Transcripts For CSPAN2 Key Capitol Hill Hearings 20141114 :

given an opportunity to help try to change the direction of the country. i believe that's not just an opportunity but an obligation and we are focused and committed to focus on the economy as well as getting people back to work to strengthen the middle class. >> joining in what my colleagues have said there is a lot of work up there to be done. i'm optimistic. we have the rules of the senate that allows us to do it. it gives us follow those rules. i'm also lost the sick there are a lot of things beyond the keystone pipeline that there is tremendous agreement on if we can just get to that work and i believe the new majority leader is absolutely committed to see that we get this work done. lots of legislation like senator barrasso just said for more american energy and things that produce good jobs to take care of families in ways that families would like to be able to take care of themselves and frankly the president is going to engage one way or another. the last four years not much reason for the president to engage with the senate or the congress and the next two years he will either have to engage the day the bill winds up on his desk. at that point his choices to sign or veto it or decide to engage a earlier in a way that we might be a will to do hard things together. i think the american people has set a clear sign they want to do the government to do with what the government is supposed to do it better than the way they have been doing it and they want the government to get out of the things they can to better themselves. that's the challenge for this congress and this president had i hope the president decides now is a good time in a divided government to do hard things. we need to get those hard things out of the way so we will see more good private sector jobs to provide good take-home pay for families. >> let me begin by reiterating what i have been telling my colleagues for the last hour or so. i very much appreciate the opportunity to represent the republican congress in the 2016 campaign. i also want to congratulate dean heller for a gentlemanly friendly campaign. we made it clear dean and i all along that this was a race between friends, i contest decided among friends and we began it and ended it that way so i congratulate him on a very fine race. i also want to congratulate jerry moran and rob portman for the wonderful job they did leaving this committee over the last two years trade let me just say we are determined that we build on what we had in 2014 for the 2016 cycle. that includes increasing our majority and making it possible to elect a republican president in 2016. the american people sent a message to strong message with a huge swing in the united states senate. listening to that message begins with good government in the united states senate so i am so pleased with the agenda that leader mcconnell set out today. the american people want us to return to regular order to bring up issues of concern to them to protect minority rights as they have not been protected over the last several years and to send to the president of united states and an act into the law changes that benefit the american belt class and middle-class families. winning in 2016 begins with good government, with good legislation and i'm glad to be part of this team for that reason. >> leader mcconnell will you be able to follow through their pledge to have no government shutdown. [inaudible] >> we will not be shutting the government down and default on the national debt. we will not be shutting the government and are threatening to default on the debt. >> senator mcconnell you just mentioned health care and i wanted to get you and anyone else to weigh in on -- what did he tell you? is there anything new and is there a change in the way you plan to approach obamacare? >> i think what he said, i think you all heard the definition of the washington gaffe, when a politician mistakenly tells you the way he really thinks. we were subjected during the obamacare debate to a whole lot of stuff that we all knew was not true, not even close to true and what this insider said and confirmed is that they were spinning tales from beginning to end because they knew they couldn't tell the truth about obamacare and have a chance of passing it even with a democratic senate the 60 votes. so the american people hate detest and despise obamacare. virtually all of us would like to see it pulled out root and branch. we understand the president obviously is not sympathetic with that point of view but we will be voting on these issues but the overall obamacare issue and the various pieces of it like the individual mandate, the medical device tax and trying to restore the 40-hour workweek. >> you talk about being disturbed by the president proposing -- what should congress do in this congress to address this? what should congress do next year's. >> what we said as is we hope the president's going to do that because there's a lot of interest among republicans in both the house and the senate in passing and immigration reform bill. i don't think there's anybody in our conference who doesn't think the current system is a mess and we would like to improve it. the president has been told over and over again we are telling him again today don't do this because his executive actions are not permanent changes. they won't necessarily be there under the next president. he really wants to improve the immigration system we have in this country he is stuck with a congress that he does not like and you know president reagan never had a house in eight years and president clinton didn't have the house or the senate for six of their eight years and they understand the american people elected a divided government. we like for the president to recognize the reality that he has the government that he has, not the one he wishes he had an work with us to try to find a way to improve our immigration system. we will let you know. thank you. [inaudible conversations] after meeting with european union officials today attorney general eric holder talked to reporters about foreign fighters in iraq and syria. he talked about where those fighters are coming from and illegal actions the justice department is taking to prevent them from reaching the battlefield. this is 35 minutes. >> to the members of the doj press we have visitors from another country here today so let's be nice, okay? i got no response. thank you all for being here. it has been a pleasure to welcome somebody to my colleagues to washington d.c. for this week's important ministerial meeting. now for the past two days we have discussed the considerable work that currently remains in the united states to coordinate on common threats in addition to the steps that we can and must take together. in the last year alone or nation has taken tough coordinated action against cybercriminals on line shopping offers and transnational organized crime. we have the provision they have hearing from some other lead prosecutors on the game over zeus cyberinvestigation in the actions against dark markets including the second edition of the silk road web site that have taken place over the last few days. united states authorities and multiple e.u. states. we also heard how we work together against traditional organized crime groups including coordinated work with italy that lead to 25 arrests in new york and latvia earlier this year. importantly we also discussed a number of steps that the united states and the e.u. and its member states can take together to address the issue of foreign terrorist fighters including for information-sharing, investigation and prosecutions and countering violent extremists. one important area that we have agreed on was developing the capabilities of our partner governments to deal with foreign terrorist fighters increasing their capacity to deal with this issue. the department of justice is part of united states government wide effort in this regard. i can announce today that with the support of the state department's bureau of counterterrorism the department of justice has detailed federal prosecutors and senior law enforcement advisers to reside in key regions including the balkans, the middle east and north africa to work with countries seeking to increase their capacity to investigate and prosecute foreign terrorist fighters. the department of justice has a been residing for balkans countries and will soon be placing a regional counterterrorism adviser in the area. the justice department prosecutors have also been placed in 10 countries in the middle east as well as north africa. each personnel -- personnel to provide critical assistance to allies to prosecute those who turn from the syrian region bent on committing acts of terrorism. are counterterrorism prosecutors in the united states also challenged other countries to collaborate with their counterparts and we assign the united states prosecutor and interim director of the international institute for justice and the rule of law for aye-aye j. located -- which provides a forum to discuss the foreign terrorist fighter problems and work with international partners to arrive at solutions. the justice department provides vital expertise and support to the aye-aye j. in partnership with the state department bureau of counter terrorism and collaboration with the terrorism committee and executive directed. finally we are working with other partners including the u.n. office on drugs and crime to help build the capacity of partners worldwide to engage in mutual legal assistance in cases involving terrorism as well as national crime. our goal in all of these efforts is to build the capacity to fight foreign terrorist fighters within the rule of law so we can stop the flow of fighters, stem the tide of violence and aggressively combat violent extremism. as our discussions have shown in all of these areas we can succeed only as partners and i'm happy to have partners such as these on both sides of the planet. i appreciate this chance to join valuable colleagues in washington as we keep advancing these critical discussions and building on good work that is underway and i look forward to accomplishing in the years and months to come. at this point i'm going to ask the minister of justice orlando to say a few words. from. [speaking in native tongue] >> translator: hello to everyone and thank you to eric holder who is fundamental in the work that we did. via tiny and presidency take advantage of the occasion today to talk about the work that has been done, the precondition for work to talk more about the things that we spoke about today. there were moments of success and strengthening of our ties. in this sense, it was very opportune the choice to put together our two agendas for a common cause. the collaboration to fight against cybercrime, the collaboration in the fight against organized crime, putting law enforcement together with italians. this was the subject of the collaboration in fighting against terrorism which is an important threat to our two countries. we talked about the protection of personal data. we still have to go into these points more profoundly. what we talked about will commit the next presidency to make more progress in the direction to homogenize, to treat equally to all citizens and equal treatment of americans and foreign people. i want to conclude indicating a fact. today we consolidated an important point, the management of security for our country, the collaboration between the two countries on either side of the atlantic, europe and the united states as a common strong pill pillow -- pillar for security and the security of single states. in this sense today we can say we made progress even though we have a lot of work to do. thank you. >> first of all let me start by saying how delighted i am to attend my very first trip european commission here in united states of america. we in the united states are long-standing allies. we stand for the same values, freedom, peace and democracy. our joint goal here yesterday and today is another concrete example of how together we can be more effective in upholding and defending our common values. needless to say the relations between the european union and the united states and the justice and affairs area are various and reflect the strategies of our partners. in our meeting this morning with attorney general eric holder and his team was very successful. i also had a fruitful meeting yesterday with the homeland security secretary johnson who has made today's meeting a success. today, as it was said before we discuss the future of the european union u.s. relations in the justice and home affairs. we intend to further develop that incentive over the next five years. the two main topics in the home affairs area in our agenda were the foreign fighters phenomenon and organized crime. both are burning issues in europe and in america and both integrate aspects of our cooperation stretching into areas such as security, information exchange, border management and policy. we will look into how we can better exchange information involving europe and to see how our respective law enforcement agencies can better cooperate and use the available tools more efficiently. in europe our law enforcement agencies have a strong track record. just yesterday as you know in cologne germany many people suspected supporting isis and other extremists were arrested. and i would like to take this opportunity to congratulate them for their excellent work. the arrests in germany also underscore the importance of our joint work here today. we both recognize the necessity to strengthen our cooperation in court nation. in fact it is a prerequisite if we want to succeed in containing isis and foreign fighters. again, in the context of foreign fighters we touched on its impact and mobility between the european union and united states citizens. the european union is following closely the discussion in the united states and especially those who are calling for an approach towards the visa waiver program. i fully understand these concerns. nevertheless i sincerely hope that all relevant authorities will offer a proportionate response to this which will not hinder travelers of good faith. i also hope that our common work on the enlargement of the visa waiver program will not be affected and that we will soon achieve full reciprocity between the european union and the united states. full visa reciprocity should become a tangible area that underscores the importance of our strategic partnership. moreover in the absence of my colleague i also discussed with my american colleagues a number of justice ruth -- justice related issues. we focus primarily on data protection issues in and ongoing umbrella agreement negotiations. we shall be more than happy to see the united states adopting legislation on judicial redress and finish all the open points in our negotiations. our teams here in washington will continue the negotiations tomorrow and i hope and wish that we achieve progress. we should also continue to urgently work to address the shortcomings of the safe harbor arrangements. we also had some good exchanges on mutual legal assistance. it is vital that our agreements in this area including extradition really work and that we use their full potential. this is the only way to be able to address effectively the challenges of organized crime. of course the topics that we discussed today did not cover all aspects of cooperation. other issues like drugs, migration, cyberthreats, more efficient border checks for victims rights require our attention and will be the subject of our discussions in the future. on behalf of the european commission i look forward to a constructive relationship with attorney general holder and his successor as well as the secretary johnson. i also look forward to welcoming our american friends at our next e.u. u.s. justice and home affairs meeting early next year in brussels this time. thank you. [inaudible conversations] >> attorney general he said they will be go -- going overseas. will they either to bring their own charges or will the u.s. bring their own charges? >> to increase the capacity of those nations to investigate these kinds of cases and to work with them in partnership and determinations made at that point if charges are to be brought where they can be the most effectively brought. that's the nature nature of alum portion and partnership come investigating together and at the jurisdiction lies in two places determining where the most effective prosecution can be held. >> mr. chairman can you update us on the number four and fighters heading to syria and iraq and how many americans are included in that group? >> i think there has been recent documentation that has been shared. the numbers that we have i think i wouldn't say they go back and forth necessarily that they are not as precise as perhaps we want. we have a good sense of what the number of people are in the categories that we have identified. i think nctc has released some information i think accurately reflects our best knowledge as of today. >> please identify yourself. >> eric tucker with the "associated press." mr. attorney general is that your sense that justice department lawyers will actually be crafting new statute in the nations were not exist similar to the material support laws and is that the overall premise here? >> a number of ways in which i think these prosecutors will be used to help with investigations and determinations as to where prosecutions would occur. also look at what you have raised. are there statutory changes that might be made in particular countries to increase the capacity of that nation to detect and hold accountable people who would engage in these kinds of activities. >> mr. attorney general kevin johnson. can you tell us how many are in this group and when they will begin their work here? how many prosecutors and advisers will be placed in these areas? >> we can get you that information in terms of when they will actually be there in the overall numbers. we can get you that information. >> brian berry girl politics. a question for the commissioner on the visa waiver program. how realistic is it that you can get reciprocity with all the member states included when the pressures in the opposite direction to restrict the program and for mr. holder how are you proposing to get the writer for additional -- judicial redress from the united states congress? >> it's not difficult because the answer is very simple. that is why we are here and it was clear before when i talked about the visa waiver and all these issues. what is our vision? what do we want to do in the future? to adopt the principle of reciprocity at all levels in the way you want to see the europeans the united states without any bureaucratic obstacles the same way the american citizens are traveling to europe. the major security concerns -- in the last few days we have talked a lot about it that but the answer is very clear. we are here to find a solution on this issue. our discussions were based on mutual respect and good faith with full recognition of the reality with which we are confronted today. on the other hand as i told you we must focus on the future and like i said before it's our vision. let's hope that this day is not far away. >> as i indicated to my friends the united states government has pledged to the obama administration is pledged to introduce such legislation. that legislation has been drafted. it is now being circulated in congress awaiting their input before it's introduced that legislation as it has been drafted is now being reviewed by members of congress. >> attorney general there is word out today that the white house is readying your recommendation the dhs recommendation. dhs immigration -- can you top from her legality standpoint are you concerned that if you give the president the authority to take such a broad policy do you set the stage for future presidents to do something maybe whirling back voting rights or civil rights or environmental things that you care so much about? are we setting a precedent here if you go down this road? >> i would first say that i'm confident what the president will do will be consistent with our laws. we have been interacting with the white house on what i call a rolling basis to look at the proposals. what somebody can do with executive action is far more limited than what congress can do. a president could not by executive action for instance rollback lets say the civil rights act of 1964. .. i'm sure within that one thousand three would be things if would disagree with. an awful lot he did that was good. i'm not sure that any of the things that president did or others have done, i would consider necessarily unlawful. >> i would like a reaction from the european ministers perhaps that the u.s. requirement -- increasing the requirements for information that travelers must provide as part of the visa waiver process. if you can give us reactions to -- mr. holder, if you could tell us your -- whether you're satisfied with the law that exists, for instance insuring italy and other countries with regard to material support and those similar laws. >> i understand that in order to make this program more successful, we all need more information. but it's good for you to know that in europe, there are two basic principles upon which the european edifice is built. respect of fundamental rights and privacy. now we have to put together these two elements. it's not an easy thing to do. but what guides us are the principals, and he we are to talk with the american administration, government, how can we find the best solution? let me tell you, something that comes spontaneously. all this measures to be taken should not become obstacles for the free movement, as i said before, between europe and the united states of america. i cannot imagine visa coming back in europe. we must defend it, protect an achievement, if we're together. is very successful. and has given very tangible, positive results in the way it functions. the fact that we are in front of a new reality, to sure puts us a all in further responsibility to enhance this program by providing even some more information, but innings that will not touch the heart of the principles and the values of the european democracies. >> i would simply say in response to your question, i don't think it's appropriate for me to necessarily pass judgment on the state of the laws in a particular country, other than i think we have come together as a group to understand that we want to examine the state of the laws in each of our nations so that we can have the most effective statutory regimes possible. and so we will share information about the state of the law in the united states as we are examining and learning from the state of the law in other countries. >> isis seems to have some growing support in some sections of egypt. is there a concern about this becoming a possible new gateway for the organization and is that a topic that was addressed during the discussions today? >> it was one of the topics we discussed during the last two days. and right now our services in europe welcome this issue. i'm not able to give you details on that but very soon we shale be in a position to make some announcements. >> from politico, on to topic of cybercrimes, we're coming up from six months when you announced indictments for chinese officials for hacking american companies and promised we would see more of the same. why have we not seen any followup indictments and whatles are you doing to crack down on state-sponsored espionage. >> that's something we take seriously and that's evidenced by the prior indictments you referenced. we have ongoing investigations, and when they are appropriately ready for dissemination, we'll announce them. but it is something that is of great concern, not only to the ute government but tower partners, our allies as well. >> from fox news. i have a question for the eu minister. is turkey the weak link when it comes to foreign fighters, and mr. attorney general, do you think there's 100 american foreign fighters headed to the region? are you reading that number as being high or low or more than that? >> on what we tried to do, we have to engage also turkey. turkey is located in the very sensitive area. we know that in the past jihaddists have crossed the country, but we cooperated very closely with the turkish authorities. and so far the results are very, very positive. when i said we must engage turkey is because they're one of the major stakeholders in the region. they know the situation better than anybody else on the ground. and as i said, they have -- they tried to erect a wall in order to protect the european borders. this cooperation, because of the time is becoming deeper and deeper, but the answer is, yes, we cooperate with turkey, turkey is engaged. turkey is committed, and we believe we're going to give this fight to the end together. >> i think as i said, and i believe the ntc has released a document that breaks down very specifically the categories of people, those who attempted to go, those who we have under investigation, those who have gone and returned, and so i would just refer you to that document because, frankly, i don't have n the numbers off the top of my head. >> dave mclawful lynn, bloomberg news. banks agreed to pay more than $4 million for manipulating foreign currency markets. i was wondering if you might be able to provide an update of the department's investigation, and your investigation resulting in a similar level of fines. >> that matter is ongoing. i expect that we should have a resolution of that early -- or at least the beginning stages of a resolution of that relatively soon, and i would expect that we will have resolutions on both the civil and criminal sides with regard to our investigation. but the investigation is ongoing. >> just ask you a question, mr. attorney general, about ferguson. can you tell us about your conversation with officials there yesterday and what assets is the federal government offering? >> i thought i had a good conversation with officials who represent the people there at both the state, local, and federal levels as well. our community relations service has been in ferguson since the shooting. ron davis is the head of our cops office, has been out there, and i think done a really great job in interacting with people in law enforcement, so that whatever the results of the grand jury determination, we can hopefully have a law enforcement response that is appropriate and proportionate, and we are prepared to help in any way that we can. as i said, we have been there since the shooting, obviously i was out there. but our presence there has been continuing. we have our own investigations that are ongoing, both criminal and the civil rights investigation. so we have fbi agents, we have prosecutors and investigators out there as well. >> did you have a message for both law enforcement community and the community snifts. >> certainly we want to ensure that people who have first amendment rights, have the ability to protest as they deem appropriate, while statement -- while at the same time make sure we protect people in law enforcement and minimize the chance that any legitimate protests devolves into violence. >> cbs news. with voters voting to legalize marijuana do you plan to push congress to reschedule marijuana as a less dangerous drug as part of your smart on crime initiative. >> the question as to where marijuana ought to be categorized is something for congress to ultimately determine. i think in response to a question like that before, i said that this ought to be done on the basis of science and experience and look at what categories one, two, and three are, what drugs are in those categories, and on the basis of the knowledge that we have, make appropriate determinations. but that is for -- ultimately for congress to do. >> to the back. [inaudible question] [inaudible question] >> would cooperate and possibly take -- >> as far as is concerned we have the deployed there program. it is treatment program. first as main purpose, to protect the european borders. before it was a program adopted by the italian government at that time, but we also have fontex. it's playing a very important role. not only in defending she european borders, buttoned that in providing member states with the necessary support for search and rescue. so, from political, from an italian point of view, the job is done in a very, very efficient way in this part of the mediterranean. this does not mean the problem is resolved. on the contrary. right now, according to information we have gathered, more than one million regular immigrants, some of them victims of smugglers, there on the shores of the mediterranean. the countries are cooperating, and i can tell you that the european union has taken the helm on that. now under the italian presidency, one more step forward has already been done, but the authorities of the member states, and of course the european union agencies, work very hard in order to intercept all direct or indirect threats that could penetrate through the immigration issue as it has appeared during the last ten years. last but not least, i want to tell you that this problem in the beginning, five years ago, was considered to be a problem only of south and european countries. enough it has become a pan-european issue, and with dimensions which has become a global one, given all this new conditions that have occurred in the meantime. >> with regard to the four countries, i have them in my mind but i see bruce swartz back there sweating and i'm sure he is concerned i will put somebody in the category or leave somebody out and rather than do that and create an international incident we'll provide you with those names. i'm not going to -- bruce schwartz is right there and he can share with you the names and i'll talk to you later, bruce to make sure i had them correct. >> thank you so much. >> thank you very much. [inaudible conversations] >> today, department of veterans affairs officials testified hat a house hearing about health care for veterans, addressing implementation of a new law passed in response to falsified medical records and long waiting lists for care. this hearing is two and a half hours. >> everyone take their seats, please. committee will come to order. welcome back, everybody. it's great to have you back. appreciate everybody joining us for this full committee hearing, an oversight hearing today. i want to ask unanimous consent that several of our colleagues be allowed to join us at the dais, representative murphy from pennsylvania, and lamafa from california. they asked to join us, and i would ask unanimous consent. and without objection so ordered. as everyone sitting around this us today is away the president signed the act into law which is public law 113-146. this law was carefully and thoughtfully crafted after months of aggressive oversight by this committee, to address the unprecedented access and accountability seasonal that had engulfed the department of veterans affairs following allegations that were first uncovered in this room. that some va medical facility leaders were keeping secret waiting lists in an effort to manipulate wait time data and ensure their own executive bonuses. we're here today to evaluate the progress that va has made to implement this law in accordance with both statutory requirement deadlines and congressional intent. this includes the effective and timely implex addition of the veteran choice program that was designed to provide rethrive veteran whose reside 40-miles or further from a va facility or who cannot get a timely appointment. also includes the required independent assessment of va's healthcare system which, in my opinion, should necessarily inform decisions about staffing and infrastructure that are to be made under the law. finally, and most importantly, it includes accountability on which i will focus my remaining remarks. section 770 of the law authorizes the secretary to fire or demote senior executive service employees for misconduct or poor performance. that should go without saying that veterans deserve the very best leadership our government has to offer. yet the events of the last year have proven that far too many senior va leaders have lied, manipulated data, or samely failed to do the job for which they were ahead. also clear that va's attempt continue still accountability for these leaders has been both nearly nonexistent and rife with self-inflicted roadblocks to the reform that each of us expects. when i originally drafted this provision, i believed it would be able to provide secretary mcdonald with the tools he needed and wanted to finally hold failing leaders accountable. when president obama signed it into law, he agreed by saying, and i quote, if you engage in an unethical practice, if you cover up a serious problem, you should be fired, period. it shouldn't be that difficult. end quote. based on these comments as well as similar statements by secretary mcdonald himself, i am both perplexed and disappoint ed at the pace chat employees have in fact been held accountable. even more worrisome is what sect mcdonald said on november 6th, that, and i quote, the new power i was granted is the appeal time for senior executive service employee of the va has been reduced in half. that is the only change in the law. so the law didn't grant any kind of new power that would suddenly give me the ability to walk into a room and simply fire people, end quote. now, it is clear that the secretary and those advising him remain confused. about what the law actually does, which is much more than simply reduce the appeal time. the secretary can't simply walk into a room and fire an scs employee without evidence warranting that action. but the law does give him the authority to remove that employee for poor performance or misconduct. the secretary is also cited a plethora of numbers that he says illustrates the department's commitment to holding individuals accountable. for example, he says there's one list of a thousand names of employees being removed, and another list of 5,600 names of employees being removed, and yet another list of 42 names of senior executives that va is proposing action on. so, let me take a moment and try to set the record straight. based on our briefing, va provided to committee staff yesterday, va only has one year of aggregated data on disciplinary actions taken against any of it over 330,000 employees, making meaningful comparisons against previous years impossible. further, the list of over 5,000 mentioned by the secretary is propose eddies plenary actions only, and the list of over 1,000 is a list of proposed removals for any type of poor performance, not necessarily connected to the debach cal we discussed at length in this committee. and only the list of 42 provided at my request on a week live basis, includes employees proposed for discipline due to crisis which has engulfed the va over the last year. what's more, since august 7th, only one se employee has been removed under the law, and this person's removal was not directly related to patient wait times or data manipulation. so i don't understand. in the wake of the biggest scandal in the history of the adapt of veterans affairs, how only 42 employees, only four of which appear to be senior executive individuals, have been proposed for discipline with none yet removed. further, va has taken the liberty of creating an additional bureaucratic office, the office of accountability review. to review proposed removals and an additional bureaucratic delay, five-day advance notice of removal, which essentially operates like a new internal appeal process. these questionable actions are nowhere to be found in the law that we wrote and the president signed. in my view, the five-day advance notice of removal only serves to incentivize poor performing senior leaders to drag out the disciplinary process while continuing to collect a hefty paycheck for ultimately retiring with full benefits. further, it perpetuates the perception that va carolina more about protecting bad employees than protecting the veterans of this country. we should not be providing credit towards a taxpayer funded pension for a time period during which an employee's actions caused harm to a veteran. that's why i'm going to be introducing a bill that would give the secretary the authority to reduce an ses employee's pension to reflect the years of service during which they participated in actions that made them subject to their removal. ing the is a fair andes billion way to emfew says to employees that retirement credit is not earned by failing veterans and that their actions have long-lastinglasting and meaningl consequences, and i'm not going to get into individual personnel actions at this time since there are serious legal issues at hap that must be dealt with respectively and appropriately. however, i want to make it clear today that i continue to have serious concerns about accountability at the department of veterans affairs, again in response to what is without a doubt the largest scandal that has ever impacted va. i'm not seeing the corresponding efforts to hold those at fault accountable for their actions. deputy secretary gibson, as we discussed on the phone yesterday, i have an increasing worry that secretary mcdonald and you are simply getting some bad advice from some of those around you within va's bureaucracy and i hope that's not the case. this is the same issue that i believe doomed secretary shinseki's tenure, and i hope you listen when i say the va's -- must be shaken up to ensure reform. i truly appreciate your service, and for you being here this morning, ask with that now recognize and walk the ranking member, mr. michaud, for his opening statement. >> thank you for having this very important oversight here everywhere. to get an update on the immigrantplex addition of the veterans access choice and accountability act of 2014. this was passed in august, addressing a number of serious issues that department had with providing timely, quality health care to veterans. long wait times are the problems that got us where we are today. we shouldn't make veterans wait for the solutions to be implemented while today is a first public update of the va's implementation of this law, staff help updates have been occurring on a regular basis since early september so thank you, mr. tush tuchschmidt, and i appreciate the time you invested in openly communicating with the staff on both to the house and senate side of the committee on the implementation issues and the progress you have been making on those issues. this is a marked change that in the va congressional relations, and i hope that it's a precedent for improving working relationships as we go forward. the law provided additional resources and authorities to provide four key improvements for veterans, timely access to health care, expansion of va's internal capacity for care, improved accountability, and additional educational benefits. today i hope to hear tangible ways veterans are getting the improved outcomes intended. if there are real and reasonable road blocks to implementation, we need to know what they are and how we can fix those road blocks. with regard to timely access to health care, i'm aware that the depth has expressed serious concerns with the 9 0-day deadline under the choice program. the program requires va to determine eligible, authorize and coordinate care, manage, utilization, set up a call center, and implementer new payment system. va has taken a phased roll, out approach in order to balance ex-speedens with effective programs. that's my be reasonable but i want to understand the overall timing and how the department of veterans affairs is handling eligible veterans access to care in the phased approach. a phased approach may be okay but the phased approach to access to care is not. the law provides $5 billion for the department to augment staffing and infrastructure. i know the secretary has personally been out to recruiting, and i look forward to hearing how successful that effort has been, and how many new doctors and nurses va expects to bring onboard and when they expect to bring them onboard. i'm also interesting in hearing how va will implement the funds and authorities for new infrastructure. we have seen many problems with the department of veterans affairs construction problems in the past, and i look forward to hearing the changes va is making to the process in order to deliver these new projects on time and within budget. with regard to accountability -- inurned that removing a federal employize not as simple as many thing it should be even with the new authority in the law. i appreciate the difficult position the department is in when it comes to holding employees accountable for wrongdoing and poor performance in a highly charged and very public environment. that being said, we need to feel that the department of veterans affairs is taking the necessary action to move swiftly as possible, and decisively as possible to get rid of those employees who failed the american veterans. the explanation for delays need to be clear, concise, and compelling, not just to congress but to veterans some the american public. and while much of the focus of the law has been on access and accountability provisions, we should not forget that the law also includes substantial enhancements to the education benefits for veterans and their families. i look forward to hearing what is being done to implement these provisions of the law as well. beyond the veterans access choice and accountability act of 2014, i know secretary mcdonald has announced a number of reforms aimed at addressing the cultural and structure of the department of veterans affairs. many of these reforms reflect ideas we have discussed in the past, and i'm pleased to see them being embraced and actively pursued as well. and i would encourage the secretary to quickly define detailed execution plans for these concepts. do not get stuck in analysis of processes and figure out what actions need to be taken and then take them. be fearless enforcing these reforms, just as our nations veterans are fearless in their battles. once again, i want to thank the panel for appearing before us today. look forward to hearing your testimony. we appreciate your time and effort and want to thank each of you for all that you're doing to make sure that our veterans and their family get the access, the quality care in a timely manner for our veterans. i know you have been under a lot of pressure over the last year, and look forward hearing how the new law actually helps relieve some of the burden and what you're daigh administratively to help compliment the law that was passed and signed by the president. so once again, thank you very much, and thank you, mr. chairman. i yield back the balance of my time. >> today we're going to hear from one panel, already seated at the table. joining us from the department of veterans affairs, the deputy secretary, the honorable sloan gibson, accompanied by mr. james tush schmid, the act illinois principal deputy under secretary of health, and gregly giddens. i appreciate you all being here. please proceed. >> chairman miller, ranking member michaud, distinguished members of the committee, our guiding principles for implementation of the choice act have been to do what is right for veterans, and to be good stewards of taxpayer resources. while our challenges are clear, we're turning those challenges into opportunities to improve the care and service we provide to veterans. we are re-organizing va for success to make sure we maximize those opportunities. we call that reorganization, my va, and an associated customer service solution that goes along with it. because we want veterans to view us as an organization that belongs to them. providing quality care in the ways they need and they ways they want to be served. my va entails combining functions, simply identifying operations, and -- simplifying operations, improving processes, leveraging technology, enhancing efficiencies, and effectively implementing the act. a 360-degree effort to provide veterans with a seamless, integrated and responsive va, regardless how they come to us. since may our top priority has been accelerating care to veterans, moving them ought wait lists into clinics. for example, we have reduced the number of veterans waiting the longest for care by 57%. from june through september we completed 19 million appointments and an increase of 1.2 million over the same period in 2013. over a half a million completed appointments were conducted during extended hours of operation, nights and weekends. we have also improved access using nonva care. from june to september we approved 1.1 million authorizations for seven million -- more than seven million care appoint empties in the community, 47% increase from the prior year. we appreciate thens hansed authorities, funding and programs the act provided to ensure veterans have access to health care. we continue to make the best use of them all to give veterans the high quality care they deserve. we appreciate enactlement of the expiring authorities act of 20 4 , signed in september. amended and fine-tuned key provisions of the choice act. we'll continue to work collaboratively with you and your staff to address remaining implementation challenges. as va works through the appropriate rulemaking implementation process required by the law, we conferred frequently with the committee, with veteran service organizations and with other stakeholders. we're especially thankful for the opportunity to engage what i have your staff, chairman miller, and those of ranking member michaud and to understand your intent and hear your concerns october maiming improvements in implementation. we look forward to continuing this pardnership -- partnership that allows us to do the right things for veterans while being good stewards of taxpayer resources. among the challenges that we face in implementing the act's requirements are an estimated $400 million in unfunded requirements and resources that will be required to implement the provisions of the act over the next couple of years. resources not provided by the act. as mentioned previously, one of the things the act does is streamlines the process to remove or demote senior executives based on poor performance or misconduct. as sect mcdonald wrote to the chairman last week, va is committed to building a culture of sustainable accountability throughout va. employees at all levels must understand what va expects of them in terms of their performance and their conduct, and must be held accountable if they fail or refuse to meet those expectations. i think it's important to understand what the new law does and what the new law does not do. the new law does shorten the time to resolve an appeal. the law does not give va leaders the authority to remove executives at will. any removal must still meet stringent evidence dear shear snoreds and provide due process and does do away with the appeals process. the law does not give va the authority to deprive a senior executive of their property, including earned retirement benefits. only a criminal conviction for treason,ed digs, aiding the enemy 0, terrorism, as provided in statute, can deprive a federal employee of an earned benefit. the objective behind our process, this removal process, is for va removal actions to withstand appeal. if our actions fail to meet the preponderance of evidence standard, or fails to provide the due process expected under case law, then the merit system protection board will simply overturn the decision, order the employee returned to their position and direct that their back pay and legal costs by awarded. that would not be what is right for veterans or for taxpayers. another critical element of the act is the veterans choice program. as we have discussed with your committee staff during a dozen meetings, va identified a number of areas went the section that could present implement indication challenges or potentially confuse veterans. first, there were significant challenges in inherit in the 90-day timeline. we had to establish a new plan, produce and distribute choice cards, determine patient eligibility, authorize and coordinate care, macutilizeation, establish new provider agreements, process complex plans. there was an emt plinths addition focused on delivering the best possible veteran experience. second, we recognize the challenges so-ed with maintaining continuity of care to ensure the best possible healthcare outcomes for veterans. this is a vital distinction between the choice program and a health plan in the private sector. as an example. we have head significant invests to provide access to mental health services in the primary care clinic as part othe holistic, integrated care we want to provide. as one third of veterans receiving va care have a mental health diagnosis, coordinating care, including mentality health care, is essential. mental health resources are often not available, particularly in rural areas and are rarely integrated into the private sector primary care experience. third, we know that healthcare systems across the nation face challenges in efficiently sharing treatment and healthcare information record. in order to ensure sufficient continuity of care for veterans treated in both va and nonva settings we'll continue to work to share information and knowledge with these providers. lastly, we modified the 30-day time limit standard set in law for the purpose of choice program access to measure wait time from the date preferred by the veteran or the date that is medically determined by their physician. while this will help ensure that veterans receive timely access to the bent fits -- benefited of the choice program, it's not a clinical standard for timely care. the veteran that needs to be seen today, 30-day goal is irrelevant. the va's goal will always be to provide timely clinically appropriate access to care in every case possible, in the shortest amount of time possible. that's real what "my va" is all about. we want to provide veterans an organization that belongs to them and provides timely care in the ways they need and want to be served. we'm continue to work closely with the commit year on immigrant place of this vital legislation. i thank the committee again for out. we look forward working with to make things better for all of america's veterans. this concludes my opening statement. dr. tush -- we are prepared to answer any questions you may have. >> thank you very much for your testimony. there's been some criticism that the department hasn't taken sufficient steps to meet with the intent of congress with regard to the independent assessment. va's only contracted as far is a know with mitr to include federally fund research and development center, the cms alliance to modernize health care and the institute of medicine. this not an expert team of independent visits with private sector healthcare expertise as we intend. there is any intention to subcontract or competitively compete for experts who assess each of the 12 elements to be covered by this assessment and what if any information about the assessment and contracts that have been let have been made possible so far, and how much money has been expended on the independent assessment today? >> i will start, mr. chairman. i'm going to pass it then to dr. tuchschmidt, and i expect that some elements of those questions will have to take for the record. i don't think we have all that data with us. we actually contracted the intent that we contracted with, as you act accurately stated is mtre. there will be 12 different components, an organization called cam h which happens to be an organization, an ffr dr. c, that work clothely with the health and human services organization. so we specifically went for an organization that carried the specific quality -- qualification of a healthcare organization. in fact, they will be looking to engage a number of different entities and to ensure that throughout this entire process, that what we are doing is tapping into very independent and objective expertise all across the private sector. >> so, the part of the assessment that they are doing will be done by the camh folks. some of that they have partnered with other entities outside of mitre so they partnered with the rand corporation to do some assessments. there are some options in there that all the options have been awarded for all of the 11 assessments, to the coordinating entity, which would be camh. they are assembling an expert panel of healthcare executives from private sector across the country, and expert panel that will help guide the assessments that are being done and will help look at the various recommendations coming back from the independent assessments to come together with a unified and common set of recommendations out of that which ultimately we will pass to the commission for their deliberation. but we thought it was the intention of congress that this would be independent so we sought an entities entity outside of very to do that. clearly the law says that if we have different people doing different parts of the assessment, we need an integrator. that's what camh is, and i think that the health care nature that you want, the expertise you wanted, will be there in this essentially blue ribbon panel they will be assembling. >> my time is about to expire, but i think that we need to sit down and discuss it's little bit. i think congress' intent was that those that were -- not a panel would be brought in to testify before the group that people that were experts in their field would have the opportunity. while i still have a minute left, i'm referring to the public law, and the biggest concern that i have about the accountability portion is that there was a 30-day requirement for notice before you removed an employee. is that correct? >> that's provided in tight 58. >> and we -- title 5. >> and we in the law removed that, basically says the procedures under section 743 parent b parent parent -- ) shall not apply to removal or transfer. where did the five days come from? >> mr. chairman, the clear and unequivocal advice from legal counsel -- >> wait. wait. okay. it's counsel. but the law is clear this law says there's no period for appeal on the front end but there is on the back end. >> the case law is very clear that we have to provide a reasonable opportunity to respond to charges, and as you note under tight 58, that's 30 days. that was shirtenned to five days. the view is if we fail to provide that opportunity to respond, that the msp will view that as a failure to provide due process -- >> please, please, if we had intend for there to be an appeals process, at the beginning, and we put it in at the end, why don't ju just keep it at 30 days? if you're not going follow the law as it's written, why did you come up with this phantom five-day appeal? >> because we understood the intent of congress was to move bed dishesly and we also balanced that against the requirement to provide due process or risk that our decisions be overturned. that's simple. >> i understand the risk part. but the secretary keeps going out and saying the law needs to be changed if we want people to be fired immediately. no, it doesn't. the law is clear. it says they should be fired. and now my question is, should somebody continue to accrue benefits while they await disciplinary action, which includes being fired, and if you think it's so, justify that. and if not, will you happen me change the law to prevent that from occurring? because the taxpayers are tired of paying bonuses, and benefits, to people who are not serving veterans. >> the law requires that federal employees be paid until a disciplinary action has been affected, which in fact is, in this case, a removal decision, not a proposed removal but a removal decision. as soon as that removal decision is made they no longer are compensated and no longer accrue benefits. >> why can't you remove somebody without pay, suspend them without pay? why do you allow them to continue to accrue that benefit? when you know there's a problem, just -- prom a person enemy standpoint, why don't you or why can't you do that. >> suspension without pay is a disciplinary action symptom review by the merit system protection board. with tea ache, a disciplinary action, without evidentiary support, we're going to fine that gets overturned. >> has anybody that's been involved been suspended without pay? >> no. it's disciplinary action. >> mr. michaud. >> thank you very much. just to follow up on that same line. so, if i understand you correctly, what you're saying is even though we've loosen ode -- given you authority to discipline employees things concern is if you fire someone, discipline them, and you move too quickly, that could be overturned. >> it's not literally moving too quickly. it's -- there are two requirements. the mspb and their implementing regs places stipulated we're required to meet the preponderance of evidence standard, whether it's removal for misconduct or removal for performance, and that's one piece. we have to have evidence. the second piece is, that we believe case law is clear that we have to provide a reasonable opportunity to respond to the charges. what we're talking about here is five days. five days to be able to protect these actions, we hope, from an overturn on appeal for a failure to provide due process. >> do you think five days is long enough? >> obviously we think it is because that's what we proposed. we felt like it was the appropriate balance between what is provided in title 5 and the intent of congress. >> thank you. i understand that the choice cards are being rolled out in phases right now. for veterans who have waited longer than 30 days on a wait list but have not received their choice card, what is va doing to reach out to those veterans to let them know that they are eligible? >> many of those veterans are already being called to determine whether or not they want to exercise their option for choice. we're going through the entire list of veterans that are waiting more than 30 days, uploading those to what we call the veterans choice list so that we hope as early as next week we're able to activate the 30-day group as well. and be able to contact those veterans to schedule appointments or to offer them that choice. >> in other veterans that are in the choice program, do you have any sense how long it took them to get an appointment? >> i'm not -- i don't know -- >> for -- as far as the veterans in the choice program, going to try to get an appointment, do you know how long it's taken them to get an appointment? >> we're still only five or six days into implementation of the program, so we know that we see the number of calls coming in every day, the number of authorizations, and the appointments are beginning to be scheduled. there's a standard stipulated within the contract, within which they have to make -- get that appointment scheduled. how many days, jim? >> the authorization has to be made within five days and an appointment within 30 days. we only had a week's worth of experience. i can tell you as of yesterday, i think we had about 6,000 of the people in the 40-mile group. there was 320,000 people in the 40-mile group. 6,000 of those contact either health net or tri-west, and i believe that first week we have had something around maybe 40 appointments scheduled. >> are you keeping an eye on -- to make sure that the private sector notice going to do what va facilities have done as far as gaming the system on timeliness? do you have metrics in place. >> we do, and we will be auditing and monitoring what guess on with a third-party administrator. i have to say that beth of them, both tri-west and healthnet have done an amazing job of helping us standard up this program in the time frame that we had. and i believe that they are sincerely doing everything in their power to make sure that those veterans are referred into the community. as you know, sometimes waits in the community are also long. so one of the, i think, tests of when the rubber hits the road here is, what this capacity in private sector to really absorb patients in a more timely way than we have been able to provide that care. >> thank you. how is the va tracking the use of the $10 billion allocated for the choice program? >> all of that will be accounted for separately. this is a mechanism similar to we set up back in may for the accelerating care initiative, where we were allocating specific amounts of funding out into the field so we had already established a separate accounting chain to be able to track and record all this information. so, we'll know exactly at any point in time what has been expended and insured that only been expended for those choice program activities. >> great. thank you very much, mr. chairman. >> mr. lambborn. you. >> you said an employee cannot be fired without what the chairman called phantom five-day notice period. this is not required in the letter of the law, the bipartisan law that the congress passed and the president just signed. as long as poor performance has been documented, i believe, and i think the committee believes, there is no need for a five-day notice period. in effect this amount0s an additional appeals period there is an appeals period that the new law allows for and the old law slightly different terms, allowed for as well. so, so no one has been fired for poor performance -- excuse me -- for the data manipulation that we saw in phoenixings arizona, that i'm aware of, and there's now two appeals processes, a five-day and then the existing -- the new appeals process after a person gets notice, and in addition to that you're setting up a new office to review administrative removals. i have there'd his new office will have up to 30 people in it. so, not only has no one been fired for data manipulation, and you say the law doesn't lay lou for an immediate firing, as long as perform performance has been document wed believe the laugh says that and the chairman made an eloquent description of what the law says, but you're setting up a new lawyer of bureaucracy, with up to 30 people. this is what sends a bad message to the public and the veterans and poorly performing employees of the va. nothing is been done, and how could the -- that's my first question. how could the law be anymore clear that someone, as long as poor performance has been documented, can be removed by the secretary without a notice period. how can we make the law more clear than it already is? >> well, let me answer with a question of my own. do you want us to propose removal of employees that is overturned on appeal? >> would like it to survive on appeal. >> we would, too, so we have adopted a process that allows us to meet the evidentiary standard and we believe will withstand the appeal process with the merit system -- >> you're adding to that the law -- >> that and nothing -- >> add tolling what the law -- >> the laws isn't just what is sitting in the statute. the law is also the case law. that you evolved over a period of years around the removal of federal employees and the case law is clear. we have to provide a reasonable opportunity to respond to the charges, and if we fail to do that, we're going to be trouble these decisions -- >> but there is an appeales process there was under the old law and with modifications there is still one under the new law. >> this is not an appeal process. it's an opportunity to respond to the charges. that is what it is. it is not an appeal process. >> so what happens during the for days is not an appeal. >> it's not an appeals process. it's a reasonable opportunity to respond to the charges. that's all it is. let me also make a comment here. the issue has come up a couple of time busy the office of accountability review. i'm the person -- somebody doesn't like what we did there i'm the person that you need to blame for that. there were comments you made, mr. chairman, and you were absolutely right. i think historically we failed to hold people accountable for misconduct and management negligence in the organization, and so as we waded intoing this situation where we had at the peak 95 or 97 different ig reviews underway we realized we would have large number of disciplinary actions to consider, and b., we knew we would have to go through a process of recalibrating accountability in the organization, and i was not willing to take those actions as they came out of the end of thegys pipe and turn them over to any part of the organization -- turn them over to vha as normally would have been the practice in the past. you'd return toes to vha and go form an administrative investigative board, and do your own investigation. come up with charges and decisions -- >> mr. secretary -- >> i thought that was adequate. >> my time is about up. in the view of this member of congress you send the right message to the country to veterans, and to poorly performing employees by remove them. not giving them an additional appeals process of five days and not setting up a new layer of bury rock case. >> we're going to send the wrong message to veteran is if have our removal decisions overturned on appeal. there's no further appeal after that. they come back to us and we have no recourse at that point. we're stuck with them. we're not able to take any additional disciplinary action. we make up all their back pay, all of their legal costs, and i don't think that's what veterans want or expect, and i don't think that what taxpayers expect. ... >> again, we will beat this thing until the sun goes down and we woken up the next day and we will do it again. what i perceive you doing is when you give them five days if that person wants to quit, they just quit. and in the past the vhs said that of the disciplinary action and something happened. and that is not a disciplinary action, a person goes on to another agency somewhere in the federal government area where they go ahead and put their papers and then retire. they retire with all of the whistles and bells just like what happened in alabama, where there is a great fanfare, this person did 42 years of great service when they knew they were going to be fired. they went ahead because they had that five day notice. so that is the concern that we have and i think that we will all work together. you claim that there is a constitutional requirement and we don't believe that there is. it might take going all the way to the supreme court to figure it out. but i think that the taxpayers deserve accountability swiftly and correctly and you wouldn't take the effort to fire somebody if you didn't have it. i trusty whip back there. again, i am perplexed but several other people are probably perplexed as well. >> i will say that we provide the case law, mr. chairman. >> thank you, mr. chairman, thank you undersecretary for being here today. my two questions are critical pieces of the choice act. before i ask, i just want to say that i find it outrageous and my constituents find it outrageous that sharon holman is still collecting her salary at $170,000 after being put on leave in the month of may. we just want to know that we are calling for her immediate firing and we want that to happen immediately. going now to my question. a critical piece of the act is the $5 billion that we have provided for the new medical professionals. it's a competitive environment out there and we know that. my question goes to the hiring process and here is why. because if if i'm a physician's assistant or a nurse and i want to work at the d.a. and i apply and it takes six weeks, three a year to process my application, i need to find a job somewhere else. what are you doing to be competitive with in the hiring environment for these medical professionals? >> a couple of things. one, we know that we have extensive opportunities to streamline the hiring process is with providers and bob mcdonnell recently approved increased salary ranges to allow us to be more competitive to attract and maintain talent. i'm aware of instances on a case-by-case basis across the country were particularly with nurses we have gone in and done market surveys to be able to justify changing salary ranges in that market area and we are looking now at doing that same process all across the country in every market to ensure that what we've got our salary ranges that are competitive and that we are taking a hard look at the credentialing process and ultimately that we will move to the same system that the department of defense uses for documenting credentialing so that we are able to work very transparently between the two systems. no doubt that we have opportunities to streamline. the other thing that we have been doing is part of the push for accelerating care is to accelerate our hiring activity and oftentimes we wait until the position is vacant and then we study it for a while and we bring it to him kind of word and then the board of finally decides and it's months before we post the position. now we hire into turnover so that we are already out there recruiting and hiring in anticipation of the turnover. we look specifically at hiring activity during the second half of 2014. the months from april until september. i think most of this happened in the last four months of the year and the net increase is 1700, 600 net increase in doctors, 700 net increase in schedulers across the organization. material improvement, meaningful improvement there in the staffing levels and we will keep after that. to your point, we have continued room to improve in the process. >> thank you. my second question goes to the choice program and i know that you are sending out these cards now. my concern is that a lot of rural veterans have post office boxes and what i'm hearing is that the letters sent to them have to verify their post office box and here is the problem in my district. i think there is an assumption that they have to pick up the utility bill. but in my district we have veterans that do not have running water or electricity and they rarely go to the post office box because there's nothing there. so we doing specifically to reach out to those veterans who have post office boxes. let me just say that they have offered to help to reach these veterans and physically go out of their homes. i would like to ask your thoughts and comments on that. >> we are in the process of sending letters to all of the veterans whose address would suggest that they reside more than 40 of miles from the nearest va medical facility, offering them several different ways to invest their residential address so that we can determine the eligibility and their access to the benefit under the choice program. and i had not considered instances where veterans don't go to their post office box. where the opportunity for us to enlist the help of others, it's a wonderful idea and we will pursue it. >> thank you very much. i yield back my time. >> thank you. >> thank you very much. thank you, mr. secretary, for your attendance and testimony. as we incorporate this to increase the hiring and other infrastructure, having no report on how the department intends to use the funds, without the proper staffing assessment, how does the department know how many positions in which facility will yield the benefits for veterans seeking the quality of care that they deserve? >> i think that we have shared pulmonary information with your staff on our intentions for this plan. but we will be sharing a formal plan with you as soon as that is ready. >> when do you anticipate having ready? >> probably within the next couple of weeks it should be finalized, i would think. we are putting the document together that not only have planned the kind of exactly what each of those line items entails and some information about it so that it's more than just a spreadsheet. and we currently have plans to hire about 9600 staff with that money. some of the money is for staffing and some of it is set aside for i.t. tech things. so that when you hire a new person they have a workstation to say that. and so that when we have a new space we put cabling and all that other stuff in there. the balance is really for the projects and those kinds of things. but we plan to hire about 9600 staff across the country. we've gone through a detailed process of reaching out to each medical center, asking them to look at what additional staff that they need or space for that matter, to improve the access and specifically how will it improve the access. and that plan has been aggregated at a national level. >> how far along are you with that? have you reached out to every the country two. >> yes, that is basically done and it's been put together in a final plan that is in draft form right now. >> making the determination as to staffing, the regional director, which staffing is needed as far as services provided. >> we've asked each facility to come up with that plan. and then we asked them to come back to us. >> when you mentioned facilities, hospitals or clinics two. >> hospitals, working for the facility, we've asked the facility leadership to take on that project hassan rouhani okay, thank you. mr. secretary, including the veterans access choice and accountability access, authorizing 27 facilities including one in florida. authorizing these will surely improve the timeliness for veterans to receive the care they need and in my district and in 17 other states around the country. i'm encouraged that the veterans in my district will have the option to visit a one-stop consolidated clinic and i would then have concern about the time the expected and the completion of these facilities. what is the process for the va members who have these up rise in their districts as part of these initiatives. and what engagement with the community of these does the va intend to conduct the necessary services will be offered at these various facilities? >> we have a number of leases that we are standing up with. we have two that are in the works right now and then we have a number that will be coming in fiscal year 2016. we will absolutely be working to the process community and the stakeholders in the community both to find the property in the first place and also to make sure that the services that are being placed there are appropriate. >> yes? >> the other issue, i happen to agree with you, it takes too long to get these out of the ground. so we have looked at the typical timeline from where we are right now with authorization and plays and it is as long as four or five years and i think that is unacceptable. we've already visited with the omd and we are finding ways to accelerate that including standardized design so that we are not reinventing design with each facility that we go look at. to your point, we have to work through the site selection issues does oftentimes those at a lot of time and effort to the overall process and we have to find ways to deliver these more quickly. my guess is that in the private sector they could go to where we are too completed facility in three or four years and we need to find a way to do it faster than that. >> asking a couple of questions just briefly. will you assure me that the community will have input on that location and the services provided and the additional services? >> yes, i will. >> thank you, mr. chairman. i appreciate it. >> did you say that they would be initiated in 2016 or finished in 2016? >> i think the contracting action happens in 2016. nothing is going to be -- were not going to these inpatients in these facilities in 2016. >> but you're going to start the contracting? >> looking down through what we have here, those that are he way behind? >> what we will do is work through the finalization of the tyrants to inform the design process and that sets the stage for the contracting action to commence. somewhere you have to get the gsa to delegate the authority for us and they have to delegate everything. seventeen of the 20 are above the delegation and we have to find a way to work around those issues and then we have to give the contractor, we wind up contracting with so we have time to build the facility. >> thank you. doctor? >> thank you, mr. chairman. ranking member. veterans have spoken and i join them in their message in saying that anything less than the highest standard of health care that the veterans such her -- the veterans need and is centered, that must be the sole standard by which we judge ourselves. i hosted a workshop that educated 70 medical professionals in high demand specialties for the va in my district about how to work with the va loma linda and tri-west to provide veterans with health care in their communities. the goal was to get more veterans better care and recruit physicians to treat veterans in the community and we will continue to speak with the medical professionals that attended to measure the success of the event. i received a call from the secretary of mcdonald's, which i appreciate, to discuss this event, and i shared with him the lessons that we learned. i think it is important that we discuss these lessons learned so that all of us on the podium can implement these in our own district as well. based on the feedback that we got and the phone calls that we did, the three takeaways was positions don't even know who to began to call. so there's not a clear were streamlined understanding of who could they call to sign up for the va or loma linda. i think that helping them navigate the system clear and concise, it's very important. and i think that creating a how to guide and we recently asked questions and answers about how to provide care, the veterans will be very beneficial and we're putting it out there now and standardizing it around the country. and so i will continue to hold these workshops collaborating and i look forward to working with all of you so that we can create benchmarks that can be replicated throughout our country for the veterans. however, we cannot recruit physicians in areas that have shortages already to began life. areas in rural places, that's where we need the physicians in the va to begin with, in my area i represent riverside county, which has the ninth largest veteran population in the country, more than 50,000 veterans reside in my district alone. unfortunately, the inland empire where i'm from in southern california also has one of california's lowest numbers of physicians per capita. so we definitely have a physician shortage. i understand part of the law is to recruit this for the programming. how do you plan to implement this nude gme position and accountability act into caring for veterans in underserved areas or areas with high physician shortages to begin with, like the inland empire in my county? >> i think that your suggestion on more robust meditation is a great idea and we take that for action. let me ask to talk about that in this area. >> let me just start by saying that for providers in your community who would like to participate in this program, the 800 number actually has an option. i know we all hate these things, but option one, press one of your veteran, to if your provider, three if you're someone else so they can get it a call with a third-party administrators to get information and we are working to put together a provider information tactic that will help them to understand. with respect to the gme, i'm excited about this, we have a plan to stand up 300 resident physicians in resident areas, particularly where we need physicians. this you're quite frankly i think that we were all talking and not anticipating that we would get a great response, given the short timeline between now and when the academic year starts. but we have been targeting this for the next academic year, over or hundred west for additional resident slots. so some of those could be established programs that want to expand those programs. some of them might be wanting to start new programs and some of them might be community medical centers that want to start a family practice residency program. we are working with those. i think the challenge is for them to stand up those programs. >> i appreciate that, and i appreciate you prioritizing below physician to population ratio that exist. and it's time now to began building pipelines of individuals who want to serve in the va. and the place and that you can find those is in the military. when i was in haiti working with the 82nd airborne, a medical director for a nonprofit after the earthquake, there were plenty of medics that which we met wrote a letter of recommendation for several for medical school and if we can identify them early while they are in the of defense, put them into a gme slot after medical school with a contract with the va and department of defense, those are the ones that will be committed in our va. >> i couldn't agree more. >> thank you, mr. chairman, thank you, mr. secretary for being here. i'm going to take the theme of providing care and you all have work to do in your shop. let me give you an example of what happened in my district. the g.i. doctor was cleared through the system. he quit his job. he's waiting to be hired and his paperwork is that some central office that is a black hole in washington. so during this political campaign i've got my staff on the phone somewhere here in washington to get this doctor who is approved to see patients. he goes out and gets another job during that time until the va bumbles along and get him hired. those things are so frustrating that you can't imagine how frustrating that is to see that after all of this. and so i walk out of the hospital on monday when i bump into the veteran and he's driven 2.5 hours to get there. for his appointment that he's waited four months for her. i got three calls to come to that appointment and he shows up that day and his doctor is not there. the guy has severe pain in his knack he says he has had spinal fusion surgery. the man needed an epidural steroid injection. he has to drive 2.5 miles back to knoxville. fortunately i have some friends there and i made some calls to friends of mine and we get him, and these rba friends, were going to get him in knoxville so he doesn't have to come back. and that is a kind of thing that we hear every time we go to the va. my question is when is it going to stop. that is the thing that i am so frustrated with. we spend and warmest amount of time during this october time listening to people at the va. and i want to work with you on this. i am a primary care doctor. until you reform and provide the care, we can't hire enough doctors to train enough doctors to ever get it done. we will get what they go through to actually see a patient and what i had to go through to the that patient, and to the gentleman, he's not here, but when others talk about the system on the private sector. it is if the va will write the check i will get paid. so i have incredible teams. you have teams put together that i could only dream of in private practice, but yet they are so bureaucratic and slow that they can't see many patients. so like several others, let us help you and show you how to do that and use that as a metric across the country to create more efficiencies. we had a young psychiatrist in st. louis that was seen six people a day. and so i appreciate the efforts you are doing. but there is a shakeup that needs to happen. this mid-level bureaucracy and this filter that is pulling all of his down, you need to get after that. and i can't imagine why it would take anyone but a piece of paper or a signature to have doctors working. >> let me offer up a quick thing. your story frustrated me at least as much as a frustrated you. i've run into the story still and do everything i can to clear where the bureaucratic obstacles get in the way. what we have to do is revise the system so that we don't have to intervene either of us individually on a case-by-case basis. i'm deeply disappointed in the story they told me about the veteran came for his appointment and the doctor was not there. thank you for intervening on his behalf and i want to ask the doctor to comment on a third observation that you've made about primary care physicians. >> let me just also say that i am the black hole in the central office, it's my job to prove those and i tried to do it immediately when they come in. as of the beginning of this month we delegated approval out in the field up to $350,000 per year. they don't have to come below that level at the beginning of the month. we have to your suggestion than benchmarking with kaiser permanente and others. and we are in the process of developing practice management standards and tools to deploy and try to improve some of those processes. >> you can't have physicians doing clerical work. you can't have them walking out were calling to make the appointment. when i saw somebody come in a most valuable time you had was the physicians time. when someone comes and come you have to be able to put that in the record, have someone do all of that stuff. the other thing i want to talk about, mr. chairman, give me 10 more seconds, the thing that i hear all the time that decisions don't have enough room to work in. i can tell you as an efficient primary care provider, i can be very efficient. you give me one or two rooms and you slowed me down by 30%. it takes time for a woman or man to get their close off. that takes time. when they are doing that, you can be seen someone else. i had a different motivation where i was to be efficient in my practice. and i don't see that in the va system and i think you have real problems in the way that the clinical is working. and i yield back my time and i appreciated. >> think you. >> enqueue, mr. chairman, thank you very much for being with us today. just wanted to tell an anecdotal story about a veteran to receive his card last week and we were very excited. we walked through the letter that the veterans received and i just want to make sure that in terms of the volume of calls and questions, because it was great to receive the card and it was nice to celebrate that are veterans day. but it's clear that it wasn't going to do anything until you went through the steps of eligibility and making sure that you are authorized the card. so i worry a little bit about veterans with him how think the card has some magic to it and they go to a private provider and then end up with a big hill that they didn't expect. number two is the question that was raised in a memo provided to us by the staff about the co-pays and the dockable's and is there sufficient communication for the veteran to understand that they may end up with a financial obligation that they would not have had if they had been seen through the va. i have another question, but i would love to have someone address that. >> i can start out in the doctor may want to jump in. we took great pains, as you would expect, with the drafting of the communication and we actually went out and had others not only reveal it but actually have veterans review it and provide us at feedback area so part of what we are seeing an attention is that they have to take steps to access the care that they are eligible for her. and so that was one of the reasons because there is a potential liability associated with co-pays. just like there are with care for a non-service commission or a third-party insurance, different circumstances, there may be instances where the veteran is accountable for some of that cost than we have done things in interpreting the legislation and policy decisions that we have made and regulation that we have, updated to make the operations from the standpoint of co-pays work as close as we could absolutely make it work to traditional non-va care. we don't want to set up a situation where the veteran was saying, oh, i want to use this. i don't want to use the choice card. so we eliminated those obstacles but there are instances where the veteran could be obligated for some of the cost. >> i think that we have -- we have said from the get go that designing this program we want to do the right thing by the veterans. and i think that we have and we are pretty much resolved with the va co-pay. and so we don't have an out-of-pocket cost as a visit. we don't honestly believe that we can determine what that is until after we get an explanation of benefits back. with this type of third-party copayments, technically that is a contract between the patient and his or her insurance company that we have no control over. but the way that we have tried to implement this, i think that we will be able to cover that most of the time the way the choice payment is made. ..

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