including the media, and my colleagues that a nation of American Veterans for 242 years have fought to establish and maintain a nation of laws, nation where man is considered innocent until proven guilty, and i would hope that we are not sliding towards a nation of allegation and accusation. Regarding extended care facilities, sir, i see in the budget that theres a 66. 7 increase request for grants for state extended care facilities and a 0 request for grants for veterans cemeteries. Seems to be a disconnect there. Im concerned about our veterans, especially our asian veteran population as we attempt to provide for veterans who, in some cases, certainly are Vietnam Veterans did not return to warmth and open arms from a nationing that they served at that time. These are the same veterans that are not cared for in the caregiver program. And theyre approaching their golden years, their last years on this earth. So an extended care facility and longterm care facility i would think that we would at least seek to provide for our aging veterans end of life period of dignity where they can where they can be revered and visited by family in their community where they live. And i just see a disparity in budgets, sir. Would you please address that . Yeah. Well, we did significantly increase the amount of Funds Available to the state homes where 50 of the veterans are being cared for right now in the state homes. I met with all those directors this week and theyre extremely grateful for the support that were providing for them to be able to do that work. Because the number of veterans are aging of course is increasing. On the cemeteries, we have i think its a 334 million increase in the fiscal year 19 budget, or right . We do have a large increase in the fiscal year 19 budgeting to address Major Construction and minor construction for National Cemeteries. The grants program say flat request, but that grants Program Amount is adequate for funding historically the grants that are on the priority tlaft list that have the matching funds and provide a grant award for the fiscal year. So you feel that the funding thats in the fiscal year 19 request is sufficient for states to perform at that level . Sir, i do. Servicing an aging veteran population that obviously the next stop from extended and longterm care is a cemetery. And it would be our goal amongst this bipartisan committee, it should be our goal as a nation, to provide our veterans with end of life dignity, and that would include appropriate services, military services, patriotic services, and to be buried amongst their veteran brothers and sisters. Yes, sir, thats exactly the mission of the National Cemetery administration and we work with our state partners to operate this network of our 135 National Cemeteries as well as 107 grantfunded state cemeteries to provide that National Shrine for final resting places for our nations veterans. Thank you. Thats an encouraging answer. Quickly, mr. Secretary, va witnesses have testified previously that noninstitutional care settings are more costeffective than institutional care settings. This budget allocates 556 million as a, quote, continued investment in noninstitutional settings. How exactly would this budget invest in noninstitutional care settings . As you know, i think its exactly correct that we believe that it is often better to allow people to remain in their home and look at alternatives, even things like adult daycare which we want to make easier for veterans to get access to. But with the advances in Technology Like telehealth remote monitoring, our aides we have a package of services thats now a Priority Service for to us make sure we implement that. And we are supportive as i know you are in our last discussion about expanding caregivers to older veterans. And we think thats an important piece of this as well. Thank you. Mr. Chairman, my time has expired. Thank you, gentleman. Thank you. Thank you very much, mr. Chairman and welcome very much mr. Secretary. Were happy to have you with us and i appreciate your comments at the top. I do think its important to restore confidence in our executive officials and so i hope in the coming days youll be forthcoming with the American People. I want to turn to the issue of coordination of care and collaboration. Mr. Bella remembering cuss and i will be introducing a bipartisan bill today that is a Pilot Project for integrating veterans care in our federally qualified health centers. And in my area where we have a rural northern part of the state, often the fqhc is the kpl place that people can get care without traveling long distances. Could you comment on that issue or other collaborate tivive iss that the va is getting into . Im not sure people recognize how important these federally Healthcare Centers are. They do amazing work for a very vulnerable population. And i believe that as a large provider of federal healthcare services, that these organizations should look for the chance to collaborate more and to integrate in ways that we really havent in the past. So i think thats a Pilot Program in that area would be very productive. Excellent. Thank you very much and well look forward to working with your team on that as we go forward. I want to focus in on the Leadership Structure in the va. You know weve had issues in New Hampshire around manchester, veterans hospital, weve learned of some very serious concerns in bedford, massachusetts, at the va hospital. My biggest certainsy dont see the visn stepping in in an effective way when there are problems in our va hospitals. Do you think that we might have come to a time where we need to change the visn organizational structure and particularly with regard to hospital leadership and their report direct in to your team as compared to a visn that maybe is not sufficiently responsive . Yeah. Well, first of all, i appreciate and i appreciate you sharing these concerns as you have. Youve been a very strong advocate forgetting this issue right. Our visns were introduced, the concept, over 15 years ago. Yes, its time to take a look at how modern Healthcare System operates. And thats what were doing in our modernization work. Weve looked at Large Health Systems like kiser, extension, trinity that have multiple hospitals throughout large reasons and how theyre organized. And were looking at those best practices and seeing what we need to do. The basic strategy, though, is we have to give the people running our facilities, our Medical Center directors, more authority and accountability to be responsible for the decisions. And we have to look at what then the role of the visn is and how that modernizes. I appreciate that and, again, look forward to working with your team on reviewing that structure as it particularly focusing in on hospitals where this has not been an effective oversight structure. I appreciate that. Yes. In my last minute and a half, i would love to hear your thoughts on it looks as though youve created a new account for the va modernizing the Electronic Health record system, and i want to drill down a little bit. Is this new account, will it include funds to support and maintain the current vista Electronic Health record during the modernization process or will these funds only be used on the adoption of the and implementation of the department of defense Electronic Health record that were adopting . If you could walk us through how those two things will be funded at the same time. Yeah. What is it ht has to be both. In order to implement an electronic record, were going to have to i investigate in the infrastructure of our connectivity, of our servers to get ready do that. Were going to have to undergo significant change management because when you implement an ehr, its about technology but only a little bit. This is about how you do business. Were going to take 130 different systems and were going to really be creating a single instance. Thats a major change. It should create great efficiencies, improvements in quality as well. So we are we are going to be focused on maintaining vista because we have 130 transitions to happen. So thats why were a tenyear period of time youre going to be running vista up until that will very last instance is turned over. So my time is up, but i hope you will keep the Committee Informed of your timeline and your progress as you go forward. Yes. So thank you and i yield back. Thank you gentle lady for yielding. Just to comment about this, and i think well get into this more as we go along. But the stress distressing part for me when i was at fairchild im not sure that youll ever be when you get to the new system thats fine. In the old system youll ever be able to turn it completely off for 50 years because until the last of us die that are in that system, theres no way to download all theres so much information in the vista system, you cant download all that information. Vow to have a way to look back to get information. I dont know how complicated that will be, but it is a major underta undertaking do what theyre doing. Mr. Banks youre recognized. Thank you mr. Chairman. Thank you for being here secretary shulkin. First and foremost im enormously proud with what weve accomplished in partnership with this administration. President trump, this committee over the last 14 months weve done a lot of great work for veterans we should be proud of. I appreciate the seriousness that youve taken the ig report and look forward to consider you do that. To dive a little bit deeper into the question, i know that you agree that veterans agree a scheduling system that gives them immediate access to care, shortened wait times, the ability to track and manage information and progress throughout the care continuum. I want to make sure, though, as we appropriate money and pass budgets that the money that we provide to the va is effectively utilized, which is the reason that youre here today. And weve seen this past year that with the Electronic Health record rollout, that thats run into trouble. Weve seen the delay of implementation even further. So my question is, with the readily available cuts, solution, and the appointment scheduling Solution Program that could be deployed nationally in a twoyear time frame, what are your plans and timeline, to be a little more specific, to utilize funds you receive for i. T. Improvements to pay for a full deployment thats not dependent on the stalled tenyear va rollout . Specifically on scheduling . Yes were with i. T. Yeah. The strategy that we are using now is to move towards cots or off the shelf products, and there are plenty of good commercial systems that are out there. The mass scheduling system is being implement the right now in columbus, ohio, and we look very much forward to seeing how thats working. Thats that pilot is on track to be do you remember the live date that that will go in columbus . I dont, sir. I think its in march. Yeah. It should be in the next few months that this goes live and were very much looking forward to seeing how thats working. We have some other cots products that are being tested in three other sites, i think bedford one is of them that were very much looking forward to seeing how thats working as well. In the meantime, weve rolled out to right now its gone to 35,000 different veteran transactions, an internal system called veteran scheduling enhancement. But i think our plan is to go towards an off the shelf product. Okay. Thank you. Please keep us posted on that. Yes. Earlier this year on a different subject i was disconcerted when the va considered taking frunds Homeless Program case managers and converted them into general purpose funds. I know you and i and others in your on your team and i have talked about this, i appreciate the motives of wanting to provide flexibility to the visn directors but i dont believe it should come at the cost of assisting the veterans who are most in need. I know you agree with that, especially because if less veterans find their footing into stable situations, well be spending more money, not saving money. For fy 19 it appears the va intends to revisit this possibility once again by soliciting steak holder i put first, which say healthy part of the process. If steak holder input remains opposed to this change as it was overwhelmingly for fy 18, you can guarantee today that the va wont go execute this change in Homeless Programs affecting fy 19 . The mistake that we made was letting anybody think that were taking the foot off the pedal on ending veteran homelessness. We are not. We are laser focused on this, this is a commitment. We have 1. 8 billion in the president s budget for ending veterans homelessness. What were trying to do when you look at the data, as you know, veteranss homelessness went in the wrong direction last year, went up 2 . But there were five specific cities that led to that increase. Two of them, seattle and los angeles, were by far the overwhelming increase. We wanted to find a way to be able to use this 1. 8 billion to focus conwhere the veterans are having the most problems. We need steak holder input. We need to do it thoughtfully before we make any changes. We do not want to have unintended consequence fs anything were doing. So weve not decided to do anything until we have a chance to sit down, review it with you, review it with stakeholders, make sure that decisions made would be good decisions. So were not going to do anything until its a very thoughtful plan. But we do want to get the restores where the veterans are homeless. I appreciate that very much. I yield back. Thank you the gentleman for yielding. I now recognize advice chair of the committee for five minutes. Thank you, mr. Chairman, i appreciate it. Thank you mr. Secretary for being here and testifying. I have a few questions. The vas fiscal year 2019 budget request is 8. 6 billion for veterans for Mental Health services. Part of this funding accounts for critical oneyear period following uniform service and transition to civilian life. My colleagues and i on the committee have had multiple hearings and round tables, one just the other day, on the transition assistance process. You can specifically tell me what the department is doing to assist in this transition in the upcoming here . First thing were doing weve taken a look at this Transition Program and recognized that we could be doing it a lot better. This is a shared responsibility with the department of defense. Our Veterans Experience Office has really looked at this and made a number of recommendations that were working through at the department of defense to make that a better program. Think changes already have taken place that have made it a better program. We need to preenroll our veterans in in their benefits so that they know they have them when they leave instead of wondering and going through a lengthy process after they leave wondering how they get access to benefits. Thats our Biggest Issue to make sure people know these services are there for them, make it easy for them essentially in auto enrollment process so that theres no work to be done. Thank you. Next question has to do with the Blue Water Navy veterans. The va budget seeks 2 point nigh billion dollars for Veterans Benefits including disability Compensation Benefits programs for 4. 5 million veterans and 600,000 survivors. As you know, certain veterans such as the Blue Water Navy veterans are excluded from these benefits. While you have said in the past that these veterans shouldnt be waiting any longer, thats a quote, i want to know if the va has any plans to reexamine this in the upcoming year . If not, why not . Congressman, the problem is theres not much to reexamine. Theres not data there that we can go back. Ive tried every which way to see if we could find ships and do microscopic analyses or new studies. Theres not going to be new studies. This is about our obligation to those who have served. And to simply keep on passing the buck on this and not honoring this countrys obligation to our veterans i dont think is moral lit right thing to do. So im committed to working with you and i know the chairman feels the same way, to try to find a way to honor our obligation to these veterans. And were working now to have discussions with the administration to work with congress. We need to find those offsets. We need to find a way do this. I believe its morally and ethically the right thing to do because theres not going to be Scientific Data unfortunately 40, 50 years later to be able to rely upon. So you would consider this a top priority . I think we have to do this. And i think we have to find the offsets to be able to go ahead and to resolve this issue. Theyve waited too long. The chairman has found the offsets and i know he wants to proceed. Good. So hopefully we can get this done. Yes. Very soon. Like i said, they cant wait any longer. Thank you. Appreciate it. Question three has to do well, the burn pitts. The fiscal year 2019 va budget requests 727 million for direct research, a 14 increase over the fiscal year 2018 levels. One of my priorities in this committee is to examine efforts to improve research and treatment for veterans who may be experiencing negative Health Effects due to toxic exposure such as burn pit inhalation during the military service. I know its a priority for a lot of members here on the committee both on the republican side and the democrat side. What is the va doing to further this goal . Yeah. Im trying to see, i dont know the answer to that question. Does mark, do you can we get back to you on that . Please do. I agree we should. Ive got 20 seconds. I guess ill yield them back, mr. Chairman and ill submit the rest of the questions. Thank you very much. I thank the gentleman. Thank you, mr. Chairman and thank you, mr. Secretary and thank you for taking the time to meet with us yesterday and i think its really important that we keep open lines of communication. Were here today to talk about how we can better deliver care for veterans and their families, and i know we have a shared goal around that. But we in congress have a responsibility to make sure those taxpayer funds are wisely spent and appropriately sent in service of all of that. And i do appreciate your willingness to speak with us on the igs report and ill deal with that at another time. I do want to associate myself with the remarks of the good gentleman International Business machines rack they have legislation on both of those bills and were looking forward to passing that and the one other issue i want to flag is what we discussed at breakfast yesterday is rethinking a little bit on the disability ability issue. What can we do for more temporary disability status in order to able our veterans to get back and fully participate in the economy . And i think thats something i hope we pursue and big out a way to do that. I want to focus with our time here and im reserving mr. Chairman, 30 seconds for my friend the gentleman from minnesota, my former district in minnesota 1 for 30 seconds at the end. So ill keep track of time here. I want to turn to the appeals modernization efforts. Yeah. And what we talked about over the last, you know, last several months. Looking at the as the appeals modernization is enacted and ramp expands into new va regional office, do you feel that the proposed fy 19 budget the appropriately handle the continued focus on completing pending legacy appeals . We have a lot of concerns orn legacy appeals. Yeah, i do. I think i think that we are adding 605 ftes to the appeals process. We are hoping that in fiscal 19 we have as much as 25 that are going into the ramp process. The numbers are extraordinary. Of the 680 veterans that have chosen the process electively theyve gotten an answer in 38 days versus over a thousand days in the traditional process. So working with our vsos and working with you in outreach efforts, we hope to make people aware of this as an option. Because we want them to get these resolved quickly. Were encouraged by the drive to reduce redundancy of selfreporting income status because we know this has been an issue for pension benefits. As i understand it, income information will be provided by the Social Security administration. Yes. Irs. What systems will be in place 10 to sure that reporting errors are not taking place in that communication . Jamie, do you know . On reporting errors . So ill have to get back to you on that with what checks and balances we have in place. Okay. Id like to turn now to a followup on the caregiverss hearing from last week. You proposed limiting an expansion of the va program of comprehensive assistance for family caregivers to only those who fall in tier 3, the most severely ill on injured veterans. You can clarify . Because i have to say there was some disagreement within the press and those in the room and understanding what you meant by that limitation, whether youre recommendation is to maintain the current Eligibility Criteria for post9 11 veterans and expand only to pre 9 11 in tier three or if it would be only limited to veterans in tier 3 from then on whether theyre service is pre 9 11 or post9 11. First of all there are is your decision. Im giving you my advice on this in terms of using our resources most effectively. My recommendation would be that everyone who currently has the program should be grandfathered under the current rules. I dont think its fair to award somebody a support and then change the rules on them after youve started the process. So for our 27,000 that are currently in the program, i would not recommend changing that. But going forward, if were if there is a decision to expand eligibility, i believe you should pick a standard that is used by other professional standards today which would be equivalent to a tier three, three adls plus cognitive function disfunction. I think general bergman, youre up. Five minutes. Thank you, mr. Chairman and thanks, dr. Shulkin, and all the rest of you for being here. I know i had to step out to a Different Event here for a while and i know that my colleague dr. Wenstrup asked questions about va facilities. In the reinvestment of the dollars that youre getting from closing or shutting down unused space, you can track on a shortterm basis and then a longterm projection as to exactly how youre going to reinvest the dollars that you save from not maintaining a space open that is not being used . Yes. Yes, we will be able to do that. Currently today when we dispose of a property, sometimes very Large Properties like in pittsburgh or in new orleans we disposed of the whole site that we had flolast in katrina. We give that back not to the va but to the gsa or the treasury. Under the president s Infrastructure Program that he announced on monday, in there would be a proposal that va could retain those proceeds if we were to give back property and we would track that very specifically and they would be reinvested in infrastructure in the va. So if we looked at the inventory, if you will, of facilities whether theyre not being used at all or whether they have just you know theyre being phased out because of new building in that particular area, could we do a, if you will, a multiple listing . You know like youd see in real estate, that as the va hears what we have in our inventory across the country and heres whats for sale, if you will . Yeah. I think thats i think thats a great way to do it. Weve been handling them individually by local markets, but think we could and the republican i ask the question is because ive been involved for decades in brak. I know sometimes people get scared when you use that term but ive been on both sides of that equation whether arguing for the base staying home or for it being repurpd and weve had some good examples on how do it over the course of the last 30 or 40 years. With you it takes an informed partnership between those trying to dispose of the facilities and those within a local community or wherever who might want to use that. So i look forward to you continuing to developing that and also providing that availability for those of us who want to see how its going, whats the market look like, if you will, whats the fair market. Different subject, in your pamphlet here we talked about this yesterday, the addition of fulltime equivalents to be handle new tasks, bringing people up and online. Is there is there an alternative, rather than just adding fulltime people, and specific to the appeals process, we know that theres a probably a ramp where you have a peak and then if we do it right its going to drop off. Thats just the way it is. Yeah. Do we really need to add the fulltime equivalence to the point where will they be up to speed in what theyre doing in time for that peak or, you know, have we got things synced up . Yes, sir. So were taking a multipronged approach to getting our fte up and available for processing claims when the law is fully enacted. What were doing is were using a program called war tak where we recruit military members as theyre transitioning from service to civilian life and teaching them to be claims processors and appeals processors. What do we do after the peak has passed . Whats their job after the peak . Because we have an x number of veterans are going to be applying and theres going to be a spike. Sure. What do we do with that fulltime equivalent after that peak has passed and now thats a great question and how id respond to that is we experience about 55 fte per pay period in attrition. So i think natural attrition will take care of the issue of the initial fte that we have left on the books. Thank you. We, as a committee, there are no easy decisions here. You know that, we know that, and the point is as a committee to Work Together with all of you, we hold each other accountable up here, we know that you do the same. The question is we all have is how do we do that together. I yield back. Thank you the gentleman for yielding. Youre recognized for five minutes. I thank you chairman and Ranking Member for holding this hearing today. Thank you, secretary shulkin, and your team for coming in early to answer our questions. Its always a pleasure to see you. Thank you again for yesterdays meeting are a meeting, it was very useful. My home district more consistently boasts one of the highest rates of recruitment and i course i never get tired of emphasizing this fact and im extremely proud of and thankful for our islands veterans. Unfortunately this increased enlistment means a disproportionate amount of our community suffers from these issues. While it would be a grace dishonor to characterize these brave soldiers as victims, it would be a greater dishonor to lapse in our abgation to provide them with the care required for their complex and often misunderstood Mental Health issues. Mr. Secretary, several different charts and figures have come across my desk and i hope you could help me interpret some contradicting figures. Could you please clarify whether or not the Budget Proposal requests more or less funding for medical research compared to the 2018 requests, and how Much Research funding do you hope to dedicate to Mental Health research . Yeah. Our Research Request in the 19 budget is 727 million. Thats a small increase but its an increase from the fiscal year 18. In addition to that, we have about 1. 1 billion of external grants, some of them government grants, some of them commercial grants. So together its about a 2 billion budget for research. Mental health is one of our key areas of focus. This is critical. I dont have the exact number. Mark, do you have the number for Meantal Health and research . Not for Mental Health, sir, but the actual increase to the appropriation goes from 640 million in 18 to 727 in 19. Yeah. We can get the number for Mental Health. My staff and i have had meetings with companies and groups who are interested in working with va to do ptsd and Mental Health research. What role do public or private partnerships play in maximizing vas use of their budget especially regarding research and developing Mental Healthcare . We need to be doing more of that. There are, you know, the advances in science and technology are absolutely incredible. So you take our 727 million that were proposing for research and you match it with the 1. 1 billion of federal and commercial grants and now you have a very substantial amount of research dedicated all to the health of veterans. But we need to be doing more of that and working with the private sector and reaching out more to see whats out there that could help particularly with ptsd and Mental Health issues. Thank you, mr. Chairman, i yield back the balance of my time. Thank the gentle lady for yielding. I now yield to herrington for five minutes. Thank you, mr. Chairman and secretary for being here along with your team. I want to focus on the stewardship aspect of research, 12 billion additional funds to deliver for our veterans on behalf of the taxpayers. And as somebody who has helped run a government agency, i though the challenges you face. But its imperative that youre able to manage your assets and the most important of your assets are your people for any organization. How many people will this 12 billion translate into, new people . Yeah. I believe that our budget prior to the budget caps deal was an incremental 6,200 people. But it may be more now that there have been additional funds allocated. Okay. 6,200 additional additional. Employees at the va. And that brings the total number of employees in the va enterprise to . 373,000. Is that your biggest budget expense . Sure. So we got to get this right. Absolutely. And i must say that my initial introduction to the va was frustrating with respect to managing people for performance and achieving the desired outcomes. Accountability would be at the core of that and thats a challenge in any organization, but in government especially, bureaucracy, Civil Service rules, unions. I mean, how do you do this . Well, under the leadership of chairman roe and Ranking Member walz and the bipartisan efforts, we gave you the accountability tools or at least some accountability tools, authority and flex ability. How is that going . How are you exercising it . Do you need more . Well, first of all, thank you for giving us that authority. Since weve opened up the office of accountability and whistleblower protection, 1300 employees have been removed in the last eight months. We dont have a target or goal for that, its not our objective to reach that. But our objective is, is to make sure that we are doing the job that were doing and everybody understands that they serve veterans is doing that job. And so were were focused on that. Its going to can you tell the difference . Do you feel a shift in the culture with this new tools, set of tools . You know, i think that one of the things that you learn when you run the organization as big a va, theres a different culture at each va. And i think that theres a lot of work do at some vas that still remains and there are others that clearly have used this to improve and that is noticeable. But its not yet noticeable at all of our facilities. In this same vein, and i am so grateful to work with Ranking Member orourke in our subcommittee and delighted that weve been able to achieve a lot of bipartisan work, probably the most productive committee in congress. 35 bills passing the house, 12 have become law. I mean, so i think weve got a great team, including the president pushing on this. And hes fighting for our veterans as are my colleagues. This is the biggest point of frustration for me with respect to managing our people and getting that right. My first hearing we got a report from the gao that there were hundreds of va employees who were Union Members who spent 100 of their time on Union Activity, 100 . Now, there could have been more because the tracking was terrible and wed been asking for data since the 1970s. But the people back in west texas and my veterans, 40,000 in 29 rural counties, they find it outrageous that somebody would spent 100 of their time on something other than the job they were hired to do. Could you please tell me how you feel about that . Ive got a bill, what could we do to help you . Is that i chal fleng changing t challenge in changing the culture . And after this i yield back. I come from the private sector, ive run institutions with very, very large unions and ive not seen that before where the time that is spent on union time is usually supported by the union dues and the union itself. I do believe that our unions are productive partners with us and i do really appreciate the collaboration that we have because i believe they care about getting the right services to veterans. But i do believe that the time spent that the government pays for its employees should be to serve veterans in direct veteran services. This is not an antiunion position, i believe very strongly we need to work with them. But i believe that we should be looking at alternative ways to make sure that Union Activity and direct veteran care are separated. Thank you the gentleman for yielding. Dr. Dunn youre recognize ford five minutes. Thank you very much, mr. Chair and thank you, mr. Secretary. Im going to change focus put requested a Major Construction increase of 1. 13 billion, the largest element of that is a 4million seismic correction fund. Yes. So your suggested appropriations language stipulates that the fund be available regardless of the estimated cost of the project. Thats regardless. So what yeah, i think youre right in asking that question. Im not sure what that means. Are you familiar with that . Because 400 million should be 400 million. You dont want to have it go i mean, im reading that and im thinking slush fund. Right. I dont think that was the intent but frankly, its a good question. I would have to come back to you with an answer. Lets visit that again before the final. In the past, the gao has raised concerns about the va employees gaming the Capital Projects ranking system to skip by improperly coding projects as seismic corrections. I would like to be assured that these requested seismic Fund Projects are truly to harden buildings that are in earthquake zones. Can you give me that assurance . Yeah. Yeah. I do know mark, are you familiar with the ratings on the skip process . I do know when i took a look at this last time, i was concerned about the same thing, how highly prioritized the seismic issues were. And i was afraid that if you werent in that part of the country, you werent going to get any of our funding. We did change the prioritization of the seismic, but this is the first time that we have been able to really start substantially dealing with some of these seismic issues that are decades old in deficiencies. But in terms of these projects, i know the specific projects that the 400 million are going for, i do not believe i believe that they truly are for size many mi seismic improvements. We all have the appendix that lists some of these seismic projects in arkansas, illinois, south carolina, not famous earthquake zones. 44 states are involved in the Shopping List of seismic correction projects, plus d. C. And puerto rico. Puerto rico, no doubt, needs some rebuilding. I dont think its seismic. I think its hurricane related. Id like to be assured that these requested projects and on the wish list, long wish list, 7. 6 billion worth of seismic corrections, wisconsin and louisiana are in this list, that, you know, these are truly for seismic projects. Im concerned about that. We will i think youve raised several good issues about the language of which it said, and also about the criteria. We will, if its okay, get back to you and sit down with you. Okay. Let me leave you with a thought. I was reading through the budget, and it says even though this is a quote out of the handouts here. Even though some facilitylevel planning officials told us they didnt think these demolition projects would score high enough to get funding, officials who oversee the skip process told us its possible that if the projects narratives linked back to Priority Areas such as seismic corrections that they might get priority that they otherwise wouldnt. So its a narrative that causes concern for misleading the oversight committee. Yeah. With that, i yield back, mr. Chairman. Thank the gentleman for yielding, and i would mention on the seismic issues, little over 200 years ago, there was an earthquake in the west tennessee area along the fault where the Mississippi River backed up. Thats how some lakes were formed there, and Church Bells Rang in philadelphia from this. So there are needs along the Mississippi River you might not be aware of that one of the largest earthquake faults in the country is there. Youre recognized for five minutes. That you knnk you, mr. Chair. Thank you, mr. Shulkin, for being here. I know that the chairman put this graph up here earlier. And its really important, i think, for everyone to see. Were in the business of caring for our veterans, and if im not mistaken, i would like you to confirm this, doctor, when we have the wwii folks and the korea folks that are now moving on, the population of our veterans that were responsible for caring for is dropping, but at the same time, i know a lot of our young men and women coming back from the middle east are gravely injured and hurt and need to be cared for. And i understand all this. But when im looking at is a budget that has grown dramatically over the last five or ten years, pick the period, greatly outpacing the growth of the total federal government, greatly outpacing the growth of our economy. And so the point i want to make, why im holding it up so long, is when you have an economy thats growing at x and a department thats growing at, i dont know, six times x, whatever it is, five times x, is that its not sustainable. And i would also like to remind you, mr. Secretary, and i know you know this because we talked about this yesterday, is that our federal government is horribly in debt. Horribly in debt. 21 trillion to be exact. Or almost 21 trillion. And with Interest Rates rising and the economy picking up, theres going to be more and more pressure on Interest Rates, so the debt service requirements, the interest on that debt, is just going to continue to go up. So, my question to you is this. Youre coming back to us, asking for another 12 billion in a budget that has gone up dramatically, continues to go up dramatically, greatly outpacing the growth of the rest of the federal government and the economy. Its clearly not sustainable. So could you please just in a nutshell tell us, mr. Shulkin, what are the two or three top drivers that is causing this to happen and why you have to come back to us every year asking for, in this case, another 12 billion. Yeah. Well, congressman, i share your exact concern. I think you said this correct. Its why we produced that graph, that we cannot continue to do business as usual, that this will eventually lead to us not being able to support our countrys veterans, which would be a great error and lapse of our responsibility. So, we have to do things differently. We are dealing with problems that have been essentially neglected in the va for decades. Putting in a Financial Management system that still runs on cobalt programming. 130 different versions of an Electronic Health record thats 35 years old that were putting all of our money just to maintain it. Dealing with old hiring practices and not having the right accountability in the past. So, what were doing is we are doing everything we can, this investment, to change that. To bring us modernized systems, to decrease the rate of increase. And my whole team knows thats our goal, to bend the cost curve, because we cannot have another graph like that for another five or ten years. So, the drivers are Vietnam Veterans age 67 now on average, getting older, requiring more services. Youve talked about people that continue to return with significant needs. Our mandatory benefits rising at huge growth rates. Our veterans have earned those benefits. But we have to make sure that our benefits are designed to help people return to well functioning well being. Im glad you mentioned that, mr. Secretary, because i believe and correct me if im mistaken the goal is when a veteran comes to us with a malady is to get them better and have them become independent and okay. Would you cite for us what we talked about yesterday at breakfast about sleep apnea versus somebody that comes in whos an amputee and go down that path . Because i think it will be important to get that out there. Yeah. What were doing is we started a process six or seven years ago which is to relook at all of our body systems. Were now in the process of looking at issues like a sleep apnea. Sleep apnea has a 50 Service Connection with it. We are spending billions of dollars on that. Fortunately, medical advancements have helped us in being able to treat this condition. We need to diagnose it properly, treat it, manage it, then people can go on with their lives in a normal, healthy functioning way and we want people to get that treatment. Thats our goal at va, to get the right treatment. But once we get people back and being able to function in the way that they should with adequate treatment, there should be a recognition of that in our benefits program. And so were going through this process. We work with our vsos through this process. Its been going on, but we believe a good system like this needs to evolve and change as science changes. May i have a few more seconds to ask a question thats imperative to the staff . Few more seconds. Thank you. I know that was a lean yes. Mr. Secretary, you requested 25 million this year to reimburse the Judgment Fund for construction claims and settlements. Will this zero out the vas liability to the Judgment Fund . Anybody know . We have to get back to you on that. Im glad you gave me the time to ask the question. Gentlemans time is expired. I will now, having no further members here, ill yield to mr. Walls for any closing statements. I yield one minute to the gentleman from texas. Thank you. And very quickly, i had asked you for total outstanding Mental Health hires, vacancies. Your staff got back to us and said its 2,912. Id also ask for all outstanding primary care hires. They gave us a number thats in the hundreds so i probably dependent ask the question the right away. Apart from Mental Health, impact to know how many outstanding primary care provider hires there are. Many of us are getting questions at our town halls. My primary care provider is gone, i havent been reassigned, i dont know who to go to. So would you get that to me and the members of the committee. Yeah. I was handed probably what you were, which says 270, but it seems small. Its got to be higher. Last point. I think inadvertently, my and the secretary conflated two distinct terms. Official time and Union Activity. If someone is performing 100 of their job on official time, thats one thing and we can have a reasonable debate on that and come to different conclusions. That is not union time, and i think you misspoke earlier. I would like you to just, for the record, share that you intended to say, official time, not union time. No ones allowed to spend 100 of their workday on union time. Thank you for clarifying that. I thank the gentleman. Thank you for being here, mr. Chairman, and i want to be absolutely clear what distinguishes this committee, i think, from any other, and its been noted, is our ability to focus on the issues together that matter. Im glad there was a lot of press here today. I hope they were here for the budget. Im sure i think all of us know what that is and thats a fair thing and i want to be very clear. No one is not taking those things very seriously. Weve had those conversations. I have indicated it appears like there have been allegations of criminal conduct on both sides of these things. Those things need to be found out. Im grateful for you and the decision to reimburse the federal government and move on. I would note that the reason this Committee Works is because we have chosen, collectively here, not to allow partisan natures to get into this. Your predecessor sat in that chair and took an awful lot of grilling because he was a democrat president s nominee. You have a unique position of spanning both of those. I would also like to clarify one thing because this one does get into a little bit ive sat on this committee longer than anyone else. Ive carried the Blue Water Navy bill. I was there with parkinsons. My disagreement is not about getting this done or the commitment of doing this. My disagreement is we should not be asking one group of Wounded Warriors to pay for another. My suggestions are to ask for a 1 10 of 1 off the tax brackets. I even suggested somewhat facetiously that if you got a deferment to vietnam, you could help pay for the ones that were there. No one disagrees up here. The chairmans commitment to fixing Blue Water Navy is second to nobody in this country. He is doing yeomans work of trying to find these things and i do not take offense to that. He brings up very valid points. I hope from the perspective of where youre at, we are all committed to getting this right. Were trying to find it. I understand the commitment to use the rounddown. I think theres valid arguments on that, but they are not coming from a position that we do not care about getting it done. So i want to make clear on that. I would note that the accou accountability act, again, 30 of the people removed come from food service and laundry. Just as a thought of where were going. Perhaps training on that end. Perhaps new employees that are there. Perhaps were quick to move feel before we get them in. I believe strongly in accountability because i was there to help graph this but my intention was not to get rid of housekeepers if these are things that can be corrected with training and hr and management, if you will. I thank the gentleman for clarifying the position on official time. Really important clarification. We get that wrong, theres a lot of tensions around this. But now were back to the work of a budget. Im grateful. The president sent down a budget. The constitution is very clear on this, that we appreciate his suggestion. Congresss job is to write the budgets. Congresss job is to find that out with the input from trusted and folks who have to deliver that. I think theres a lot of commonality in getting there. I think the issue on budget growth, we do need to have that conversation, though, because once again, i dont disagree. Management practices, all of that. We do have to acknowledge, though, i would argue, the va, especially the clinical folks, are doing such a fantastic job, weve haddadded 2. 5 million vets who want to get their care there. Vietnam veterans are going through the rabbit through the python. There are other things at work, and i would close with this. If you go to war, theres a cost that does not end with the last bullet. And weve been at war for 16 years. Weve asked people to go. Were going to have to budget for that, and yes, it has to, if it does not become sustainable, but this is one that i do not see that this is an option or a discretional funding. This is an absolute mandatory requirement to care for our veterans and were going to have to budget accordingly. So again, i thank the chairman for his leadership. I thank you, mr. Secretary, for being here in the midst of a lot of chaos and focusing on veterans. Thank the gentleman and i thank the panel for being here today and certainly the start of the discussion of the 2019 budget. And i was sitting here thinking, as we close, about, for our folks that are watching this, just what are the services that va actually provides . And ive been here now nine, going on ten years. And basically, it provides Quality Health care for over 9 million veterans. And whether its inside the va or outside the va, their commitment is to provide quality care wherever the veteran gets that care. It provides memorial benefits. We talked about that earlier to over 140,000 veterans a year who have now passed and those benefits to their families. Pension benefits. Hundreds of thousands of veterans get pension benefits. Group life insurance. We dont think about that. 6 million. Home loans. Veterans now over 3 million get a home loan from the va. Compensation benefits over, what, four to five million of our benefits get the educational benefits. Huge benefits, both the montgomery g. I. Bill, the post 9 11 and now the forever g. I. Bill and half, i think, of the young men and women who separate from the military use that g. I. Bill benefit. One is sitting in this chair who used that g. I. Bill benefit. And i want to thank the president for his focus on the va. I remember sitting up at night and late in the evening when he gave his acceptance speech and one of the first things out of his mouth was his commitment to the nations veterans, and i very much appreciate that, and i dont think its stopped. Every time he talks about gives a speech, he mentions our nations heroes. And i thank him for that. We have a huge this committee in a bipartisan way, as the Ranking Member mentioned, has got a huge amount of work to do this year. We have transition of the Choice Program. Weve got to get that done, so you can move on with that. Weve got the asset review to get the va right sized, to begin to go down the pathway of more efficient care in the neighborhoods, in the communities where our veterans live. Weve got ehr modernization. Thats starting. Weve got appeals reform that were just now weve talked about that just a little this morning as mr. Walz brought up. One of my passions i want to get off the table is our Blue Water Navy friends. I want to get that solved. Weve got caregivers. Were moving forward with that. The 7th of march, we have our first round table on that. Statement veteran homes were mentioned. I think those are tremendous. Everywhere ive been, ive looked at estate veteran homes. Those are really quality places that our older veterans can go. You mentioned at as your Number One Health priority, suicide prevention. Weve got enormous work to do on that and theres a Huge Investment in this budget for reducing the amount of suicide we have in this country. And lastly, i know we always privatization comes up, its hard to do that with a straight face. In the nine years ive been here, there were 250,000 employees at the va when i started on this committee, 2009. I think you just said there are now 373,000 and the budgets gone from 93 billion to 198 billion. That doesnt look like privatizing to me. That looks like a commit this nation is making to its veterans and im proud of that. I think this is something, when i go home, and i live in a very conservative area of the country, i will never apologize for helping earn money we spend on our nations veterans, and i dont think a person on this dais does. I think we can go home proudly and say that we have supported, in this entire congress, both republicans and democrats have done this. Just lastly, as we close, we have a number of questions for the record and one of those i want to get out before is transition to choice, and you dont have to answer it right now. But we have money that will last until the end of may, and then further money was appropriated. Yes. And then thats until the end of the fiscal year, which is 1 october, 30 september. Then how do we get from 30 september to march of 19 because that appears to be when were going to have this youll have the time, your team will have the time to get this new Choice Program fully implemented. You dont have to answer that right now but i need that. And will it be under the budget caps . With that being said, i ask unanimous consent that all members have five legislative days to revise and extend the remarks and include extraneous material. Without objection, so ordered. Hearings adjourned. I think ive been very conservative. Given what ive had in colorado, in the most mismanaged construction project in the history of the department of Veterans Affairs with 1 billion of funds. And that to kind of basically, in front of the and this is a continuation. Its a continuation of that culture. And so i just dont see how this particular can change. Its such a part of it. And i think this situation just demonstrates that. So, i think that its unfortunate for the Veterans Affairs. I just dont think hes the one to clean it up. Well, hes really not there are other hes giving personal information. That was only after the fact, when he got caught. Hes been all over the place. In responding. Its a moving target. It is a moving target. Now theres some story of a hat coming out, which is amazing to me. But no, i think its im just incredibly disappointed. But you know, the question, to me, it represents the the behaviors of the prior administration, when it was always sweep everything lets sweep everything under the carpet, everythings going well, theres no admissions that there are problems. And i dont think how can you solve anything when youve got that sort of leadership. You dont envision anything he could do to regain your trust . I mean, i think theres always been a question in my mind about him. I think what the president wanted and the president really campaigned on cleaning up the va, and what the president wanted was somebody from outside the va to come in. He couldnt get the i think he went through, like, three different picks who all backed away. And so, i think he just kind of gave up and went for somebody within the va, and i think ultimately, thats been a mistake. How do you think shulkins resignation would affect the choice overhaul, though . I wonder if thats a major factor in the treatment of this report by this committee today. Im not at all why . I think were on that path. I think well continue on that path. We got to get the system to work and obviously we have to pass good authorizing legislation. I dont think it would. I dont think it would. I mean, thats a congressional issue thats going to be debated between members of congress. But i mean, ive seen over years now that the va spending of mandatory funds through choice has a huge impact on how you guys have to move in response to make sure the veterans still have access to care. So, i wonder if a vacancy at that high of a level could really threaten your ability to manage it depends on how long the vacancy is there. I would hope that the vacancy wouldnt be there for long at all. Yeah. Okay. Thanks so much for your time. Just all of a sudden record, do you have anybody youd rather see as secretary . Well, i think i mean, i know who i certainly rather see somebody from the outside that has experience that, number one, has a military background, number two, has a background in preferably managing a Major Hospital system. But that brings an executive experience, executive experience into the va and thats not thats not going to be to morph into becoming part of the system. Part of the culture of the va. Which weve had in the past. This one and the two predecessors. It seems like when they get in there, they just become part of the system. Part of the culture. Thank you, senator. Thank you for your time. Coming up this afternoon on cspan, remarks from Supreme Court Justice Clarence thomas on his life and career on the high court. Hell sit down at the library of congress, and that gets under way live at 3 30 eastern on our companion network, cspan. Both chambers of congress are in session today. The house gavelled in to work on a bill that aims to reform the americans with disabilities act litigation process, also educating state and local governments on ada compliance. The house is done for the week and members now head home for the president s day recess. The senate, in the meantime, continues work on immigration policy with several proposals to be voted on today. Watch the senate live on our companion network, cspan 2. Tomorrow night, former president ial candidate mitt romney will speak at a republican fundraiser. You can see it live at 9 00 p. M. Eastern on cspan. Our live coverage of the savannah book festival starts saturday morning at 9 00 eastern and includes Robert Latiff with his book future war, preparing for the new global battlefield, author Scott Shapiro and celeste headlee. Watch on cspan 2s book tv. This weekend on American History tv on cspan3, saturday at 8 00 p. M. Eastern on lectures in history, former Virginia Governor Douglas Wilder at virginia commonwealth university. I have a one definition that i use for politics. Can anyone guess what that is . And ive said one would define politics. Money. Give me something thats a proposition before any tribunal that doesnt involve money. Sunday at 10 00 a. M. Eastern from the west point center for oral history, henry hank thomas, a combat medic during the vietnam war. My grandfather served in world war i. My father served in world war ii. Always for a black man, whenever you served, it was your military service you hope would confirm your bona fides as a first class, redblooded american citizen entitled to. At 4 00 p. M. , on reel america we look back to 1988 when president reagan spoke at a cpac dinner. The American People know what limited government, tax cuts, deregulation, and the move toward privatization have meant