And now Veterans Affairs secretary Denis Mcdonough testifies before the senate Veterans Affairs committee on president bidens 2024 budget request for the agency. He weighed in on the camp lejeune water contamination suits, the agencys claims process and womens healthcare. There was also testimony from the heads of various veterans groups. This is just over an hour and 45 minutes. [inaudible conversations] [inaudible conversations] [inaudible conversations] i am going to call this hearing to order. We are little bit ahead. I want to thank Denis Mcdonough and our friends and partners for joining us today. For those of you joining us on television, you will hear a great opening and questioning of the secretary of the va and what is interesting is we have three folks who are going to do a combined statement which will be particularly entertaining, i think. Something to look forward to. We are here to take a closer look at the president s fiscal year 24 budget request from the department of Veterans Affairs, a time when theres Unprecedented Demand for Va Health Care and services, we have to make sure the department is equipped to pay for our veterans. Over the past year, the va completed 1. 7 million disability compensation pension claims. And served 6. 3 million veteran patients, 115 million employments. Through the demand it is only increasing, last summer as congress came together, a historic step that has delivered all areas for veterans and survivors, their va care and benefits that they have earned. This law created an exposure fund to cover the new costs of delivering this earned support. I have serious concerns about the attempt to got the fund whether it is attempts to relitigate the nature or purpose of the fund or place artificial caps or make dramatic cuts to the fund, it is all bad news. I might say this was we send folks off to war, we put it on the credit card. They come back, we make excuses not to fund their benefits. In montana, something comes out of the backside available. After finally making good on our pledge to address the costs of war, our next step cannot be to renege on that pledge. Im concerned with house efforts to rescind 1. 8 billion, reimbursing Community Care. Let us not forget, to not cut va healthcare. And job Training Programs and what was next. And with livelihoods at risk each month. Treasury makes 25 billion in payments, of that 25 billion, nearly half is for benefits payments of 7 million veterans. The rest pays for salaries and keeps va medical clinics open and reimburses private providers to receive care in the community. The debt limit is reached while payments could be delayed or stopped, creating incredible uncertainty for the nation and veterans who served this nation and made the country what it is today. Lets get past the political posturing and make sure veterans are not harmed because representatives in congress can act like adults and do what they were sent here to do. They have forgotten their mission was with that said, i want to hear from Denis Mcdonough on concerns, priorities and impressions of the 24 budget. I turn it over to my friend. Welcome to Denis Mcdonough and our witnesses. I appreciate all of you being with us today and appreciate hearing your testimony about the fy 24 budget request. There have been big changes the chairman mentioned since the last time we met for this purpose, namely the enactment of the Heath Robinson honoring are packed act. I know one thing that has not changed is there is bipartisan bicameral commitment to provide resources needed to support veterans and their caregivers, survivors independents. I am committed to protecting and prioritizing and supporting veterans and ongoing budget talks and i know my colleagues in the house and senate share that commitment. Nearly 70 of the federal spending is on autopilot, or what is known as mandatory program. The passive approach to the federal budget got us in this deficit mess in the first place. Veterans are not insulated from rising inflation and slow Economic Growth caused by outofcontrol spending. As a longtime member and Ranking Member of this committee, my priority will always be to make certain the va has the funding it needs to provide timely and high quality Healthcare Benefits and services to the men and women who served our nation. I believe this and every va budget request can be judged through a single lens and that is what will deliver for veterans. This years budget request is the largest yet for the va totaling 325 billion. That is a big number and it should lead to big improvements for veterans. The point i am trying to make, ive done it myself from time to time in which we brag about the amount of money we spent or the increases we are providing veterans. If bigger numbers were all that was needed to deliver we would have better results so it is what we can deliver. With bigger numbers and better results we still wouldnt have better suicide rates, hundred of thousands waiting on claim backlog, troubled new Electronic Health records, 12 months of a trend of meaningful decline in access to care. Scores of recent reports from the Inspector General and Accounting Office detailing serious and sometimes fatal failures. Persistent problems getting the va to respond to basic requests for information from the committee. Im interested in hearing im interested in hearing from the secretary on how the budget request will produce different results from past years. Im interested in hearing the secretary justify healthcare that outpaced the demand for va healthcare. We request 11 increase but the projected need for that increase is 3. 5 . This is the first budget request that includes the topic exposure fund and the va is asking 20 billion for the fund in fiscal year 24. When the fund was established 9 months ago it was not projected to reach 20 billion until fiscal year 2030, six years from now. Given that the va doesnt have a way to track the number of veterans and rolling in the enhanced eligibility authority or raise this concern about unexpectedly high influx of claimants, this request needs explaining. Delivering more money for veterans is not the solution but delivering Better Outcomes is. I have no doubt but i wouldnt want to put you in my category but have no doubt we that there is any disagreement about the need for better results. For these reasons it is good or congress put Veterans First by remaining engaged in the budget process and avoiding the urge to turn a blind eye to issues facing the va to more mandatory spending. It is time we get it right for our veterans, loved ones and i thank you once again for all being here and i look forward to our conversation. Thank you. I agree with the debt that you may on the money. We talk about how much money has increased when in fact it is how the money is spent. That only includes the va and every budget we put our hands on. Todays hearing will consist of two panels, first, we have a great honor to have the secretary of the va, secretary Denis Mcdonough to talk about the va 2024 budget. Budget. Well, thats good. Is that okay with you . Now i i feel guilty. I know, i know. Thats a great Opening Statement. That will get two points right off the bat, right . Mr. Secretary, in your testimony that you have written, you highlighted the v. A. Has delivered more care and more benefits to more veterans over the last two years the meantime in our nations history. Put more of that in perspective for us. Yeah. Well, thank you very much, mr. Chairman. It is important to keep in mind that these big numbers deleted to Better Outcomes. We are not big on just measuring what we put into, what you give us to put into veterans care but we actually measure what it means for veterans and their families. Just last thursday there was a release of a report, actually was consolidation of 40 separate reports, looking at care provided by the v. A. , including throughout the pandemic. What that report found, from one of the leading medical journals in the country found, is that v. A. Provided care is at least as good as and overwhelmingly, overwhelming number of cases care better than care provider and other settings including private Health Care Setting so were very proud of that. Just consider the clinical appointments and engagements with had in the last year, 115 million clinical encounters, 40 million inpatient encounters at v. A. Facilities, 31 million telehealth appointments, 38 Million Community care appointments. You already talked to the benefits side of this at the 1. 5 million claims that we processed last year. 15 ahead ofare that number year on year. The point is these dollars mean real engagements. These engagements been Better Outcomes for veterans. And i standnd by the assertion that we are now providing more benefits and more care to more veterans than it anytime in the v. A. s history. Can you tell me about firsttime veterans entering the system. Who are they . The most, the Fastest Growing cohort of veterans are Women Veterans. We have just as result of the pact act we had 77,000 new enrollees in v. A. Healthcare. Ast i i say the fastest growg cohort are Women Veterans, but the beauty of the pact act that you all gave us last year the president signed in august is that it allows us to restart a conversation with younger and more diverse veterans, at the same time were deepening engagement with Vietnam Veterans including those who have hypertension. As a result of exposure to agent orange. We are seeing younger veterans, more diverse veterans, including more gender diverse veterans, meaning more women in our care and worse thing that record as the pact act. There is been debate the last coupleas weeks about the bill te house passed that cut programs, and the debate most of the debates revolve around veteran benefits act. Senator rand paul addressed it in his Opening Statement and by the way he is an honest broker and believe what he says when he says well to make sure Veterans Benefits and Health Care Programs are funded. But as a look at that bill the attempt recent 1. 8 billion for v. A. Medical services ib modernization facilities, 1. 8 billion. And the question for me becomes if we didnt cut any veteran benefits this isnt called benefits because it has to do with administration . I i guess thats way to look at although v. A. Medical services is the a medical services. You had chance to look at the bill and look at the proposal put out buyer agency. Tell me what you see that comes out of that and what kind of impacts that came to fruition. A bill by the way the speaker said did not cut benefits in fact, called the president a liar when, in fact, the president was the one who was telling the truth. Thank you, mr. Chairman. Obviously the bill itself is vague for the reasons you talk about such a difficult to ascertain, but weve looked at this a lot of different ways. Weve been talking with members on all sides of this debate since january whenar this debate really got engaged. If you just apply the 22 budgeb cut to v. A. , which again may not be what end up happening at the end of the day maybe it is less than that, but if you just take the top lines of the bill and recognize that v. A. Is not held harmless the way, for example, dod is held harmless in the bill, then we are going to be confronted with very significant challenges. I will just give two examples. We think that if, if that 22 cut applied to v. A. Healthcare, that would mean 30 million fewer outpatient visits of the type that i just talked through that we had last year. Those are all patient visits in the direct care system or in the Community Care system. Alternatively, if you look at it from the benefits administration, again i talked about the fact that claims filed our 30 above where they were a year ago. We are fulfilling 15 more claims year on year than we did a year ago. And were able to do that because some efficiency with him but also because of hiring we have carried out. If you apply the 22 reduction, that would mean 6000 fewer staff there. With 28,000 staff there for the first time. We have talked many of the members of this committee through how our staffing model works, where we are in that staffing model. But if there are 6000 fewer personnel to process claims, that will beth an extension of a timeline that already too long. Senator moran. Chairman, thank you. Mr. Secretary, the v. A. Inspector general recently found a substantial, there was a substantial comingling between the 14. 4 billion in supplemental funding the v. A. Received under covid19s related care and the v. A. s regular appropriations. It seems to me that would be separate account but thats not what the inspector found is my understanding, what i read. The intent of the supplemental was to support urgent timelimited needs, kind of one time or one period of time circumstances, not to create an artificial increasing of a v. A. s budget. What steps did the v. A. Take to make sure cost projections for fiscal year were talking about,o years, 24, 25 were not based upon those supposedly one time amounts of money . Its a fair question. This has been an historic challenge for v. A. How does it account for supplemental funding . Many years,ck many, do with the age of our infrastructure and how we track the stuff and ituc also has to o with where we push the money to for operators to execute it. The important thing we have done is we have now taken responsibility for that, the outlays of those dollars, and put it the hands of the cfo here in headquarters. We are making sure that he and i are directly responsible ultimately. The covid funds . Those funds being the medica care funds, and so rather than making every individual facilith have to account and try to forget where this money come from, what color it is, were going toak make sure that we dot at headquarters. We work that out with omb. Weve been briefing her staff about this because we think this is an important change. Secondly, we have regularly updated the committee on how it is that we are spending the sons and thats whys we can have confidence that we have now that will use the overages that weve had to date w which remember the overages were for what we expected to be a surge of care as people come back to us at the end of the pandemic. Weve had that conversation in this room. We have great confidence will use that money this year, and partially into next year. Our regular updates to you guys help us do that. But the ig has routinely raised this issue of supplemental funds with us. Were kind of figure out a good way to do it. We think as i said bring the responsibility of this to the cfo level is a a way to do t none of this obviates the need to continue to stay in close touch with the committee and make sure that the Committee Sees clearly how were spending the money. Y. I understand the v. A. Plans to track expenditures from the Toxic Exposure Fund fun toe they are justified. How will the the v. A. To fid track which healthcare is associated with exposure to environmental hazards and which care is not pursuant to the law that created the font . We have had now a handful of discussions with your teams here in the committee and with others among the appropriators and the house as well about our methodology. We arer comfortable with our methodology. We havee worked this through wih omb. Were working it through withmb your team. I will let them characterized to you their degree of comfort. If we have to change it methodology will do it, but the base case is that we are in a position to ensure that as the law envisioned, Toxic Exposure Funds, will be spent only for toxic exposure requirements. And weve made sure we have given clear guidance to the field. Again, operating as a do with the cfo and meet responsibly for this to make sure that we can execute it that way. So the problems or the lack of accounting of the money from covid which you are not trying to address by bringing it to the central office, that is not anything that would suggest the same probleme will occur for the money in the fund for toxic exposure . We wont have the same problem we had with covid money being comingled. The department will be able to e determine what is appropriatee spent for toxic exposure benefits . Yeah, we think yes. And again the methodology, the basis on which we have established that methodology to track that funding fundg where talking through with your teams in very minute detail. Are also going to continue to not only talk to you but continue to be subject to the igs oversight, to the gaos oversight, to ombs oversight, and if there is something we need to s change we will change it. But we havee great confidence that it will be able to invest the toxic exposure dollars for toxic exposure care. Mr. Secretary, thank you. Senator brown. Thank you, mr. Chairman. I appreciate what you said about deity being held harmless and the v. A. Not. Senator tester and chairman tester and i and others fighting for the pact act remember last summer when it was perilous weather was going to pass because some people said it was too expensive. I do roundtables. Im going to do one on the pact act in every county in the state. I think i did the 31st when the other day and there is a sentiment theres always money for defense but too many people want to skimp on spending on the v. A. , so mr. Sp chairman, thank u for your work on that. Mr. Secretary, thank you for all that you were doing in so many ways. I want to thank you for taking the right step in stopping the Electronic Health records issue. I know weve talked many times. I appreciate your