Health care, decreased wait times and modernize the va i. T. System. Good morning here today were pleased to welcome back our good friend dr. David shulkin, the new secretary of the department of Veterans Affairs. The last time you appeared before our committee you were v under sector for health. Now youve been kicked upstairsp after a Unanimous Senate confirmation vote, we become unanimous and that says a lot in this political environment so congratulations. We come with your background i know you a great background inph philadelphia. I just learned you certainly bring a lot of experience to the job. Although im sure these days the challenges are very daunting for you. We realize this ring is a bit unusual. Ua rather than a typical budgeting where you have at this time of year we are limited tod discussion of the skinny budget, the skinny budget mentors that omb sent to the hill in march. The two page entry for the va doesnt give us much to go on in terms of Program Priorities or plans for the choice Successor Program but skinny budget does give us one remarkable bit of news for the va. Apparently the administration is proposing a 4. 4 billion, or 6 , funding increase for the agency. In addition theres 2. 9 proposed in new mandatory funding for the va. You must come youll probably the only domestic federal agencs not facing a substantial cut and so i suspect im going to need kevlar vest when talking to my fellow appropriations subcommittee chairman. So when we see your full budget later this month we will be asking some tough questions about the merits you propose increases, we know others will be struggling. Despite not having a completes budget im sure the members will find plenty of topics ask youu about this morning. How you envision va strike a balance between care and va facilities versus nonva community facilities, making making Electronic Health recordd work for veterans especially as they see more doctors through choice, your efforts to appointment scheduling problems, how you plan to approach disability claim backlogs and appeals, your plans to decrease veteran suicide and homelessness, your campaign to limit opioid abuse amongns veterans, plans to access care for rural and female veterans. And thats probably just a start. They will think of other things im sure. We will include your full Statement Today in hearing record and will be pleased to have your oral statement but before you begin ill ask our Ranking Member ms. Wasserman schultz hs any opening, she would like to make and then after that and the Ranking Member of the full committee. With that, ms. Wasserman schultz is recognized. Thank you, mr. Chairman. And welcome, mr. Secretary, its been a pleasure to talk with you over the last few weeks and im good to have you in my office yesterday. We do appreciate you being here in your new capacity, and i go to chairman scott meant, particularly given its been awkward in the choice we find ourselves in a secure operating on a bigger stage than previously and with greater responsibility that come with the duties of being on thee secretary of the va. Mr. Chairman, since the screw 2008 the va have seen a tremendous 70 increase in accounts, medical care accounts have grown from 36. 7, 64. 6 by note and the overall discussion accounts have increased from 43. 6 billion, have increased from 43. 6 million, the 74. 3 billion. Fy 20 teen is certificate the president skinny budget evenue request 78. 9 billion, or 6 8. Increase from the 2017 enacted level. In 2018 budget requestority legislative authority, 3. 5 billion in authority to continue better veterans Choice Program. And what is a question that arises is that this would support a program that was initially met as a stopgapin temporary fund. While i am certainly thrilled to have you heard today, its unfortunate we wont be able to discuss the specifics of the vau budget because and the lack ofic detail makes it extremelydg challenging for the committee to properly do our job. Moreover, given this 70 increase over the past ten year its critical this committee has the opportunity to analyze and understand these numbers as well as know more about why the va continues to issues oft mismanagement, wait times and less adequate care. While i can understand the degree of growth has its growing pains it is crucial we understand how these issues are being addressed. Once we were fully understand the issues at one point to ask if this continued growth issecrt unsustainable . Mr. Secretary, i ask these questions with a genuine concern for the future of the va for obviously our driving concern must be to provide the best cari to our veterans. If we dont control costs and d ensure the resources thiss committee provides, or use inappropriate and efficient fashion, we actually hurt our ability to help veterans and deliver on our mission of providing topquality care. It comes to mind that while we are providing additional resources, were not seeing what would normally come as the commensurate response from the people who are receiving the services because of the challenges that the va salving in providing those servicesef efficiently. Topquality care is really our top priority and we need to make sure that we help you deliver on that mission. Mi with that in mind its imperative we discussed a number of key issues including the Choice Program and the state of the das Electronic Health records. Has the va and vision choice, a program which with committee care, and discussion program. After creating the committee care account which includes 9. 4 billion in advance, white is a budget request also include 3. 5 billion for the Choice Program . Where is of the v the va in in d approving its Electronic Health record system and executing congresses mandate for full interoperability with dod systems . As we discussed this past monday in my office, mr. Secretary, a solution is long overdue. And finally i hope you can address a significant number of vacancies that the department and when disposition type of expected refill. 11 senate confirmable position remained vacant including the undersecretary for benefit of the sector for health, the undersecretary for memorial affairs, the general counsel, this is a subject of Information Technology mss and second for policy and planning, thesis executive for management and the chairman of the board of veterans appeals. And by the way the veteransss appeals process is an absolute mess and so for it to have no chair for as long as that has occurred is really unacceptable. From our discussions i really believe you always want reform and approve the va pickett is reflected in the confidence and was placed in you with unanimous vote in your confirmation from t the United States senate. Its our duty at least to ensure that you adequate resources to do so in the proper oversight is in place to go out after abusive. Av we have a lot to discuss today. Thank you for the opportunity to chairman concerns and i yield back. At this time i like to recognize that chairman of the full committee. Thank you, chairman dent and Ranking MemberWasserman Schultz. First of all i want to give you a shout out for passing your bill last year, september. Thank you for the effort. You were the pacesetters. I wish we couldve followed youd base, but in reality we didnt. But i cant think of a moret Important Department done the department of Veterans Affairs. Those who have served our country and serve our country right now in dangerous places deserve when they get home they get the best care possible. I know you from your time in nef jersey and wonderful things you did there. And for good reason to her nana is the senate. Theres not a lot of unanimity over there but im glad they focus their attention and support for you. Two areas of interest to me, i dont want to take time away from your marks for your questions, continuing the appeals and benefits backlog. Its a nightmare. Ive even shared with you some of the three or four year waiting periods where people obviously evidence has to be collected and verified, but in reality its pretty nightmarish prospect since early the confirmation of your undersecretary might be hel heln that regard. Hopefully that will happen. The last year has been continual interest to me, is Electronic Medical records. I think three years ago then chairman rogers posted chuck hagel, secretary of defense, and reduction seki, one of yourri predecessors, and we received a committee, commitment from i think former general since i keep that we have within a year some sort of solution. I know that department ofan defense, and given the resources they been given is getting up to speed i do view your systems as sort of the weak link. I personally feel this is something which is enormously important in a day and age when with so much information passing back and forth obviously, encrypted and protected. That did not at that available to our Healthcare Providers is pretty inexcusable, but good luck and godspeed and thank you, mr. Chairman. Ms. Lowey, id like to recognize you. Thank you very much, and i would like to thank chairman dent and Ranking MemberWasserman Schultz for holding this important hearing. And i welcome secretary shulkin today. We as members of congress, and you as the secretary of Veterans Affairs, have a duty to provide the best care available to our veterans who have sacrificed and faithfully served our nation. The va faces serious challenges in meeting their health need. After working for years to reduce the claims backlog, it is once again increasing, and the Choice Program will soon run oua of money and is in need of reform. Nd and the va and department of Defense National closer to the interoperability of electronicni Health Records than they were years ago. We owe it to all current and former, future veterans to tackle these challenges now. The subcommittee is committed to achieving that goal. I must say after reading your resume, i am so optimistic, as was referenced before, chairman rogers and i had i think for hearings, right, chairman frelinghuysen . We also met in closed door sessions but we havent been able to resolve this. Now, i have my own personal preference about who who is to blame, as were talking about it before, but thats irrelevant now. And looking at your resume, i am so enthusiastic, and i know youre going to get this done. In my own district, i worked to secure federal funding to improve rehab facilities, and ensure that veterans can receive a high quality of care. But for too many the va is unable to provide the types of services they require, from women struggling to find care in a health if so help system that is traditionally served we men, to veterans who are turned away from va facilities when they are most in need, the va has a responsibility to serve all veterans who seek the careca and treatment they ever earned. In light of these challenges, congress awaits the details of the president s fy 18 budget request. The budget framework requests an increase of 6 to the va, but lacks detail. Providing just seven bullet points of vague proposals. S why you may not be able to speak to details of the Budget Proposal now, i hope you will return after its release so we can fully discussit. In thank mr. Secretary, i again thank you for being here today. Thank you for your commitment to improving the lives of veteransr and thank you for assuming the responsibility i look forward to hearing about all your success sooner rather than later, so wew wont come in a bipartisan way, continue to talk about backlogs and the lack of records. So we have confidence in you, and i thank you for appearing here today. Ou, at thank you, ms. Lowey. At this time i like to recognize secretary shulkin for five minutes. [inaudible] maybe thats better. Okay. Chairman frelinghuysen, chairman dent, Ranking Member lowey, Ranking MemberWasserman Schultz, and all of you who are here today, i was so impressed with your Opening Statements, so many topics that you thought about and that you care about, and i know are serious issues here and were trying to do things differently at the va, that i have a terrific Opening Statement, but im willing to, mr. Chairman, to actually forgo it and get right into your questions and then she would prefer me to go through the Opening Statement people because i think we have so many issues and a want to use your time most valuable. I have submitted it for the record, but be glad to read through it, read through my oral say that but i will leave it up to you. You would like to hear . Good, okay. Okay, i told it was terrific. The abridged version, about five minutes. I will try to do it quickly, but thank you. So thanks an opportunity to be a today to talk about the president s 2018 budget. I also want to all for your support of the 2017 budget that really gave us for the first time our full budget from the start of the fiscal year. It really speaks well of thee u. S. Congress and really of the American People that despite all these differences, and you thint to the sometimes, though we can come to get on this topic to support our nations veterans. I have submitted the full statement for the record. The president s 2018 budget reflects a strong personal commitment to our nationsid veterans, provides this a resources to continue ongoing modernization of the va system. The budget request 78. 78. 9 bn in discussion of funding or va, 6 increase from the 2017 enacted level. It provides 4. 6 billion more foe medical care, 7. 1 increase, and a 3. 5 billion more and mandatore Budget Authority was mentioned to continue the veterans Choice Program. Ng for more veterans are opting for choice than ever before. Ef ive times more in fiscal year 2016 that fiscal year 2015. An choice authorizations are still rising. more weve issued 35 more authorizations in the First Quarter of fiscal year 2017 that in the same quarter of 2016. All told, including both care at the facility anthony kennedy, we project a 6. 6 increase in ambulatory care for 2018 over 2016. I urge you to support and fully fund our 2018 request to enable va to meet increasing demands for va services to modernize the va systems and to invest in choice. As you know i came to va during a time of crisis when it is clear that veterans were not giving the time access to highquality health care they deserved. I know va has made significant progress in improving care and services to veterans but i alsoi know that much more must be that if va is to continue keeping president lincolns promised to care for those who are borne the battle. Last week i had an opportunity to meet to courageous young americans, michael and sarah of rhode island. All michael ever wanted to do was be a soldier, and he became a soldier serving his army, serving in the 82nd airborne division. Then he lost a leg and part of his arm in an ied explosion afghanistan. He suffered other ones as well. They told it when he sought care from the va in 2014 they did not receive the care. We cannot allow ourselves to ever again fail our american heroes. Meeting michael answer underscored for me the urgency va modernization. I5 prayers of secretary are greater choice for veterans, to modernize our systems come to focus resources more efficient efficiently, to improve the timeliness of our services, and Suicide Prevention among veterans. We are already taking bold steps towards achieving these birds. To reach of the president signed a reauthorization of the veterans choice act ensuring that veterans can continue to get care from community providers. Just last week thepresident ordered the establishment of a Va Accountability Office and removing as quickly as we can within the limits of the law to remove bad employees. Va has renewed Medical Center directors in san juan, Shreveport Louisiana and recently we have relieved the Medical Center director writer in washington, d. C. , and remote three of the Senior ExecutiveService Leaders to misconduct or deplorable service bu. We simply cannot tolerate employees who count who are counter values trick since january of this u. N. Authorized an estimated 6. 1 Million Committee care appointments, 1. 8 million more than last year, 42 increase. We. En we now have Sameday Services for primary care and Mental Health at all of our Medical Centers across the country. Veterans can now access wait time data for the local va facilities using the easy online tool where they can see this week im spared no other Healthcare System in the country has this type of transparency. Va setting nutrients with Publicprivate Partnerships. Last month we announced a Publicprivate Partnership of ambulatory Care Department center with a donation of roughly 30 million in o