Transcripts For CSPAN3 VA Secretary Wilkie Testifies Before The Senate On The 2021 Budget Request 20240712

Before we proceed to todays hearing id like to take a moment to recognize last monday was memorial day. It was a different memorial day for me and other americans than normal and it was more difficult for us to gather together. But last monday gave us an opportunity, an opportunity that we should take every day to pause and remember the brave americans who gave their lives in defense of our country. And we honor the sacrifices they made to keep us free. While let me start by saying that the veterans we honored on memorial day, they served our country and that peaceful protests are a demonstration of the freedom our veterans served to safeguard and protect. And while we reject the defacing of our National Monuments i would take another moment to express my gratitude the National Park service, its employees and volunteers who quickly restored our memorials. All of them but especially those that recognize the service of our men and women particularly the world war ii memorial. I know that this committee will continue to further our nationll pledge. One nation under god indevisibility for all. We use this committee to pay our regards and respect to veterans who lost their lives to protect our freedoms. Todays hearing is on the vas fiscal year 2021 budget request and the supmental appropriations contained in the cares act to respond to the covid19 outbreak. We welcome secretary wilkie as well as dr. Stone, dr. Paul laurchs, under secretary for benefits and john, assistant secretary for management and chief initial officefinancial o. I appreciate your presence here today. Weve certainly done a job to socially distance. Despite the distance between me and your team theres nothing but covid19 that causes that to occur, and i look forward to continuing to work closely with you at every opportunity. I look forward to discussing with you all today how we can Work Together to improve outcomes for veterans in our country. Id also like to acknowledge the passing of veterans and va personnel who lost their lives due to covid19. Part of our discussion food to make tour had the va has every tool. And id like to thank our doctors and nurses and support staff. In addition to serving veterans the va has executed its Fourth Mission to support the American Health care system struggling during this National Emergency. And this response from these Health Care Professionals has been and continues to be admiralable and important and necessary. While the va continues to devoted resources to suppress the pandemic veterans will continue to rely on the va for their needs such as education, Home Financing and transition services. To this end the pursuit of the wellbeing of our nations veterans must continue unabated. Between the release of this budget and this hearing Congress Passed legislation to support federal agencies responding to the pandemic. Following a supplemental appropriations by the president Congress Passed the cares acts. Cares provides 19. 6 billion for telehealth services, equipment and supplies, personal protective equipment, emergency room and urgent care. Cares also sets aside 2. 2 billion for i. T. Retrospectively did cares act appropriately fund the right places and prospectively given the shifting health care demands does the president s fiscal year 2020 budget address the budget needs. The president s fiscal year 2020 budget request includes a proposed increase of 22. 8 billion in funding from the va for a total of 243. 4 billion. This represents an increase in active levels. I look forward to hearing from you how the proposed budgetary increase will create Better Outcomes for our nations veterans. Iest pleased to see it includes an increase for medical care as the va includes the mission act. As we have discussed states like kansas depend upon Community Care providers for timely care. It is strongly supported by every Veterans Service organization, and you have been a champion, mr. Secretary to ensure its proper implementation. We all want veterans to receive the care they need in the va or in our community and i look forward to discussing the mission act today. Addressing another of the committees Health Priorities i request the additional funding for Mental Health and suicide provention. Mr. Secretary, i know you share our priority. In january this committee unanimously reported the commander in the Mental Health care improvement act to provide grants for Community Partners and improved coordination to quell the rates of veterans who die by suicide. It is my hope you will continue working with us to get this bill signed into law soon. Mr. Secretary, as always i thank you for being here. I appreciate the difficulty of your job. As the administration works to find a whole government solution to the pandemic i look forward to hearing your views on the fy 21 budget and i now turn to my colleague and the Ranking Member from this committee the senator from montana, senator tester for his opening remarks. Thank you, chairman. I want to thank you for having this. Before i get into the prepared statement i do want to say ten days ago was memorial day and it was a different memorial day than ive ever experienced, but the bottom line is it did give me an opportunity to really think privately quite frankly the things veterans have given us in this country, the freedom and the promise to live with liberty and justice for all. And i think its appropriate as weve all said that every day is vettens in this conbecause quite frankly without the sacrifices, without the job our military has done over generations this country would certainly be a different country than it is today. And i hope with all my heart, quite frankly, that we keep in our mind that this country is about liberty and its about justice. And its about liberty and justice for all. So thank you to the veterans out there, and secretary wilkie, i want to thank you and your Leadership Team for being at the hearing today. Today we get to go over the details of the president s budget request. But truthfully in the last four months the world has changed and the va has changed. More than 106,000 americans have died, many of them veterans returned from wars abroad to die fighting a very different battle here at home. I know the va has been focused on saving as many veterans lives as possible with more than 12,000 veterans having being diagnosed with covid19 by the va. And while many are covering the convalescing we should never forget more than 1270 have died. Its deployed staff and supplies to nonva facilities like state veterans Nursing Homes. Vas front line workers and their work force have done an incredible job and deserves more than just a thank you because thats enough for the work theyve done. It has been stellar. We must ensure the va has everything they need to keep the employees we have safe and take care of our veterans in the process. Todays hear sg an opportunity for us to take stock in where we are and where we need to be. Mr. Secretary, at the outset of the nations response to covid19 Congress Fulfilled vas request for nearly 20 billion to support its ability to take care of veterans. We do need a better understanding of how va has spent those funds and whether unspent dollars will be available to address veterans needs whether it be covid19 or otherwise in this next fiscal year. We also need to ensure that the president s budget request for va inhouse care meet the anticipated health care demand of veterans when looked through the lens of of coronavirus. We also need to know whether private sector providers are prepared to administer care given the virus unprecedented effect on American Health care. And we must anticipate the rip 8 effects on industries across the board. Prepare for a potential increase on reliance on va. Weve seen the devastating physical effects coronavirus has had on those who have contracted the disease. But i think we also see large scale negative psychological impacts and not having actecesso traditional in person Mental Health resources. And as weve seen with this covid19 crisis va facilities need more space certainly not less. We wont get there by short changing va emphasis infrastructure. With vettens unemployment on the rise its also critical the va indicate what programs we need to support in order to get vets rnz educated, trained, back to work and able to provide for their families. One way we help veterans provide for themselves and families and ensure their claims are processed timely and accurately. Im truly concerned with the mounting backlog of claims due to deferred and disrupted in person examinations for veterans and how these delays will affect them and their families. So i look forward to todays hearing to learn more details about how this budget request and the departments response to covid19 has gone, and i look forward to our conversation, and once again thank you, mr. Chairman, for having this hearing and i want to thank all the witnesses for being here today. Senator tester, thank you for joining us. I appreciate the relationship you and i have whether we are close or far apart. Maybe sometimes this works better for us. But im delighted youre with us. We have almost every member of the committee present either here in person or remotely. This is a hearing our Committee Members take seriously, and they are participating. While im pleased all of our members are here i also would acknowledge the presence of senator bozeman who chairs the millcon Va Appropriations Committee who has a lot of interest and involvement in your appropriations. Thank you for joining us with your expertise and interest. Mr. Secretary, before i introduce you i would say not only thank you for big here but you have been very kind with your time to senator tester and i tlahroughout the pandemic. I couldnt ask for more opportunities to have conversations with you and your team, dr. Stone and others. And that was very helpful as we explored and hopefully made suggestions and asked questions that were beneficial to you in fulfilling your duties during this pandemic. Mr. Secretary, well sqcome and please proceed with your testimony. Thank you, mr. Chairman, and senator tester. You stole the first line. I intended to say and actually i will say that in my experience working in this institution everywhere from the Majority Office theres no committee with authorization thats been more collaborative or more supportive of the department it oversees than this committee, which is why i do say with a straight face it is a pleasure for me to be here. I also want to pick up on what you and senator tester said about the events of memorial day. Memorial day has been part of my life for as long as i can remember as senator tillis said, i was born in khaki diapers and very proud of it. This memorial day i looked out at the National Cemetery and saw three families scattered amongst the thousands of veterans at that seamitary and realized this really was a different time. But i will say at va we made sure every possible obstacle was moved so on that day those families could be at the cemetery representing the 1. 3 americans that have died since the first shots were fired at lexington 1975. Mr. Chairman you noted last year we presented the largest budget in the history of this department. Thats now been surpassed by the budget presented to this committee this year. But i want to say that your support in that budget reflects trust in va that did not exist six years ago. This is not the va you read about in 2014. Today we are rededicated to lincolns vision that we take care of all who had borne the battle and for their families. And our record of turn around is something that may be unprecedented in the history of the federal government. In just a few short years we have implemented major reforms. Under the mission act we have successfully given veterans real and permanent choice. And while some said that the mission act meant the privatization of Veterans Affairs the numbers show the opposite has happened. In the last fiscal year we completed more than 59. 9 million internal episodes of care, a record high. And while we were doing that between june 6th and the declaration of the National Emergency we sent almost 4 million veterans into the private sector to fulfill the mission acts mandate. We implemented critical updates to the bill. We took on the new task of caring for thousands of Blue Water Navy veterans, and we continue to make progress in the highly complicated development of the Electronic Health care record that we will share with the department of defense so that people like my father will never be burdened with an 800page paper record ever again. And today we continue to implement those reforms even as we cope with as you and senator tester said an erratically new normal that none of us could have ever seen the last time i appeared before this committee. This depdemic was a shock to Health Care Systems around the planet. But you should be as proud as i am for the thousands of va employees who put themselves in harms way to create an indispensable resource not only for our veterans but for our nation. We continue to perform well because we took steps early on that allowed us to keep serving veterans even when there was so much uncertainty. Those steps included the immediate implementation of Emergency Management procedures in the last week of january. Expanding telehealth access and prohibiting visitors to our va Nursing Homes and spinal cord injury centers. Heres where we stand today. As of this week more than 12,000 veterans nationwide had been diagnosed with the virus. But 80 of those veterans are now at home having recovered. We are caring as we speak for 1,200 veterans with the virus, a number that has fallen in the last two weeks from 2,200. We have currently about 1,100 va employees who have tested positive. But we estimate that our infection rate with 330,000 employees and dr. Stones department to be one of the lowest infection rates of any organization on the planet. It is less than one half of 1 . And our staffing is stable because we have hired in the last seven weeks 16,000 americans who have agreed to join us and serve veterans. That means 3,300 registered nurses, 535 physicians, and 202 nursepractitioners who are with us now full time. And more importantly we have the lowest rate of infection amongst our nursing home residents. The lowest rate of infection amongst any system in the country because early on we took very difficult steps to close off our veterans sadly from their families and friends. Because of that we have 19 veterans in our Nursing Homes, 19 out of the 7,000 who are infected with the virus, and i believe we have set an example how to care for our nations most vulnerable. That stability in operations has allowed us to open our doors for the mission which is back up our Health Care System in times of crisis. We are now in 47 states and territories. By april we were accepting requests to open dozens of our hospitals to nonveterans cross the country. Our expertise in caring for nursing home residents is in the highest demand. Weve deployed 204 va staff to Nursing Homes around america. The crisis as i mentioned was not costless for us. Covid has claimed the lives of 32 of our va family. But in april april brought us irrefutable evidence that the tide at va has turned for it better. On the last day of the month we released a survey showing that a record 90 of veterans across the country now completely trust va care. That is a record high and is a record high even in a pandemic. So that is todays va. It is a learning organization filled with employees who can turn on a dime to keep veterans and nonveterans safe even during this time of incredible uncertainty. Mr. Chairman and senator tester, i again thank you for your many courtesies to me and everything you do for our nations most deserving. Mr. Secretary, thank you very much. Let me begin with a handful of questions and then turn to senator tester. Committee, we will do this by seniority not knowing the presence of every member at the moment. So well work by seniority. Mr. Secretary, can you walk us through why we are seeing a steady growth and increasing funding in both internal Va Medical Services and Community Care. Let me use this opportunity to say that i believe that whether the care is provided in the community or provided internal to the va both are va care. They are both part of the department of Veterans Affairs, and they are not separated. You indicated the hiring of 10,000 medical staff. This in my mind could lead toward a greater capability of seeing people internally within the va and maybe result in less people involved in Community Care. Youve also indicated to me and senator testing over a long period of time the increasing use of telehealth. How does that have a consanyone of the amount of veterans being seen internal and the community . I raise this question in part because we are being requested in this budget for more money in both categories. Internal va care. Let me and answer the telehealth question first. That is separate category because it rests on a priority that i gave to this committee when i had my confirmation hearing. The two communities in this country who serve the nation in higher numbers than any other communities are rural americans and nativeamericans. The two populations that are the hardest for us to reach no matter what the mission act does, what we have done with telehealth is increase our footprint in rural and native america. Ill give you an example. In april we had over 900,000 telehealth encounters. That is an increase of several hundred percent. The reason that is important is at a time of crisis when veterans cant get to our facilities or they cant get to their private sector provider we have offered them a window to help with their health conditions. I intend to expand our footprint through telehealth into rural and native america. On the Community Care side i am fully committed to expanding that choice even during this time 60 of our normal mission act Community Care appointments have been carried out. The one thing we have discovered during this crisis is that many of our veterans are not going into the private sector, and youve seen that all across the country with declining rates, not only of wellness visits but visits to the emergency rooms. So that has been the makeup of how we have reacted both to the expansion of mission but also the expansion and the confidence that people have in va, and ill let dr. Stone add some comments about the numbers and budget. Mr. Chairman, the growth in the budget reflects enhanced enrollment. Were anticipating about 30,000 more veterans to be enrolled with us, enhanced dependence on the system. As you know about 80 of the veterans that are enrolled with us have other health insurance. They dont get all of their care from us. About 20 do get all of their care, but increasing amounts of dependenceance upon us as well as the growth in referral in Community Care. A small percentage of the crease is do to mission act and the increased requirements, probably not more than 2, 2. 5 but john will correct me if im wrong on that number. But it is really dependent upon us and the enrollment, and as we come out of this pandemic we certainly are concerned that financial destabilization of the veteran population may result in even greater dependence upon us, and ill defer to correct anything i said. No corrects. I would say from the early health care projection model we used to predict cost i think the big cost driver is the reliance that more people are taking advantage of the va, so were a victim of our own success. I think there are more programs, more benefits, more access, different environment and frankly people are coming in and taking advantage of it. Is there a way to distinguish between increasing number of veterans accessing care and the cost of care in your c calculations of a budget . Trz. It gets very complicated. I belong to a commercial Health Care Plan and they sort of know im going to use their Health Care Plan. The challenge we have is we have beneficiaries who have all kinds of medicare, tricare, private insurance and the challenge for us is predicting how much of the va theyre going to use. We may see an increase in va use because of this covid pandemic, people losing their job and thats something were looking at very closely but predicting that and sort of knowing is a very difficult thing to sort through. Thank you all for your responses. Let me turn now to senator testing. Thank you, mr. Chairman and everyone there that is testifying. You guys touched on it, and im going to follow up where the chairman was at. This budget was developed long before we knew there was going to be a pandemic. And quite frankly its a boat load of money but it needs to be right sized. It doesnt need to be overly inflated and it shouldnt be less than you need. But each one of you talked a second ago about an april increase in the hundreds of percents. You talked about the fact that 80 of the folks have Health Care Insurance that use the va. I think with unemployment increasing and you guys talked about this. Youre going to see increased dependenceance upon the va. Weve seen medicaid enrollment, for example, increase by 2. 8 , federal to april in basically that month, and its going to increase some more moving forward. So i think we can anticipate theres going to be more pressure put on the va, and i think we can all agree on that. I think youve already said that. The question is does this budget account for that . It was probably laid out long before we had a covid19 pandemic on our hands. Senator, let me senator and john can give more details. The one Silver Lining in what has happened is that when i first started talking to you and talking to the chairman we were projecting hundreds of thousands of veterans being infected with this virus. We have mercifully been spared those numbers. Of the 9. 5 million veterans we serve, 12,003 have been infect. So what does that mean for the cares act and supplemental funding . That means of the 7. 2 billion that the appropriators allocated to us for the cares act we spent 1. 01 billi 1. 01 billion on medical services. Right now we have more than enough to anticipate the problems that you have just outlined. Our our problems and our emphasis will be on making sure that the claims and that the Education Programs and vocational programs are fully up and running so that when we get back to those facetoface encounters well be able to provide those veterans with the services they need. In terms of internal appointments i dont see it going up much more than it has because weve reached almost thesucheration point in terms of the number of veterans weve had in the system and the number of veterans across the country is going down. Im sorry. Go ahead, senator tester. I would just say go ahead very quickly if you could. The secretary said we did not anticipate this in the budget, but we have a lot of flexibility. The one thing id like to emphasize though where we could really use some help we did not get all the right money in all the right places. We do have a real need to move some of that cares money into vba, not in large amount, some into nca and some flexibility for i. T. As well. Those are three areas where were going to be short. Other than that i think we have adequate flexibility. I think the budget is adequate, but we didnt know this when we started. Its not all in the right place but its not bad. Is your intent then then to get authorizization to use any unused cares act money into different line items where you need money in this budget . In fact, youve given authority to move money around in the appropriation, but we would ask in your support in expanding that a bit with congressional oversight to move it to other areas. I think were providing weekly execution reports. We are going to need to some of that money around to other areas. It transparency is good and i want to thank you for that statement. So first of all, congratulations. I understand there have been 16,000 new people hired to the va in april or may. And if im wrong you can correct me on that so congratulations on that. The question is are these folks are they in it for the long haul or are these folks that are retired and came back do you plan on losing again or is this something we can get our arms around to help solve that vagrancy problem . Yes, sir, i believe 90 are permanent and that is one of the best news stories that we can have in government. Senator tester, i want to follow up on something you and i have talked about and i believe will boomerang or can boomerang on us in the fall and the winter. I think the supplemental funding that the congress has provided us will be our hedge against what could possibly come and we have demonstrated, i think, that we have the procedures in place to ensure that if it does come back, we will be ready. And i believe we have the funding to meet that challenge. I appreciate that statement, mr. Secretary. Thank you for that. And i also say that i dont know what happened in april and may, this is not to what you touched on, but its what what you said is absolutely, incredibly important, because if this does boomerang pack, have to be prepared for it. It sounds like you are working in that direction. Thank you. But whatever you did in april and may to hire 16,000 people, can you repeat that in june and july . Can you do that for a few more quarters . Well be in really good shape. Yes, sir. From an employment standpoint. Yes. And the last thing, and ill be very quick. If my eyeballs dont deceive me, i have about 50 seconds left. The issue around masks, i mean, around testing is really important. And you have said that any employee that wants to get a test can get a test. Were not hearing that. Were not hearing that from the folks on the ground. Were still hearing that theyre not being tested. Could you shed some light on that as to what the hecks going on . Senator, you are exactly right, were not there yet. Although we tested over 12 of our employees and it is our intent to have on demand testing for all of our employees, were not there yet. Most of that relates not to the machines that we need, we have the ability to do 60,000 tests a week on our machines. It is the aavailableability of cartridges that go into that from the various vendors and the availability of swabs. When we issued the guidance to go to ondemand testing for our employees, we ran out of swabs in a because of some problems with u. P. S. Shipping and that was a National Problem with the crashing of u. P. S. Systems for a weekend. We have now recovered from that. Right now, we have about 60,000 tests available, but we do not have the ability to institute ondemand testi ining for our employees, but it is our intent to get there. Okay, thank you. And if im 3 20 over, mr. Chairman, thank you for not gaveling me down, but i should have been. I apologize. Mr. Chairman, may i mr. Secretary. May i add to that 3 20, senator tester just finished, but this is also ail dressed to senator sullivan, senator rounds and those senators who have large native populations. We have brought in to our v. A. Over 2,000 native americans for treatment. We have gone into the nations, the native nations and we are in several of those communities and it is my intention to expand our footprint there. Some of our most vulnerable veterans, but also some of our most vulnerable americans and senator sullivan knows, well have 114 individual tribal agreements and it is my intention to expand that, so theres no Tribal Community that we miss. But i did not want to go without mentioning our help for the Indian Health service and someone criticized me a few days ago for not getting payments i will worry about that much later. Most important thing is getting those services and that treatment out into indian country. Mr. Secretary, thank you. Senator tester, 4 51 over, if you include senator if you include the secretarys remarks and ill try to be more disciplined with my colleagues. Thats almost twice. Almost twice. No, we appreciate you, senator and mr. Chairman and Ranking Member tester, for holding this hearing, which is so, so very important we appreciate you, secretary wilkie, and your team, for the great job that you do. This is just a comment, i hope that we can continue to give you the ability to do the hiring process like youre doing it now. I dont know how long it would normally take you to get those people onboard, but it would be a long, long time, and so, again, we appreciate you all working so hard and using the flexibility weve given you. The fiscal year 21 vha, Veterans Health budget request is 90 billion. 10. 8 billion increase from the prior year. If you look at ten years ago in fiscal year 2011, the budget request for Veterans Health then was 52. 1 billion. Its really remarkable the growth. To be precise, 73 in the last ten years. We talked about some of the drivers that were doing that and i would argue, having been on that committee in the house and now in the senate for many years with our distinguished chairman, if Veterans Health is so much better than it used to be, and we have the confidence now, lots of people using the system, we also is it correct that we have an aging veterans population in the sense with our world war ii, our korea, vietnam veterans, again, you know, with multiple problems facing, and then the increase in health care costs, so it is a lot of money, but it is something, certainly, that we are committed to doing. But the good news is, i think the thing thats spurring it as much as anything is just the confidence that were seeing in our veterans and continuing to to use Veterans Health care when they could go to medicare or some other insurance. Dr. Lawrence, recently, we visited or, the staff visited, they were told that the recent suspension of the cnp exams due to covid, which were understanding creating a significant backlog, weve worked so hard to get that down, can you talk about the plan, what can we do to get that back under control . I think, what, are we 116,000 exams, Something Like that, is that in the ballpark . Yeah, youre being charitable. This morning, it was 119,000. And youre correct, sir. On april 2nd, when vha stopped doing cnp exams, we followed their lead. On april 3rd, we told our ve vendors, they could no longer do inperson examines. We asked them to use medical records to do things like fulfill their claim or provide partial benefits, but youre right, the simple math of what took place and you all deserve some positive responsibility for that, through the Blue Water Navy act, we began to receive a lot of claims in january and now theyre over 125 days. We have a plan to open following vhas lead and that will begin, they open 20 hospitals, were opening in that area june 8th, well start up again cnp examines in certain parts of the country and well continue that. The vendors know and theyre making phone calls now to schedule it. We have not happy about the backlog. In november, it was 64,000. Our team is very proud of processing claims quickly, so, we want to get that right away. Two things, sir, to answer your question. The first thing is what was just said about reprogramming some money, so, well have overtime money to do the claims, and the second, we have a piece of legislation in front of you to allow doctors to conduct cnp examines across borders and addition some flexibility for nondoctors to conduct the cnp examines, Nurse Practitioners and the like. We would ask you to consider that and it would expand the capacity to work the backlog. Very quickly, secretary wilkie, the Fourth Mission has been a big success. As a result of that, fema, hhs, owes the v. A. Some money. Can you talk quickly about the plan if actually recouping that, whats going on with that and they would be very helpful to us. John might have exact figures, but statutorily, fema and hhs has to reimburse us when we go on missions they have approved. One thing that i did, though, was, i just started calling governors. And we we went out ahead of many of those missions because particularly instate veterans homes, there was a crisis. And fema has caught up with those requests. But i will get you figures on how much we are owed so far, unless john has a new i was going to say, sir, we are tracking it closely. We have not billed then nor collected anything but we will be so we can provide you a breakout of that. Thank you, mr. Chairman. Senator brown . Thank you, mr. Chairman. Secretary, thank you. And Ranking Member tester, thanks for eating up some of my time, john, i appreciate that. Were here to discuss the v. A. s budget and the pandemic response. Today, v. Trapd repoa. Reported deaths, our country is in a crisis, people are dying of a disease that continues to spread, particularly among seniors and especially among the black and Brown Workers who are keeping our society afloat right now. We know who essential workers are, they are too often paid too little. One essential worker said to me, i dont feel essential, i feel expendable, im not paid very well, my work conditions arent very good, thans something that all in this committee should think about, especially when theyre veterans. Protesters in the street now because their governments failing them, its failing to protect our workers, not only has it failed to protect black and brown American Workers for generations of people who are supposed to protect everyone, who have too often been turned against them. Peaceful protesters should not be tear gassed or pelted with rubber bullets so the president can exploit a house of worship to stage a photoop. They are not terrorists, American Cities are not battle spaces. I know that the great majority of veterans, i assume the great majority of v. A. Workers agree with that and they, too, are embarrassed when the president disbands Peaceful Protesters and brandishes a bible as a weapon. On this committee, we honor those who have chosen a life of service, nothing is more patriotic than up holding the constitution and exercising our fundamental rights. We need to continue working together to address injustice and inequality to make sure all americans are treated fairly. I heard directly from student veterans about how this pandemic has effected their g. I. Bill benefits. Congress worked to provide relief, im still concerned that the information from bba isnt reaching all the colleges and universities in a clear format. I edge the secretary and the staff to work a little hardener that, we need to make sure work study students still are paid or when classes are only offered online, g. I. Bill benefits continue. Even after we pass legislation to address these issues, my office has heard from veterans and schools. My first question, dr. Lawrence, would you commit to work with my staff, with anna and drew on my staff, if we hear of additional concerns about this . Absolutely. I figured youd say yes and you have always been cooperative. I appreciate senator tester asking about vacancies. I had that same question. We need to continue to drive down the time it takes to hire medical professionals at v. A. Can you commit you will retain the expedited hiring processes that you have scaled up during the crisis . Absolutely. And if i need additional authorities, i will come to this committee. I think weve shown, senator brown, that the government can work and cut years off the hiring process. One of the incentives we gave is that we told people, if you joined us, you can say in your hometown or in your home state, should you so desire. And i think that is a that is a high incentive. That is very important. I want to take this opportunity to find a way to negotiate in good faith with the v. A. Unions. We know that workers are more productive, theyre better treated. Dr. Stone, dr. Lawrence, have you reviewed the white paper release by the National Veterans Legal Services program and jerome frank Legal Service organization at yale law school. Veterans stationed in guam nor a decade were likely exposed to herbicide agents, including agent orange. Do you agree with the assessment . For dr. Stone and dr. Lawrence . Sir, let me go first. Yes, sir, we review the paper and i believe we responded to a letter to you all about the inability of us to find the use of the die yok sin in that area. I know it was a complicated paper that requires analysis with our team. Yes, it has been reviewed. Okay, dr. Stone, do you want to add anything . Sir, i have reviewed the paper and i agree with dr. Lawrence, its very complex in its process and we look forward to coming to resolution on it. Okay, its important that the v. A. Always stand, as you know, always stand with veterans and agent orange, were sometimes slow to that with burn pits and now with this study, its important, always, that we come down the side of veterans. Last comment, secretary wilkie, dr. Stone, v. A. s made a major health to telehealth. When we passed the c. A. R. E. S. Act, we included specific funding for veterans access to telehealth. Many of the senators on this committee has more rural areas than i do. They dont have access to broadband. This is especially important as veterans rely on telehealth for the foreseeable future. I hope youll share, my times up, but share with the committee at some point what steps v. A. Or with my staff what straps y stes taking to expand broadband to our senators. You can kns that question in writing or take the time now. We will. It is a priority for us, particularly as you mentioned in rural america. I did want to Say Something about your opening comment about, i believe you mentioned gender disparities. We are in an interesting position at v. A. 49 of eligible male veterans are in our system. I can say to this committee today that 42 of all eligible female veterans are now in the v. A. System. Dr. Stone has just hired an assistant, special assistant, to monitor those issues, any disparities and report directly to him. I think we are the only Health Care System in the country to monitor gender and Racial Disparities in terms of health care and Health Care Outcomes. So, we are in the lead and i think for many of those communities, the Health Care Outcomes are much better within our system than they are in the private sector, so, i take your point to heart. Thank you, secretary. Thank you, mr. Chairman. Youre welcome. Thank you, all. Thank you for your good service and thank you in new orleans, which had a lot of covid, yall did a lot of work to mobilize resources. I really appreciate that. A couple of things. Ive heard, again, as a physician, i get these phone calls from physicians all over the country. Now, one thing that has been said that, in the referral to outside specialists for different aspects of care, the intensity of the care is greater than it would be if it were given in the v. A. That every test is done that is imaginable and some of which you would not think would be indicated, maybe you cant establish that theyre not, but they ordinarily wouldnt be done in a more wellrun system. And of course were speaking not just for the v. A. In general, but for specific facilities, you want to have a spectrum of that. Dr. Stone, i think youve been flagged for this. Yes, sir. We authorize standard episodes of care in which we define the scope of services to be done, but we do find a greater utilization of services out in the commercial space than we now, that assumes, dr. Stone, because i have limited time, if you have greater utilization of services, either underutilization within the v. A. Or over on the outside. Now, ill just say, act a doc, if you do too much, bad things happen. On the other hand, it should be done if indicated. So, do you have a sense of inside versus outside as to the relative weight of that . Sir, its economy we designed the Community Care program to be highly integrated with the primary care physician at the center of that to make the decisions in the best interest of the veteran. We find, in some very simple areas like physical therapy, dramatically higher uses in the commercial space than is done within the v. A. But begging the question, is it appropriate increased intensity or not . Not always. So, is there, i presume then, that yall are taking measures, because thats one, expensive, but two, it is also contraindicated, which is more poi important. Thats the beauty of the Health Information exchange, this allows us to utilize and to integrate Health Care Information systems for the veteran sol that theres not repetitive work being done and we have full visibility is it possible you give this committee a report on a per institution basis, the dartmouth Study Suggests its regional, state or community located in which you have increased intensity of certain services. I think the individual members of the committee would like to know how the v. A. S in their area are responding to this challenge. Wed be happy to work with your staff and the Committee Staff to really work through that request. Let me ask, mr. Secretary, you mentioned the success in hiring new people, but i was told it could take six months for someone to be offered a position, for them to be onboarded and to be seeing patients. Any comments on that . Senator, before dr. Stone answ answers that, as a physician might answer that, weve been able to cut through most of the federal p float sum and jet sum when it comes to hiring people. Ive shaved off weeks and months out of the hiring process, when people apply, that hiring application goes straight to the Medical Center or to the department that would be hiring that person. The onboarding is done quickly. So, weve cut down years, months, into weeks and i dont know that anyone right now is experiencing that sixmonth delay. Now, there may be a one or two specialties that might, but dr. Stone can answer that. Sir, it was not uncommon for us to take six months to bring a clinician on, mainly because of the prime source verification of their education. With the help of office of personnel management, weve cut that down to seven days now. If you apply today, in seven days, well have you at work. Really . Yeah. And weve hired weve hired almost 600 physicians just in the last six weeks. So, i got 36 seconds left. Let me ask you a fourminute question. During the covid coronavirus crisis, weve been using more telehealth services. To what degree can we continue to use those teleMental Health, have you found them as effective as Traditional Service fs . We have. And this is the way of the future, particularly for Mental Health. And in addition to what we provided, we have now entered into agreements with ill give you an example, walmart. I cut the ribbon on a walmart Veterans Health clinic that exists behind the pharmacy wall where a veteran can come in and talk to a Mental Health provider. This is in North Carolina. Anywhere in the country. This this is the wave of the future. It prevents veterans from having to experience the pressures of a large clinical setting, it takes the pressure off of their families. I expect it to grow and i think the one benefit of this epidemic, it has allowed us to stress stress the test and ill finish by saying, im going to make a louisiana comment, my grandmother is watching in new orleans. She was born in the middle of the spanish flu at the early part of the 20th century. Shes back, shes still in new orleans, she survived this one. So, that tells you the resilience of the crescent city. Thank you, i yield back. Senator blumenthal . Thank you, mr. Chairman. Thank you, all for being here. Thanks for your service. I saw a report, i think this morning, in the military times that the number of active coe strid covid19 cases at v. A. Medical Centers Nationwide has risen by more than 7 in the last five days. Thats pretty alarming turnaround in contrast i can answer that. The system, the Accounting System was done for several d s days, but overall, 9. 5 million veterans that we serve, weve had 12,300 infections. Of those 12,300 infections, we have less than 1,500 active infections. I think theres no Health Care System in the country thats been able to keep those numbers down, as we have, and i think we did it because we acted early. We were acting in february my question to you, though, is the trend. What has been the trend over the last five days . Are you saying that the military times was in error . Im saying their interpretation was in error. Well, youre saying theyre in error. What are the numbers . I gave you the overall numbers. The. If i might add to this, i would ask the senator to consider two things. One, the number of cases and secondly, how many are hospitalized. Our hospitalization numbers are stable and are not increasing. I think as we increase testing and were doing 3,000 to 4,000 tests a day, youre going to get numbers going up and it is just like in each of your states that as you penetrate thats an explanation but the numbers are showing an increase, correct . The actual number is showing an increase, but not in hospitalizations. Hospitalizations an increase in the number of active cases. I understand hospitalization and most of those cases are at home. At home. Because they dont require im asking you for numbers well, i just gave you the numbers. I want to make sure i understand the trend is up by around 7 of active coronavirus cases. The military times was correct on that part. And the trend the interpretation is that theres an explosion. Let me move onto another topic, because im limited in terms of time. My understanding is that you have spent only you have obligated only about 2 billion out of the 19. 6 billion that has been provided under the c. A. R. E. S. Act. Why so small a percentage of the fund i funding obligated . Well, the original projections that i discussed with the chairman and senator tester of several hundred thousands infections did not play out. Those were the projections we were looking at at the beginning of this. So, you dont need the money . Um i also mentioned earlier, senator, that i am standing by for a rebound. We dont know whats going to happen in the fall and winter. So, that 7 trend that i just mentioned, if it continues, you might need the money more than you do . Well, i think with the rebound, you would see people who have had no contact with the virus be susceptible to it in the fall and the winter. Let me ask you, with respect to ppe, how many and this is relevant to the potential rebound, how many weeks of supply do you have now in ppe . We have we have multiple months of supply. Multiple months . Yes. So, you have more than ample personal protective equipment . And i can add, the chairman and i have talked, and so has senator tester, we are setting up a system that is something that you are familiar with in your marine corps days, the marine corps and navy had supply depots all over the country. Spare parts technicians. We are doing that with our ppe and our medicines. I think this is our hedge for the future. So that we will not be susceptible to a disruption in the supply chain. So, ive adopted the models that i saw as a young naval officer and we are preparing by stocking up. The other thing i would say is that we never we never fell below two weeks of supplies during this crisis. I have one last question, i have many questions, some ill submit in writing, but one more question i want to ask you here. I introduced a bill last year that was supported by 18 Veterans Service organizations to remove the oneyear manifestation period for three illnesses linked to agent orange. And id like your support for that bill. 50 years after the veterans suffered the harms that are still well, i certainly as the son of a combat soldier from vietnam, i understand it, probably, as well as any dependent. Dr. Stone and i will be reviewing that, as well as several other studies that are tangental to your legislation in the coming weeks. And while youre reviewing that, maybe you can also indicate why you have not categorized as a presumption presumptive disability, three several conditions that are classified by the National Academy of sciences in that regard. I know that ordinarily you follow their recommendations, in 2016, the National Academies recommended adding four new conditions to the agent orange presumptive disability list, including bladder cancer, hypothyroidi hypothyroidi hypothyroidism. You havent added those conditions. Me and the secretary have spoken previously about this and we are waiting for these two additional studies to finish that are broad studies of delt rates, as well as the Health Status of vietnam veteran before we come to agreement on that. Weve talked to the National Academy of science and looked at the statistical variance that they have and frankly, im not as convinced as the National Academy of sciences, but we will defer to those two studies and then make recommendations to the secretary. Mr. Chairman, if you would indulge me to finish the original question senator blumenthal asked about the 7 increase and why i was questioning the interpretation, we have 9. 5 million veterans in our system. Weve had 12,300 infected, mercifully, an incredibly low number. And of those 12,300, well over 9,000 have completely recovered. So, a 7 increase, the way i was challenging the interpretation, sounds like there have been an explosion in terms of the number of veterans infected, it has been mercifully low, if you look at the entirety of the community we serve. My time has expired. I thank you, mr. Chairman. You have one of my Ranking Members, as is senator tester and you almost got as much overtime as he did. Senator rounds . Thank you. Thank you, mr. Chairman. Mr. Secretary, gentlemen, thank you all for your service to our country. Mr. Secretary, on a call we had with you just a few weeks ago, you were confident that any overdue provider claims were old choice error claims but earlier this week, in preparation for this hearing, leaders from your department told members staff that there are aged mission act claims among v. A. s current backlog. This does line up with your written testimony today, page six of your testimony in which youve indicated and ill quote, the v. A. Realizes it needs to do a better job of paying claims from Community Providers, end of quote. And it is certainly reflective of what my experience is and what i continue to hear from my providers until south dakota. So, looking at your request for 18. 5 billion for Community Care for fy 21, what i would like to know is, this is enough to make sure your department can do what needs to be done to get our Community Providers paid in the time that the law currently requires . Just as an example, is this enough money to get the ekams up and running at 100 capacity . I think according to discussions with staff earlier this week, its running at 33 capacity. Our expectations based on a february discussion, it would be running by may 4th or so. So, weve got a ways to go yet. And is this is this enough money to clear your backlog of the 2 million claims and help the v. A. s transition out of the direct payer role altogether . Before dr. Stone answers the way forward, and i will say, ive been in south dakota twice in the last six months. Since mission kicked in on june 6th of last year, we have processed 22 million claims. And dispersed 6. 9 billion. I can say that with the with the coming of new management into our regions, right now, the number is at 57 of all claims are now paid within seven days. Still means we have a backlog but it is moving in the right direction. Senator, last time you and i talked about this, i had between 3. 2 and 3. 4 million claims in backlog. That number is now down to 1. 9 million and we dispersed over 1. 3 billion in payments last month, in the month of may. I think were going in the right direction. Ekams has not come onboard at t where weve wanted. What were looking for is auto adjudication, where on an automatic basis adjudicates the claim, and on that, youre exactly correct, is not at the level it should be. Ive been reassured by dr. Matthews and her team, who are running Community Care, that in the next month, we will take a dramatic upturn in the amount of auto adjudication thats driving this down. Now, the first question you asked was, is 18 billion going to be enough . It looks like it. It looks like even with the growth in the dependents and the unknown that we have as we go into a potential second wave or even third wave of this pandemic, well be okay with that number. So, im confident in that number. What im still not happy with is the amount of backlog claims. We must be a good partner to every provider or were not going to keep the 880,000 providers that have committed to americas veterans. I think thats the crux of it for us. If were not paying our providers, a lot of them dont have real deep pockets and if they cant get paid to continue to pay their bills, then at some point so far, none of them have declined a veteran, but most certainly dont want to get them the position where they feel like they may. We are keenly aware that the American Health care system in the private space are losing 50 billion each month and weve worked really hard to make sure we can do our part to maintain their liquidity. Great. Thank you. Mr. Secretary, can you give me a walkthrough, the decision to decrease your requested funding for the v. A. s Rural Health Initiative this year by 10 from 300 million in fy 20 to 270 million in fy 21. I know youve been to south dakota twice, youve talked about what we need to do and work with ihs and our rural areas, but to see that decrease kind of caught me by surprise. I will go back and look. I think it is because of the emphasis on telehealth, which has cut down on cost, but i will give you a line by line breakdown of why that happened. And i would also add, and this is a parochial matter for you. I was on kelo yesterday and i wanted you to know that i renewed the commitment to hot springs on south Dakota Television and my staff has been in contact with your staff to make sure that when we deal with that record of decision it is not only airtight, but it is also in line with the legislation that you put in the appropriations. Thank you. Thank you mr. Chairman. Senator rounds, thank you. I meant to mention after senator bumen thats questions that this committee will have a hearing next tuesday, he was asking the secretary about ppe. Our committee will meet next tuesday afternoon to have a hearing, the title of the subject is building a more resilient v. A. Supply chain. And so were going to spend some more time with the department in regard to this topic. Now senator hirono. Thank you, chairman whats happening in our country right now is a tremendous acknowledgement of the disparities that have existed in our country for far too long. The pandemic has further exposed the disproportionate access people of color have to critical services, health care, housing, education, social support and protests are happening all over the word, all over our country, including, of course, in hawaii, in response to violence against black americans. And we cant just go back to doing things as usual and if ever there was a time to have some kind of reckoning to move us forward, this is it. When the top leadership of our agencies does not reflect the people they serve, that can have real lasting consequences, so, mr. Secretary, would you agree that diversity in those who are making decisions that impact the lives of all the Diverse Group of veterans that you serve, isnt diversity a good thing in order to provide truly Equitable Service to veterans . Senator, i will be careful in my answer. I i grew up in this world, i think you will find that the armed forces of the United States have been the great leveller when it comes to equal treatment. I have surrounded myself with people who have the same experiences. Everyone at this table has served in uniform. We understand the culture and we speak the language. My deputy, she graduated from she graduated from the United States air force academy, our assistant secretary for legislative affairs who is sitting behind me, i actually served under in the air force. We have one goal, it doesnt matter where we come from, weve all served and i think for us at v. A. , that is the most important thing. And i would also add what i said earlier, were the only Health Care System, senator, and you and i have talked about this, we follow gender disparities, we follow Racial Disparities. We have now brought up, just in the last few years, the percentage of veterans who are women to 42 , the percentage of veterans eligible who are male are 49 . So, we are moving up. Just a fuew years ago, there wa less than 200,000 women in the system. Today, there are 500,000. So i acknowledge that. I talk about the people who are making decisions on behalf of the Diverse Group of veterans that you now have, and many of them are women and were already acknowledging that they may have different kinds of health care and other kinds of needs and therefore you are seeking to address those, but its really the people who are making decisions. Lets face it. I am not disparaging anyone who is in the military, by the way. There should be an acknowledgement that we all have if bias, so, no matter how fair we may all think we are, unless you walk in the shoes of somebody else, it is it is not the kind of thing where we can say, oh, yeah, i know what you feel. I know what youre thinking. This is why i would say diversity in leadership is important. I do have a question. I would just say, my deputy served 30 years in the air force and i think thats a testament to how far v. A. Has advanced along the lines. I am all for women in decisionmaking, but we all know within the military, there are still major issues relating to Sexual Harassment in the culture, but thats a whole other matter and we also know there are disparities within the v. A. And im glad you acknowledge it and i hope do something about it. But do you do implicit bias training within your Leadership Group in the v. A. . Yes, senator, we do. Good to know. For years, i have been brought i brought up the Outpatient Health care access project and it was scheduled to be completed by fiscal year 2020, but has encountered multiple delays. Earlier this year, the v. A. Said that the lease award was expected by mid may, but in the recent weeks, we have learned that that has been delayed due to covid19. Now, a lease award is not expected until mid august and the project is not expected to be completed until spring of 2023. You can see where the veterans are very concerned that this project keeps being delayed. Can you explain to me what exactly is causing yet another delay and how v. A. Is working to address it and provide a detailed timeline for the project so i can let the veterans in hawaii know when they can expect this facility to be built . Yes, senator. And you know ive been in hawaii several times, and the aloha clinic is a classic example of what happens when there are too many layers of federal bureaucracy. Some not attached to the v. A. Gets involved in construction projects. This is a problem that i will bring to the chairman and i think ive mentioned it to senator tester, as well. The way cbo scores these projects is not realistic. The other thing that i will bring to the chairman is that for projects like the aloha clinic in hawaii, which have stopped and started because of cbo and gsa bureaucracy, we want to give more flexibility to the department and to the leaders on the ground to be able to engage in these contracts, contracts that reflect the situation in hawaii and not a one size fits all. So, i take your point. You are absolutely right. And we are working on providing this committee with hopefully some legislative solutions, so what happens in hawaii doesnt happen again. Thank you so much for acknowledging that and of course things are so much different in hawaii and one size fits all does not does not do it for us in hawaii. So, i will do whatever i can to assist you, mr. Secretary. Im glad that one of the senator, your time has expired. Sorry. I will send more questions for the record. Thank you, senator. The announcement about the vote has been delayed ten minutes, its now 4 40. I dont know what we have. Senator till lis . Just enough time for my round. Thank you, mr. Chairman, and senator tester, great to see you found your flat top again. Its a good look. Mr. Secretary and for all the witnesses, i want to go back on ive completed 45 telephone town halls updating people in North Carolina on covid and one thing thats required me to do is to take a look at the numbers and not view any one number in a vacuum. Im sure that you guys are taking a look at any increase in cases, youre adjusting that, youre looking at the rate of doubling, youre looking at how you adjust that for the rate of testing and those numbers, so, dr. Stone, in your opinion, do you believe, because this hearing, people could leave saying that the v. A. Admitted theres a 7 spike, but are you looking at all those numbers in that context, viewing it as a manageable number thats within your expectations . Yes, sir. Early in this, we were dealing with very rapid doubling rates. Were now dealing, your state has had gradually increasing numbers, but with the doubling rate that extends out between 30 and 40 days. Right. And early into the crisis, we were in five and tenday we were in one and threedoubthreeday doubles, yes, sir. I just want to say that before anyone takes one number, they need to understand the numbers. Because clearly youd be surging if you had a concern. Senator tillis, i was not trying to be disrespectful, but and you know i went into the law because i couldnt do math. Yeah. But when we have an infection rate that is as low as ours, 7 increase is in the tens or maybe at most the dozens. That doesnt mean its not serious. But it is not a crisis and i think weve shown since this began that weve been able to manage and our veterans have responded. We sent out well over 50 million individual communications to veterans and families. Weve warned them of what was out there and we have given them instructions and they have responded magnificently, which is why i think the numbers are as low as they are. John, you mentioned the need for reprogramming some of the additional dollars, i think youve been good stewards, i think you would have spent all 18 billion if you thought it was necessary. You are demonstrating good sfu wardship of the money that was given under the c. A. R. E. S. Act. I know ichd. T. Is something yo would consider. I know as you scale up telehealth, thats where you need to make sure you get that information. I also think that im looking ahead to a surge. If we take a look at the breakdown of patients, particularly acute cases and deaths, its clearly in congregate care facilities and populations where we have higher risk categories over age 65, Underlying Health conditions, et cetera. Were going to have another wave. The question is, how many therapeutics do we have, what have we learned in terms of protocols to reduce the spread. And also, in particular among the senior veterans populations in congregate care facilities at large, we should already be creating a mentality for a posture that we take before we hear of the first case in november or december. Are you all taking that step and trying to do that as part of your culture . So, we have. And the Nursing Home Community is the example. We serve a little under 8,000 veterans in 134 Nursing Homes. We put in emergency protocols very early on in this. We test everyone in the nursing home. We also test all of the employees. We stopped visitors and families. Very difficult decision, because more than half of those veterans are from korea and world war ii. And secretary wilkie, because i want to ask an openended question before the red light. You know how heartbreaking it is when you want to go visit someone in these facilities, i think if we set the expectation now, so that they just know that thats standard operating practice, its going to be easier to manage that, make it less likely that we see anything approaching and i dont believe well see anything approaching we have in this way. Last question, and its really maybe something for you all to think about, ive had this discussion with d. O. D. , as youre looking at deadlines and youre looking at other Requirements Congress has placed on you that you could rightfully assert that maybe you need a little bit more time to get certain things done, it could be projects, it could be reports, it could be any number of other things, i hope that youll report back to us and let us know the extent thats going to require statutory action and i think youd have a rational basis for knowing what those are and offline, well talk about the Electronic Health record implementation, i know it was delayed somewhat, id be interested in knowing whether or not there are resources that we could put in so that we can continue it, maybe through teleemfully menation, a number of other things, i know the Platform Providers did that. Thank you, senator tillis. Senator manchin . Thank you, chairman. Im just going to take a moment to thank all of the veteran Affairs Employees that we have in our state and that you have all around the country, because they have been stalwarts, theyve been on the front line and done a great job, they really have. My concern has been, and i think secretary wilkie and i spoke about this, the testing. Veterans are having a hard time, theyre confused about the test, theyre told they have to pay it for and theyre having its been, you know, preapproved and going through all the red tape. Have you been able, dr. Stone, maybe, to work through that, to prioritize this for them so our veterans can get tested if needed . Sir, i appreciate your advocacy for this and you and i have talked about it, and where were having trouble is the drivethrough testing and when the drivethrough testing is being done by somebody not enrolled in our system is where were having trouble with it. What we would like to get and what weve reached out to do is try and look at every drivethrough testing in place we can find it and try to enroll those Health Care Systems in this. Unfortunately, some of them is there something we can do to help you . Is there anything we can do legislatively or something through our office officially to help you . I think that we will work with your staff on at this time. Right now, Community Care believed they were well on their way to working their way through this to make sure that there was no bill sent out to any veteran and i can reassure you that within our system, there has been no bill sent out for covid testing and if there is, well reconcile it. Okay. Well, also, and mr. Chairman, you said that ppe, were going to be doing that next week . The ppe we put nearly 20 billion in that, in order to train, so, well get accounting. No use for me to ask that question if youre going to get into that next week. We will. And dr. Stone, ithe v. A. In clarksburg two years. If the rumors going around now are just unbelievable in the local circles about even the person of interest, maybe still working, being employed or coming back as a contractor sir, i can reassure you, as of a discussion yesterday, that is absolutely untrue. Well, i think it is, too, and its a vicious rumor going around thats hurting an awful lot of families. But the most important thing is, two years, do you see any end in sight . Sir, the answer to that question has to be done by the i. G. And the justice department. Senator, ive expressed my frustration with this. You and i talked and this investigation began before i was secretary. Right. And that is a disservice to the people of west virginia. This is its just i cant explain it. I mean, you can imagine what the families are going through. Why would you put anybody through this and i know youre not intentionally, i know that secretary wilkie, you couldnt believe, either, the insensitivity of whats going on, but weve got to get an answer and im going to go to, i think, to attorney general barr, ive got to go to attorney general barr and ive gone there before, but now its urgent now, two years. And now with the rumors starting to creep up, you understand, the whole uncertainty of whats going on and these people being left in limbo like that is just sir, this is a disservice to every veteran in that community and as you know, this is a Small Community that these employees have done a great job of cooperating every step of the way and we look forward to resolution with this. Anything you can do to help us, we appreciate. Thank you. We only have senator cinema left and shes to call in at 4 40, which is now, senator cinema, are you available . Let me ask a question, then, mr. Secretary, to which id intended to ask at the end of the hearing. I was caught my attention was caught by the two questions by both a republican and democrat about testing and about the 7 increase. I want to make sure i understand what that reflects. My assumption is that as more people are tested, were going to see more positive numbers. Perhaps this is a question for dr. Stone, but what is it that we should what if something happens, what should we be concerned about . What is the standard by which it raises a concern or a significant challenge for the v. A. Based upon its numbers in caring for veterans . What you should be concerned about in the community is the pref lanvalence of the disease. We built the budget for this, anticipating that 2 to 3 of the population would be infected. Were dealing with a fraction of that, frankly. Were dealing with a tenth of that. Secondly, what v. A. Must be concerned about is the ability to take care of sick people. About 20 of the positives are really sick and, do we have enough beds, do we have enough equipment, do we have enough personnel to care for them . Hence the reconfiguration of the v. A. s Delivery System to grow by almost 4,000 beds, as we went through this. And the hiring of massive numbers of people and the reconfiguration and retraining of am la toir nurses and providers toll provide support for the less ill so our Critical Care providers can deal with that. The v. A. Is wellpositioned to remain the backstop of the American Health care system and fulfill the mission that the secretary gave us and that you all expect of us, and at this time, as we enter this, im at 37 on our icu occupancy, meaning twothirds of our icu beds are now empty today across the system. Secondly, were at about 53 occupancy on our medical surgical beds. Those are the key questions that you want to know, as we walk through. Now, what weve seen across this nation is this slow background of cases, not in rapid spikes like we saw earlier in the disease in late february, early march, where we saw these huge spikes. Weve seen the slow back ground, and we anticipate having about 600 patients a inpatients for covid right through the fall. The question will be, will this repeat the activity of summer to fall 1918, where wave two is much more malignant, much tougher disease, so that wave two really resulted in dramatic deaths in late 1918 and in the early winter of 1919, january, february. Dr. Stone, what does medical Scientific Evidence have to say about that at this point . Anything . At this time, we have no idea. But i think your expectation should be, and i know the secretarys expectation of me and my leaders is to build a system that can appropriately backstop. So, mr. Chairman, i mentioned that we started preparing for this early on. Weve done things like purchase mobile hospitals. We did not have to deploy them, but they are ready. I also mentioned the creation of a militarylike depot system. The other part of that is that i signed a memorandum of agreement with the Defense Logistics Agency so that we are joined at the hip with them and their computerized systems so that v. A. Is no longer the ad hoc system that it has been. The year that i became secretary, there were over 4 million credit Card Transactions buying everything from tongue depressers to raid logical equipment. These reforms go a long way to eliminating that and making us better prepared for what may come in the fall. Thank you, secretary. Im going to turn to senator tester for a second question and then senator cinema is joining us now. Senator tester . Well, thank you, mr. Chairman. A couple things, and these can be really quick, guys, but on masks, i know theres been multiple guidances put out on masks, about how theyre to be used, if theyre to be reused, all that stuff. Have you fguys been put anythin in writing to direct the staff so they know what the expectations are on the n95s . Yes, sir. The guidance you reflect occurred on the 7th of april and then when we went to a crisis mode, and then we went to contingency mode on the 14th or 15th of april and ill get you the exact date. It was for only one week when we went into crisis mode and we remain at the guidance was that was given on the 14th or 15th of april, which provides one mask per day per patient that needs an n95, which is those employees in direct contact with covid patients. Okay. Thats good, mine, i think that theres some confusion out there, but if you feel that information has flowed to the proper sources, thats all you can ask for. Electronic health records. I dont really want to talk about this, but i got to. Well, i want to talk about it. Well, i mean, heres the deal. It seems like every position ive ever been in in government, elected position, over and what kind of timeline are we on here to get this up and going. And are we going to have to send doctors and nursing for training for a month so that they can understand how to use a record. This is a good news story. I mentioned in my Opening Statement that the va demonstrated the most agility of all the departments. Weve been working this even in the pandemic and on april 18th we were able to show that the joint Health Information exchange works. We spoke to d. O. D. And it tucks to us. The private sector can work the records. Were going to be going live on the scheduling portion in Columbus Ohio and then i expect that spoke can and then later seattle will be up and running. That will be later on this year. You are correct that we took practitioners off. So that they can handle the electronic supply of the system, out west, many of our facilities have buildings that date back to the 19th century. That was the case in washington state. We are in a much better position than we were the previous time i spoke to the committee. We need to conclude with a vote. Thank you so much mister chairman. Thank you for your patients with our technical issues. So we are hearing from moran and she supporting the homeless veteran community, the pull that the serve and the step they employ, one key reason for the luckless a port is theres just not enough support for national. Veterans testing strategies across the population. Access to personal protective equipment, and care for veterans that test positive for coronavirus. I know that the va is in need of more resources to support the veteran community. We are going to address these issues. The work increases the resources the public has for veterans. Its important to lead on a National Strategy in support of our veteran community, in collaboration with the organization that provide services to the. Community why has this not been done thus far . Senator, thank you, i know that this committee and you and senator sullivan have been working on this. Your efforts are designed to give us more flexibility. I can tell you what we have been doing during this epidemic. Weve used fringed Million Dollars of additional funding to augment the three major programs that we have. First is supported services for veterans and families to increase the number of vouchers available for transitions and housing. We have tripled the podium unveils so that more now addressing the basic food needs of our veterans, and weve augmented our Emergency Shelter programs. In hotspots like los angeles we are actively working with the community to bring veterans into. Tense regardless of whether they want our health care, we are getting in them into the tents which gives them access to food and other services that agree to have. I will be announcing later this month our national roadmap on suicide prevention, and as i said, when i first address this with you, it was just a roadmap, if it was just roadmap looking into the future of veterans life it wouldnt be worth much. So we are looking at Mental Health and homelessness, these areas that the nation as a whole has ignored. I will let the doctor respond to any of the medical questions you raised. Senator i appreciate your advocacy for this. This is one of the areas were deeply concerned about. I spoke earlier as did the secretary about the financial instability, and the risk of this population. Weve added 30 Million Dollars through the supplemental funding to support homelessness, thats a 1. 3 eight billion Dollar Program that we asked to increase to 1. 8 nine billion. Weve increased by 70 in the port of services for veterans families. 220 million to the 300 million was added. We also added 80 Million Dollars for the grand per, dm and thats for emergency housing and hotels primarily to get veterans off the street, especially the so that we can help to manage the potential illnesses in that population. As you know, in certain high cost areas we are gratified that we were given more money to support the community. We also added an additional 10 Million Dollars to ensure that theres adequate personnel. We continue to be pleased with your advocacy for this population as we work our way through this. A quick followup because i know that my time is expiring mister chairman. I would love to circle back and talk more about this. We are providing services to veterans, normally that happens outside the normative system. The disjointed operations outside of the country, i am advocating for us to have a joint strategy to address this pandemic. Thank you mister chairman. I appreciate your time. Senator, let me indulge the chairmans questions. I think thats one of the reasons the chairman has interest the legislation that is still working its way through the process. Its something that we supported, that we have more robust relationships with charities and the state, Non Governmental Organization so that we can get into those places that the va cannot. I cant thank the committee enough for taking that idea that you just express and putting it into action. I think the committee has taken a huge step forward. Thank you mister chairman. Senator, im going to ask two quick questions to your secretary. Then im going to see if there are any additional quick questions and we need to conclude our hearing. Two more questions related to the committee chair, mister secretary, your staff and my staff, between the two groups there were 1000 signatures. March 4th to april 29th 2020, so through the pandemic, could you tell me how many authorizations of Community Care were provided in that same timeframe a year ago, so that i can make a comparison . I will have to take that for the record. I believe that were getting that information to your staff. Thank you. Yes sir. Second, youre reopening plan mentioned that the va will open virtual appointments when quote clinically appropriate. I want to make sure that clinically appropriate is not a freeze thats will be used to deny community here as appropriate, which in most instances is when its in the best interests of the veterans. Yes we have the same interpretation. What ive seen with veterans is similar to what practitioners have seen across the country with regards to veterans. Most instances of veterans not going into the community has been on their wishes. We are doing everything we can to wrap this back up to where it was. 60 is not good enough. Its not in line with the forms that you and i have championed. So clinically enough is not an impediment to here in the community. Senator . Thank you mister chair. Quickly, the chairman mentioned this in his opening remarks. Especially with covid19 now, i think the challenges around Mental Health will be more significant, not less. I appreciate the work that you and your staff have done with our staff to make sure that we are prepared. I will encourage my side to keep that up, because i think that this bill is important. I dont think that you see these things differently. We need to keep these things going, because im not sure, we dont have arms around it yet, so we have to use every tool we have available. If you want to comment on that you, can but i would just like to say that i appreciate working on, it and i think we need to get it done, unanimously despite the wide differences in politics on this committee. In closing mister chairman, ive been watching you on tv for the past two hours and i would say that if you decide to give up the va, you have hope of becoming local announcers on tv stations. I dont know if there was a compliment in there, i was distracted. Yes i look forward to being on high definition. Senator, there are two bills pending in the senate, i was informed today that i think one of them is ready, and the other is cleared on our side and not yours. If you could check with your staff at this is something that we both support and the department has been asking for. I will check. I always give witnesses in front of my committee the opportunity to clarify or retract, nick corrections if theres something they wish they said or wish they didnt. I will go back. That wont stop me from thanking the committee as i did in the beginning. Theres no Better Committee when it comes to the oversight of the department for what you have responsibility, or a more collaborative committee. I want to say one thing. Thousands of va employees have put themselves in harms way. They deserve the thanks of the american people. Weve opened our hospitals. Weve sent people into extremely dangerous situations. Theyve responded in a great way. We have a lower absentee rate, and a lower leave request rate this year than in previous, is because people have responded to the call to the d as they always do. Mister secretary thank you very much. I appreciate your testimony and our conversation. I would express my gratitude on behalf of all americans. A lot of veterans have arose to the cause of caring for their brothers and sisters in the va. We thank them for their service. Thank you for your bra duration of that. I join you in that sentiment. Thank you sir. For the disabled veteran americans have each year introduced a independent budget based on their assessment of their needs. We have no partners to submit written testimony of the budget request for the va. They provided valuable feedback. Without further notice i will enter their numbers. You have the opportunity to submit for us today different questions for the witnesses, please do so in the next few days. Mister secretary please have your committee respond as quickly as possible. Without further conversation, we are adjourned. Tonight on American History tv, a look at the American Revolution beginning at 8 pm eastern with historian and author philippe green walled, on the origins of the revolutionary war. Thats followed by a discussion about revolutionary war closing, and how american tailors impacted the era. Then the origins of the American Revolution. A number of historians offer their thoughts on how it started. Watch American History tv tonight and over the weekend on cspan three. The Senate Budget Committee Held a confirmation hearing for the nominee of the white house budget director. Senators asked o