Budget Hearing – Department of Veterans Affairs

well we're ready to start and we uh thank you uh uh mr. secretary for coming here uh we appreciate it very much uh good morning to both of you uh welcome mr. topping welcome glad to have you here i recognize it is somewhat unusual to appear before this committee to discuss the budget after the house has already passed the bill with a tremendous bipartisan support unbelievable quite honestly

mmm

uh i hope today's conversation will include discussions about that legislation i'm sure the department would always always welcome additional funding but i would simply say that the process will continue to evolve over the coming months and we welcome the department giving us their input and perspective as we move forward but we are not through with the possibility of more getting some uh more money we also appreciate the the opportunity to discuss the many issues currently facing the department i'm certain today's discussion will include staffing levels and ongoing reorganization i appreciate your efforts to inform the the department reform the sorry reform the department and i think everyone here recognizes that there's always room for improvement and that maintaining status quo is not enough while i support efforts to reform and modernize the department i also want to ensure that the efforts are approached responsibly and most importantly never jeopardize the care and services our veterans allow Paul

mmm

i know that we all will not all agree on every issue discussed today but i sincerely believe that these reforms reform efforts are being undertaken with the veterans at the forefront and are intended to improve the delivery and care of services

and

to close i wanna thank uh i want you to know that we appreciate uh the improved communications and transparency from the department and we value the ongoing dialogue and now i would like to recognize miss washington schultz for her opening remarks

thank you so much judge mister chairman appreciate your partnership and uh i think you and i might be crowing about the outcome of the milcon va bill a bit for for quite a while uh yes for quite a while that that that might have to hold us no no no no uh cause i'm i it it might be uh irreplicable if that's a word maybe i just maybe i was telling other chairmen we set the standard we did we did so uh and then we can go so you know forgive us for the needling uh to our other colleagues um and welcome mr. secretary and assistant secretary topping it's good to see both of you again thank you so much for coming in um we are here today to discuss a bill that affects the fiscal year twenty seven budget request which has already been adopted by the full house um and unfortunately the budget once again arrived late so late that we've already written our bill marked it up in committee and passed it off the house floor all all before receiving your full set of justification materials and hearing testimony from you i have to be honest it's disappointing that it took an amendment in a committee mark up from ranking member to help and with the support of the whole committee to help insure that we finally had you uh come before this committee to testify uh our veterans do not deserve that kind of uncertainty and lack of transparency and i know you said that you were willing to testify but getting you scheduled was a challenge and thankfully last week our bill without the full input from the administration unfortunately received a resounding bipartisan vote of four hundred to fifteen it isn't the perfect bill certainly it included provisions and funding levels that i wouldn't have included but it reflects bipartisan compromise something i wish we'd do more of here and i have to tell you mister chairman one of the best pieces of advice that i ever got was right at the beginning uh just after i had been elected to the state house and a person who i considered a mentor i ran into him at in a parking lot outside uh a supermarket and he said debbie i need to give you a little advice as you embark on your legislative career" and he knew that i was idealistic and you know brimming with uh with principle and uh conviction and he said as a legislator there are two kinds of votes that you're gonna take a vote that comes down on your principle and a vote that comes down on your preference and you should never compromise your principles but you you you will likely have to compromise on preference to achieve a greater good you might have to swallow hard a little bit sometimes to you know take something that you didn't necessarily prefer but in order to make sure that you can build consensus and work together and build trust then voting against your preference is gonna be something you'll you'll have to do probably more than occasionally and that advice has carried me through for a thirty four year career as a legislator um and it's one that's always served me well and so i'm really thankful mister chairman that you and i were both able to do that on things in this bill that neither of us maybe would have preferred but that made sure that we could get the result that we did um and so uh to newer members i i would uh you know i would would encourage you to to adopt that way of thinking um even when you have to buck your own leadership which i have certainly done from time to time or your own president which i have also done from time to time anyway i digress we're here today to discuss your budget request the request includes four hundred and eighty eight billion dollars in both discretionary and mandatory funding an increase of nearly eight percent above last year's level it fully funds healthcare and benefits for veterans and includes significant funding increases to important programs five point four billion for construction that's a three point seven billion dollar increase from last year's level four point two billion for electronic health records which is an eight hundred and forty million dollar increase from last year's level and six point three billion for it a three hundred and eighty nine million dollar increase from last year's level it also advance funds the toxic exposures fund something both you and i agree on mister chairman um uh excuse me uh well yes both mister chairman and mister secretary but the budget request does fail in a couple of areas first it includes a fourteen percent increase in community care without proper explanation or justification. On April first, Ranking Member DeLauro and I sent you a letter, Mister Secretary, expressing our concern about the growing cost of community care and asked that you at least explain why community care costs have suddenly grown from a steady nine billion dollars a year to forty two billion dollars in twenty twenty eight. That's a three hundred and sixty seven percent increase over the course of seven years. Now with the implementation of the Mission Act, which outlines exactly when a veteran can seek seek care in the community and you and i have talked about how much veterans prefer seeking care at the va there was some growth expected but not to this degree and we're still waiting for a response to this letter secondly the budget request cuts the inspector general's budget by twelve million dollars this comes at a time when va is undergoing significant significant initiatives including the ramp up of the hrm this cut also arrives amid the solicitation of a new seven hundred billion dollar community care network contract as well as the reorganization of vha clearly oversight is critical now more than ever yes now more than ever and we talked yesterday in in our mark-up about firing the cops on the beat and making sure that we have the ability as a a legislative body to hold the executive branch accountable um and for you to hold yourself accountable um cutting the ig is uh is not something that is in that in that um spirit and our bill restores some of that funding um but i would have supported a funding increase to the ig not cut so i hope today that we can learn more about what you're doing to address the challenges that the va faces and that includes the hiring of thousands of medical professionals in particular to address veterans mental health suicide prevention and the growing number of women veterans that require specialized care i'm also interested in updates on your major initiatives particularly the veterans health administration reorganization and i have always appreciated your enthusiasm uh both as a colleague here um when and when it comes to reform at the va the va has faced challenges for years and i agree that certain changes are necessary but i'm concerned at the pace and lack of justification for the significant changes thank you for being here i look forward to your testimony and i yield back

thank you miss washington schultz now we'll turn to the secretary uh secretary collins without objection your entire written testimony will be included in the record i will now recognize you for an opening statement and then we will proceed to questions

uh outstanding mr. chairman and recommender it's always good to be back uh with so many of you especially the ones i served with and seeing this and i'm i'm assuming this is on but is everybody hear me fine or did i just hear you speak in my badest voice The light's on, but it just didn't sound like anything was going through. So

Yeah.

For those in the back, here we go. And now the radio voice here at the appropriate committee here, a little earlier in the morning, DC's traffic's going and we're here looking at it all. No, it's good to, it's good to be back with every one of you and and and also I will just have to say, in in a little bit of uh discussion as we go forward. I am here, as I told you on the phone, because I wanna be here and was gonna be here and uh it didn't take anything in a budget to get me here. Um, I was coming, it was a scheduling, and waiting to get the committee's approval. So it was not anything for me. I'll come anytime, and it's just like our monthly calls have. So, uh, like I said, it didn't take anything to get me here, I'm glad to be here, uh, with this this morning. The big thing that I wanted to discuss this morning is number one, I I I appreciate both of your comments and your opening statements concerning uh the working relationship we have, which I think has been dramatically improved and I and really where I want it to be. And I gotta thank Richard Topping for that, our new CFO. who has consolidated our uh finances we know now where we're getting our money's, how it's going out, how we're spending, we're looking forward to that discussion today and his team has been you know, really outstanding and and I I just wanna say from a year ago today, it's it's really what I'm gonna talk about about the VA itself, it's a tale of two cities. It's something that when we came into this uh role that uh there was a lot going on, a lot of different things going on, but there's also a tale of two cities of what uh was inherited and what is being done now, and what we're actually seeing and some of that's being reflected You know, frankly, in the fact that we put veterans first at the VA, period. It's not a discussion of what happens in the, what's best for the organization, it's what's best for the veteran. And then when you take the veteran perspective first, then you put policies in line that uh begin to change that. So that's where the RISE organization has come from, that's where uh their new next-gen contract, which we're looking forward to talking about, is coming in. It's also looking at uh our facilities, it's looking at EHRM by the way, which I come from last year to here. EHRM is Um, probably one of the best untold good news stories in federal government. And you don't have a lot of those when it comes to IT work. And, uh, believe me, as being on the other side of this dais, I understand. But we've had four sites open in Michigan. If you've not heard about this so far, please hear this. They have opened flawlessly. I promised this committee, I promised the, uh, Senate committees, I promised everyone that we were gonna redo how we're doing that from the ground up. There's no comparison. We can talk all day long about the problems of Washington State. But you can't compare them to anything that we're doing now. They're just two separate conversations. And Michigan has come off uh flawlessly. Even having one facility have a tornado hit it three days in, lost power, did not miss a beat, and two days later had an open heart surgery in that same facility, and the p- the facility worked well. So EHRM is is going well. We're continuing to deliver results. Um, there's a lot of discussion about staff. We're gonna discuss that today. Um, one of the things that we found over the past year is one, as I shared last year, we had no idea how many employees we had. And also, we never had a manning document. In other words, we did not have a set document that said, okay, for this facility we need this many people. You know, for many of you who've been in business, for in the military, ha- not having a manning document was the most mind-blowing thing that I ever had, coming in, w- especially with four hundred and sixty thousand employees. So we've instituted a manning document that gives us better control on, hey, you, we need to hire here and we're hiring every day at the VA, hiring more every day at the VA. Um, and looking though, where we can put those results where they need to be. And I think that's the key. uh to a successful program. But also from a workforce perspective, I have to commend our workforce. And I do this regularly because we have seen backlogs drop from two hundred and sixty thousand when I sat here before you last year roughly two hundred and sixty thousand a hundred and twenty-five days old hundred and thirty-seven days to completion they're now at a below seventy-five thousand in the backlog, seventy-seven days to complete, while accuracy is at ninety-four point one percent. The same amount of appeals is basically the same eleven percent percentage as it was when we were doing less. Now think about this for a second. The same amount is being appealed that when we're doing less claims. So when you look at that, that's a phenomenal statement for our VBA employees and what they're actually doing. So I'm very proud of that. Wait times are going down, but here's an interesting thing. Again, we're the only one that measures wait times. I and I've said this before, I'll say it again, no other health care system in the country measures wait times. It's only us. And ours are actually going down in uh in very substantial ways as we go forward. But two points I wanna give to you, cuz sometimes you don't see this. Uh, just in the past three weeks we have had two reports from uh, outside agencies that have shown the effect of not only our great employees and our VHA and others but also the work that we compared to other hospitals. One is the CMS rating. We have over seventy percent of our hospitals are four and five star. That is compared to not VA, that's compared to the industry. You can't go in Florida, Texas, and Oklahoma, anywhere else and find that. typically the best and were continu and actually improved over last year. I've set a standard for VHA that said we're only gonna accept fours and fives. Twos and threes are not acceptable. And so we're working to get that up. And we're actually taking four and five star executives and pairing them with two and three stars to say how did you get to where you're getting to go we're actually having a peer system that is actually helping improve that and that's something we've never had before. Cuz we also had never had m- metrics to determine. When we first came in there were five hundred KPIs. For those who've been in business, how can you measure five hundred different things? in an organization. We've now got that down to eighteen, and every hospital knows exactly what they're supposed to be uh looking at. But then my favorite one is also this, and this is something, NOAH, the health care system, we're the largest integrated health care system in the country, and we have a one hundred percent safety rating. One hundred percent, not a, one of our hospitals were not rated less than one hundred percent in safety. So there's a lot of things going on. Um, as we uh have been going through this time of hearings, and I'm looking forward to it again, I have to agree um, uh, Madam Ranking Member, you and I have agreed on a lot of things, we've had some great conversations on our monthly calls. And when I was up here we had some uh, we actually worked on some things together. But I always do like to by- pawn out bipartisanship. And this is, this is my uh, and I was able to commend him yesterday. I'll do it again here. S- uh, the ranking member, uh, Blumenthal of the Senate VA committee actually wrote a letter to the, uh, editor, and I think uh, recently, and it, basically he said this. This was his words, not mine. I agreed with him. Today the Department of Veteran Affairs is providing more care and more benefits to more veterans than ever before. And I agree with him. And that's what we're here for. And I wanted to just say this. You did get your budget out. Thank you. This is something that should be the, the one thing the American people, as a former member and working with many of you as colleagues, this is the one thing they don't understand how we can't get done. Y'all did it. I appreciate that. There's things we can always have agreements and disagreements. VA will never be perfect, neither will its budget. None of this on this side. But we're always gonna work together to make sure one thing is true. and that is what i stated last year veterans are gonna come first at the va with that mr. chairman we look forward to answering questions

guys i should have welcomed you here uh got my my i think my late night is messing me up welcome

thank you chairman

um do you have something you would like to talk to about

no sir we're ready let's go

alright then we will uh we will start with our questions i'll take a stab at the first one there's a lot of discussion surrounding rise some positive some expressing concern i think my question is straight forward and could you please address some of the concerns why is this needed and what caused the department to reevaluate the existing structure recent staffing reductions and impacts on the ability to provide consistent uninterrupted healthcare including mental health and suicide prevention so i'd like to hear about that and finally will the department be administratively prepared to adjust to the restructuring restructuring or consolation of the vision i guess it's called from eighteen to five without hurting day-to-day care

yes uh this one is probably the easiest one to go at and although it is uh been discussed a lot and we have provided even more uh just in last few days we're gonna get more and we've had briefing after briefing not only internally but on the Hill with VSOs, RISE is about thirty years behind. This should have happened twenty five years ago, ten years ago, should have happened thirty years ago. We were operating off of a system that was basically based in the eighties and nineties of an organizational structure that in two thousand had a budget of about twenty uh twenty million I think was, forty million and and two thousand to a budget now as we know as four hundred and eighty eight uh billion so think about that for just a second. We were still operating and trying to operate over the system that was put in when our system was much smaller, much less complicated as it is now. So you, I mean, the common sense side is how do we actually do this? Well, it's actually is we gotta start looking. So all of last year, and we're providing, you know, more and more information, I'm happy to talk about, is saying what do we need to do? What is our choke points? I've been in over thirty something say thirty four states. I've been to seventy hospitals. And I sit down with every executive director when I go and I say, OK, what's your problem? What's your issue? What are we having to figure out? And I consistently heard this one thing, that they would ask for stuff, no matter what state they were in, no matter where they were at, they would send up issues that they had, and never hear back. It would go into this sort of just vast, dark uh chasm, somewhere between the vision and somewhere between the central office and they'd never hear back. Nothing that we have done in this ex- does anything except strengthen your local VAMPSE and your local community ho- community uh CBOcs. Nothing, because this actually is giving the executive director and giving the um uh folks there on the ground the tools that they need to actually run their hospitals they can do their FTE counts there's no there's no hiring freeze there's nothing that they can't hire if they need a doctor as as Rankin remember and I have talked about before they hire the doctor even on a Manning document which did take away some positions so you know from the Manning document side does not mean that we cannot still hire those positions it just simply says that there there were not needed time even if they were filled as early as late as January of this year if they didn't need to be refilled Then they just didn't need to be on our document, uh, in a manning document way to show, uh, you know, falsely that something was supposed to be there or not be there. It's all based on do we need the employees where we need them. So, the why is basically very simple. We needed an organization that was streamlined. Eighteen to five is actually now giving our visiting directors more control and power to do the things that they need to do. The executive level issues of main management, which also corresponds to, uh, civilian look as well. But they're gonna be able to handle the big picture items, Also the manning dot manning hours, things like that. We have HSAs, which are never talked about, which are now gonna be added into this, which are actually gonna give you better uh communication for your local hospitals. They're only gonna have five or six hospitals at most that they deal with. And so they're able to talk, so you talk about rural health care, they're actually gonna be dealing with only rural hospitals, you know, for the most part. You have urban. They're gonna be dealing with mainly urban hospitals. So they're gonna be able to talk to their executive directors. They're gonna be the direct line for executive directors, instead of EDs trying to get a vision leader that they never could get. Because the visiting leader had multiple states, multiple things, and other responsibilities. This is gonna help. And then when you break it up into policy, and uh proceed, you know, and uh what we have policy from healthcare perspective, business line, and medical center operations, this is why we have uh the new system going forward. Um, you know, this has been widely received. At first there was a lot of uh I won't be very blunt. There was a lot of uh when I was visiting late last year and we started talking about this, The hospitals themselves were scared, what is this going to mean? And when I told them nothing was happening in the hospitals, and now they're actually seeing it except that they're getting to do more of what they intended to do there's actually an excitement about what's going on. There's actually a building among the leadership to say hey we're now getting the tools to do exactly what this Congress and what everybody's asked us to do and that's take care of veterans that's all they wanna do and so we just needed to clear uh that as we go forward I know there's a lot of other things Chairman that's a long conversation but uh we feel good and we're giving more and more information, we'll be happy to give more as we go along.

mature recognized

thank you mr. chairman so mr. secretary you and i have talked about as i have traveled the country and visited colleagues uh veterans uh you know veterans affairs facilities uh sea box hospitals clinics um one of the most consistent things that i've been hearing is that it is not as rosy as you're describing in terms of the ease of hiring for positions that they need filled and you know you referenced that there are some positions that you let go or didn't that have not filled uh well i mean you just said that there are

we we let go no one there's been no firing no let goes

but you're uh ok but

yeah but that's good we're almost

when someone departs for whatever reason because some people departed as a result of the encouragement to leave with the retirement uh uh the retirement push um in the aftermath of doge va has shed close to forty thousand positions and that's either through hiring freezes attrition involuntary early retirement program or the deferred resignation program and the cuts affected every corner of the va from doctors and nurses to food service workers and central office staff and i am travelling around to talk to people on the ground like you do uh to really see what the impact has been um at the same time you've revoked the union's collective bargaining rights which my understanding based on our last conversation you've restored at the direction of a court order correct

alright

ok you you're now faced with a daunting challenge of rehiring for many of the very positions that eliminated um and i can tell you that through the conversations that i've had and we've talked about this on our monthly calls um there are folks that are not uh leaders in the va facilities i visited that are not having such an easy time getting those positions hired um that getting them approved to hire is not seamless and speedy um they face salary cap challenges they are struggling to get somebody to to them when they send up the request to fill a position um some facilities are waiting months and months to even hear back if they hear back at all and in twenty twenty five for the first time ever va va actually hired fewer positions than it lost so these staffing shortages are also leading to the closure of three clinics in oregon new york and tennessee and you've asked us for budget increases every year in particular to fund these positions in this year's request you're asking for funding to support four hundred forty three thousand three hundred twenty seven full time equivalent employees so we've talked about this by phone but what new processes and directives have you issued to make hiring at the va easier because folks are struggling to be able to fill the positions and how are you ensuring that hiring practices are consistent across all va facilities

uh thank you for that and i i enjoy our continued conversation and i do wanna comment you on one thing we're gonna disagree on some of what you said and that's fine but i do admit

you're just how i'm talking about things i've been directly told by your personnel on the ground

and and me as well so i i was getting ready to compliment you

i'm uh i'll accept the compliment but but it's not necessary

i was that you actually you're you're you're a member that uh you're a a member that actually has gone to many i have unfortunately found that many do not i'm saying you do and i appreciate that i think here's the here's the biggest issues that we have number one no clinic realignment was done because of staffing issues the clinic realignments that you just mentioned were because of poor care for veterans. And I don't think you and I either one would wanna continue to have poor care for veterans. Those were contract clinics that we are now actually putting VA employees in,

Mm-hmm.

especially in like Tennessee and others. Um, the the problem here is is this has been going on, you know, clinic realignment is is something that we've done for years. There was fifty-two of them done under Biden. There's been sixteen under us. I mean, this happens and there's reasons that we lose leases. We do think. This was not a staffing issue, so we can't go to that part on staffing. This was about poor care from contract clinics. um, that we're looking at. Number two, what have we done? This is a good news story. I've said this over and over again, I appreciate you bringing up the ologist problem, is what I call it. It's the ologist problem. They're just, we're we're capped at our ologist issue at the top end. If you don't know this, we can't hire more than the president's salary.

Mm-hmm.

So, which puts us in an ologist problem, especially with anesthesiologists, cardiothoracic, all, you know, all these folks. So, um, that's still an issue. It's gonna be an issue until we can get it resolved in some ways. And by the way, the Dole Act put three hundred in. Which was a sad

Mm-hmm.

thing when we looked at it, it was good, to beginning. But then when you actually started looking at it, I wanna thank everybody in this room. That's one point five percent of my doctors. Three hundred.

So just,

I

just to illustrate what you're talking about, because you and I know what you're talking about, but maybe everybody doesn't. So, physicians in the community, I mean if you're, if you're competing, you're basically competing to hire the best in,

We compete every day.

the the best and the best.

Every day.

And, I mean in the community, they can pay more than four hundred thousand dollars, the salary cap. in at the va and they get signing bonuses and you know i mean the va is not is not competitive they're just not and so the dole act gives three hundred positions that they can go above the cap and that's for things like podiatrists optometrists dentists physicians and uh i mean i agree with you three hundred is not nearly enough and we should uh honestly we should go further you have to be able to be competitive

well it actually had a negative effect that's the problem Um, and also the three that you just named are not ones that need that bonus. Um, the.

This is what the law allow, right?

Yeah, it is. It, it allows for all of us, so we're, we're all adults, but I don't, my podiatrists were pretty good on. Um, the problem is, is that when it has three hundred, and it's what I was getting ready to say, was it's like, um, my bride who is here today with me, we have three children. She made it a habit every year at Christmas that, much to my, you know, amazement, every kid had had the same number of boxes, at Christmas. And typically the same amount of money. Well, the the problem is, as you think about this, I have four, let's just say that it was, ranking member of the chairman, myself,

It's cause she's a good mom, just saying.

and and and she's a great mom. And thank God she stayed with me for thirty-eight years, you know, so we're good. Um, but let's just think about this for a second. We have you, the chairman, myself, and Topping are all anesthesiologists at a facility. I retire. Then we say, well, we're having trouble recruiting an anesthesiologist to keep the the numbers up, just like every other hospital is. So then we go to the field which we're actively recruiting in. The next person come in and said, " OK, we'll use one of these three hundred uh waivers to bring the new uh anesthesiologist in." So now this anesthesiologist is making more than the three of you. Guess what? One of you are supposedly are gonna leave because you said, " I'm not gonna do that. You're gonna bring in somebody in the same department and make them, let them make more." In fact, we had executive directors say, " We don't want this money." Because it was hindering their effect. What was meant for good turned out not to be as good as it was thought. So we need to get a fix on this that is a across the board fix, not just hat- and I think we're in agreement there.

Exactly. One that's more equitable, you mean?

Uh, I think you take, and you and you just add it up,

Or we move, move the, are you saying move, raise the cap?

we don't have to, yeah. Yeah, you gotta raise the cap.

Don't have a cap?

You gotta have the, you gotta ra- you can raise it or don't have it, however, I think we, I think we can be very good at this. This is something we all need to work on. This is a,

Mm-hmm.

this is a bipartisan issue. This is not, because it's been around forever.

No, no, I'm I'm genuinely asking you.

Exactly. Well, I think, so I think we're looking at this, and I think for the staff here and and for the members needing to understand this is something We're the most retail agency in the federal government. In fact, there's no other cabinet member like the one that I have to run. We're the only reason we have a job is a veteran shows up. Veterans quit showing up, we don't have a job, and y'all don't have a committee. I mean, it just, just the way it is. Let me get one thing else also about hiring, cuz you asked what were we doing.

Mm-hmm.

Hiring was atrocious at the VA. And by the way, if you have somebody that's sitting there having to wait three months, I wanna hear about it, because I I keep a close eye on that. They just need they they're not either not asking the right place or they're not asking. They may be telling you they're asking, but they're not asking in the right place, because I keep a very tight run on this. We had a hiring process that was averaging a hundred to a hundred and forty five days.

If it was more than one, wasn't more than one place, I wouldn't mention it, but it is multiple places after.

Well, but I I I'm gonna say this, and I respect that they told you that, but also I don't respect the fact that if they're leaders they need to tell their chain of command. And and Greg Goins is with them all the time. And so that I I'll be honest, they can gripe that they may not get what they want, remember half of our, over half of our executive directors have been hired after COVID. They do not know what it was like in twenty nineteen, twenty eighteen, twenty seventeen when you were on this committee as well. And they were sticking to budget numbers and they were sticking to FTE numbers. They didn't see that because after COVID we just ballooned the budgets and ballooned hiring. So they don't understand that all of a sudden now you have to be responsible for that. So some of that is is that. Um, and that's just a fact of life that these executive directors have to face. The last thing though that I wanna get to in this hiring process is I said this is ridiculous.

But th- but Mr. Secretary, honestly, they're telling me they're not hearing back. they are not allowed to get the the positions hired months go by my my

i'll accept i'll accept that

my time my time has long since expired but

yeah i'll let me just say this cause i don't want this to go around cause i don't want this cause i i'm

we

this we're cutting staffing uh the the we're cutting hiring times in fact aurora is down to twenty eight days now i'm just i'll get to the bottom line we we put in a pilot program that cuts out all the stupid waste that we were doing in trying to hire it was taking three to five weeks to get background checks three to five weeks to get credentialing all this stuff We've now got pilot programs all across the country that everybody's, all of our hospitals are really excited about. I will just say this, I accept what they told you.

Mm-hmm.

I just disagree that at a certain point in time, that if that is true, then I would expect them to be lighting their hair on fire and sending everybody messages that they can't get the answer because I have empowered them to do just that.

They don't, they don't feel empowered.

Then, I can't help them. I can't, they got ex- they got ex- I I'll uh,

The, the,

when I I c-

the buck stops with you, Mister Secretary,

Well, when I tell, when

you, you do, that is your responsibility to figure out what is the problem what is the logjam and how we can get better lines of communication up the chain to ensure that when someone needs to fill a position that is gone because of the myriad of reasons that you've shed staff at the va it is on you to make sure i'm telling you there's a problem you know i've been to multiple veterans va facilities all over the country and i'm consistently hearing this problem and i'm getting gaveled so i use my

right i appreciate thank you and we'll talk more about it

ok thank you for your indulgence mr. chairman

thank you for the awesome information thank you very much

thank you mr. chairman and uh thank you to both of our witnesses for being here this morning and mister secretary the first thing i'd like to ask about is the music modernization act

alright let's go back let's go back and bring up our oldie boogoo get the get the minority leader in here we'll go

that's a that's an inside joke but um the the the reason i brought that up though is va is gonna take the same type of laser focus that you had on that bill uh cause that was a i mean you talk about a a heavy uh lift uh but you got it done and it was the tenacity you know the determination and i know we were both unauthorizing when we started the electronic healthcare records uh problem or or fix and uh you know i i really appreciate that you're in this position now and able to bring that kind of uh leadership quite frankly to uh to to the va one one of the things that i that i'd like to ask about in in the context of homelessness uh for for our va so first let me say i i think you all have done an uh an amazing job addressing that uh in the last uh year or so but in in uh twenty twenty one in the uh johnny isaacson and david pirro um veterans healthcare and benefits act one of my bills was rolled up in that which was the uh veterans arm for success which was you know one of the things that i'm always concerned about is not just how many people that are homeless veterans that are homeless but those that are gonna become homeless and a lot of them become homeless because they leave the military and can't integrate back into the community the way that they should and that's what the veterans arm for success was all about um it's a it's a grant program so that others around the country could start operations like we had in jacksonville called the operation new uniform uh a non-profit that had amazing placement success for for veterans coming out kept them out of homelessness uh gave them great jobs in in uh in hope so we finally in twenty twenty four i think rolled out the first uh fifty or first five million of that for thirteen different recipients can can you tell me if we're gonna have another offering on that in uh in addition cause this is really to build up this same program around the country because it has tremendous success.

Yeah, uh, I think you're exactly right. One of the things that we deal with is this transition issue is is one of the big issues that we have and um grants like this actually do help from a grant's perspective. Richard um we I'll let Richard answer the grant perspective side of it.

OK.

Um, uh, thank you representative, and we've spent a significant amount of time upgrading our grant management and award process too and this is one of these or some others i know some members have some questions about that today too it's a question of funding and if we have the funding we will issue these grants we have the capacity to do so one of the challenges we have in successful grant programs like that is we spend the money because they are successful so that's one of the issues

right

we'd love to do more of this it's a question of if you can give us the funding we'll issue the grants

thank you we'll we'll follow up on that uh uh another great program that's uh that's taken place in jockstable is partnership with our department of war hospital n a s jacks that's been a godsend i think for the veterans in in in jacksonville and uh i wanna thank the va for his work in partnering with our um uh n a s jacks uh hospital this is actually saving a lot of our veterans a three hour trip over to gainesville

hmm

uh and just Uh, so can can you provide an update on how this partnership is going? Are we gonna continue that? Uh, do, Richard, do you see that as a, um, a good viable program that

It it is. Uh,

OK.

this is in this is something we're having to deal with across the board. Uh, DHA, the defense health agency, is having some issues, I think, and and again they're working through what they have, but where it also forces some more collaboration between us and the DA. Now, one of the things we can't do is just exhume their workforce and pay for those bills, that's unless they give us the money, which, you know, that's not happening right now. So, we're continuing to work through that. Jacksonville is a great success story, we got a lot of other success stories. In fact, the continuation of the bigger picture for this committee is that, uh, we're actually taking, uh, trauma doctors from um, DOW and we're gonna actually be training them in our Houston and Indianapolis facilities because they were not getting enough uh hours so to speak in their current facilities so we're doing this this'll continue as we go forward.

thank you very much and i see my time has expired mr. chairman i yield back and thank you thank you both again i'm gonna run to another area

thanks

thank you very much uh let me welcome my former colleague from georgia uh it's first time we've had the opportunity to have you before the committee but uh let me welcome you and thank you for your service and your uh friendship over the years uh i am uh concerned about several things with respect to um uh the va uh one of them is rural access uh to uh georgia veterans and of course uh we have uh two major centers um the va serves in the second congressional district uh for the albany and uh middle georgia area they go to dublin and of course for the columbus area uh it's uh uh cavus uh central alabama um area and of course that is presenting some some concerns um over the years the uh the veterans in the columbus area and them that thousands of them as you're well aware uh have have had complaints about the structuring of of that uh having to go to tuskegee or to montgomery uh and not feeling uh the love there that uh they feel that they are entitled to uh with the new va restructuring the rise uh proposal that you are going to implement uh can you tell me how that's going to uh uh uh if that will be able to address the concerns that the uh the west georgia um veterans are having with regard to having to go to

yeah

uh tuskegee and to montgomery and to birmingham uh as opposed to uh atlanta uh which is probably uh uh almost as close particularly for the the the serious va uh uh medical stuff

yeah constant it's good to see you again and it's it's good to uh work with you again and and uh even across the aisle like this as uh you've been a great advocate for that area and uh working this i think the big issue is going back to rise is one of the issues in this hsa that i spoke of earlier um And as and then we'll take it to a different way you may not expect, EHRM, which is our health records management system. We have a hundred and seventy hospitals that can't talk to each other. Okay, we got, now we got about ten that conceivably can, but we, they couldn't talk to each other. And we have this boundary kind of system of, well, we can't cross over, you know, this line of that. We're, we're moving that uh past that so that the integrated care system can actually work. Uh, we don't have a hundred and seventy individual hospitals. These are not independent start-ups. They are part of the VA system and they should be able to to work with each other. So, that is my goal in getting this, uh, getting the the local leadership not to be as parochial about what they're doing but get what is best for the veterans. So, if they can, if it's better for them to come to Atlanta, fine, Suskegee, fine, whatever is best is making sure that we then also add more facilities, more clinic space down in Columbus, so that they can get, uh, closer to home where they're at.

Yeah, we've got the um, the Porter chef center which is relatively new, which is um, uh, very, very well received. but uh we do have that problem with the that that state jurisdiction uh let me go to uh veterans homelessness for a moment the va home loan program reform act created a partial claim program and it was described as serving the va home loan portfolio of three point seven million veterans with nearly seventy thousand veteran homeowners more than ninety days delinquent at the time of enactment uh when will the partial claim program be fully implemented And will the VA report utilization by state and congressional district? Uh, I think the budget includes more than three and a half billion dollars, uh, to support veterans at risk of experiencing homelessness. And at the same time, the Veterans Affairs servicing purchase ended May first of twenty twenty five. And VA is no longer accepting new submissions for that program. Uh, what is the VA doing to prevent everyone who behind on the VA back mortgages from becoming homeless?

Yeah, we've, I appreciate that, uh, Congressman. We are, June fifteenth is the start-up for the partial claims implementation, which is ahead of schedule, uh, of what we had, uh, promised when it was, uh, passed. And, you know, that's in addition to all the other stuff we do from loan mitigation to forbearance to uh modifications to repayment plans all of this is done on the front-end. I have to b- remind this committee and everyone else, VA pits people in homes, we do not take people out of homes. The ones that actually foreclose are the mortgage industry. They're the ones that actually foreclose. We do everything we possibly can to keep them there the VAST program was something that was started non-statutorily and out of VA they shouldn't have been there it put us in a liability position it was just not helpful to anyone especially as we were going forward in a larger sense but this partial claims was just body passed the other body passed has been signed a law we will start on June fifteenth is the is the date, which is ahead of schedule

thank you my time is just about expired i'd like to maybe talk with you uh off the record about some uh particular uh VA constituent concern that i have

Anytime, you just pick up the phone and call.

Thank you.

Uh, thank you, Mister Chairman. Um, Mister Secretary, thank you for being here. Uh, thank you for the work that you and your team have done to right-size the agency. Um, thank you for the work you've done to address the backlog of disability compensation. Um, you have there in your written testimony that, uh, since you've taken that claims have fallen by sixty nine percent. So thank you. Uh, that is uh often something as you know, as you used to sit on this side of the dice that uh offices uh receive calls uh about um those disability claims. And so thank you for expediting that and thank you for working with all of our offices, uh as we represent uh our constituents. Um, and wanna talk a little bit about the electronic uh health record modernization. Uh, you mentioned that. couple of times uh in your um written statement uh you've also talked about it in your opening statement um and and just a little history um um which which you know well uh but this was from a gao report that came out uh uh in twenty twenty five so this ga report is uh about fifteen months old but it talks about some of the uh prior

mmm

uh unsuccessful attempts and so i just wanna uh frame this uh by reading from the gao report It says after three unsuccessful attempts, the Department of Veteran Affairs is currently on its fourth attempt to modernize its outdated electronic health record system. VA relies on this electronic health record system to manage the healthcare needs of nearly nine million veterans and their families, but the department's latest attempt to modernize this system is delayed and faced similar issues seen in prior efforts. The current electronic health record system used by the VA is more than thirty years old, complex, and costly to maintain. VA efforts to replace this aging legacy system began in two thousand and one. Its first three attempts were abandoned due to concerns about uh projected planning, high cost and undelivered capabilities. The VA's fourth attempt began in twenty eighteen and a new system was deployed to six medical centers at a cost of twelve point seven billion dollars. The rollout was paused again in April of twenty twenty three after users reported concerns about patient safety and system reliability issues. Uh so a a program that we've been uh Congress has been trying to lay uh roll out now for twenty five years. Um you have uh now taken the mantle um and it seems like to me from your testimony you've been able uh to put this program back on track that you've been able to accomplish something that we've not seen uh in those prior three attempts. So can you kind of share with this committee uh what you and your team have done uh and why we see now that this program seems to be back on track and seems to be uh gaining traction while those prior temps were can probably be described as nothing else than a colossal failure if we can't roll out a healthcare system in twenty five years we've done something wrong and that's been across multiple administrations uh and so uh you it inherited

yup

what can be described uh or i'll describe as a nightmare and so how have we been able How have we been able to get back on track? And what do you see um as um the projection for us to be able to continue to roll this out across other VA facilities in a timely fashion?

Uh, that is an opportunity to to show a win for not only our VA employees at VHA, but also a win for actually taking leadership in in moving the project forward. The real problem here was, is that we had a rollout that in Washington State, we had six uh hospitals that was attempted in twenty eighteen. in which we allowed everybody to do whatever they wanted to do. We allow one hospital to do it this way, we allow another hospital to do it this way, allow another hospital to do it this way. We gave them all independence, like the VA is famous for, but yet never discussed the fact that there were certain conditions in their original system software-wise that didn't work. And then when you tried to compound it with uh the individualization, if you would, it just, it didn't work at all. The DOD experience, the DOW experience is the same thing, they came back and said standardization was one of the things we looked at. Very quickly, last year during my confirmation here, it was one of the first things I heard about. We've been, you know, fourteen, fifteen billion dollars and got nothing for it. So what we did is this. I came in the, the, my first three weeks in the job, this is what happened. I brought in our folks who run the HRM system and I said, OK, tell me why this program is, is failing. I heard a laundry list of everything that, why we can't do stuff. Neil told me everything. Oh, this is terrible, and Oracle's terrible, and Oracle's this, and we're this. And so I said fine, next week I brought in Oracle. And I said Oracle down, I said, OK, tell me what's the problem is here. not with our people just with me and they said well you know your people are doing this and we're we're waiting we're ready to do but you all aren't getting in this i said ok fine so the next week i brought all three of both groups in we sat across the table just like this

hmm

and it was fun just about like we do sometimes and it was a well oh hey Neil hey and they all talked you know happy and i said ok what's the problem everybody just sorta cricketed i said ok well let me just tell you this oracle just said this about you and by way we said this about you within five minutes they were yelling at each other success We got what we needed, because now we've cut through the bull crap. OK? And we got to really talk about it. Within that, uh two days after that they locked themselves basically in a room for forty-eight hours and came up with a standardization plan that has now moved forward. The OIG r- or uh the OIG a GAO report that you mentioned is a great history piece, but it has no relevancy, zero relevancy to today. There is no comparison between the two rollouts in the previous twenty years and this rollout now. Um. We have put the emphasis to our, my Deputy Secretary um Paul Lawrence has done an outstanding job, along with Neal and many others in this to get this up and going. We have put the training in, the four sites in in Michigan are working flawlessly. They're getting ready to add nine by the end of this year, and we have over twenty ready for next year. My biggest problem right now is I have Executive Directors calling me up and saying can we move up on the list? We wanna move up on the list, we wanna get this done, because this is a, this is key. This is key for them not only to do their work internally, but also their community care aspects, but also talking to other VA hospitals. So that's really what it was. It was just a kick in the system to say, " No, we're gonna do it this way. This is, this is not an option. We gave nobody an option. You're gonna do this." Because here was the crazy part. If they walked across the street to another hospital, they were gonna use an EHRM system. So we were the only people out here using a system, by the way, that cost me seven hundred and forty million dollars a year just to keep alive. It's time we actually did something. That's what we did.

Well, thank you. Um, one last plug before, and and I know I'm over time and I apologize. Um, just want to bring to your attention um the fact that um many of my veterans uh have uh contacted me personally about parking challenges at the VA facility uh in the

Mm-hmm.

Jackson, Mississippi uh area uh I know that that is probably a common complaint that you receive for VA facilities across the country uh the VA came in in twenty twenty four, they resurfaced Uh, but uh, now we have um, again, uh, resurface parking spots, but it's the lack of parking. Um, and so um, uh, and that can be challenging as we know if veterans are trying to get to doctor's appointments, be there uh, early. So I just wanna put that on your radar, Doug. I'm not asking you to do anything. Uh, this this probably a common concern that you hear from other facilities across the country. Uh, but if something crumbs across your desk from Jackson, Mississippi, parking issues i want you to know that you've also heard it here uh at this committee and when i ask you to do anything that you could and so with that mr. chairman i yield back

the good people of mississippi will know that you're on it

thank you mr. chairman and ranking member uh and gentleman thank you so much for for being here this morning appreciate the opportunity uh and i too am very proud of the fact that our subcommittee uh put together a bipartisan appropriations product that um I wish could serve as a model for the other appropriation subcommittees. Secretary Collins, as you know, El Paso, Texas, the community I am privileged to represent is home to more than forty thousand veterans.

Mm-hmm.

In fact, El Paso has a veteran population concentration roughly forty percent higher than both the Texas and national averages. And because of Fort Bliss and the strong military community there, That number continues to grow and we are proud of that. Veterans in our region are spread across a large area of West Texas and Southern New Mexico. This creates real access and capacity challenges for the VA health care delivery in the region. So I think it's fair to say that ensuring reliable access to VA health care in the region is a significant priority for the department. Would you agree?

It, as it is all over the country.

Thank you. I'm glad to hear that. Um, that's why in uh twenty twenty two I helped secure roughly seven hundred million dollars for the construction of a new VA medical center in El Paso. This facility will serve not just El Paso but the broader region. It will be a major anchor for care in West Texas and Southern New Mexico. The facility is expected to open around twenty twenty nine or twenty thirty, and even though that sounds like it's quite some time away planning for the staffing, quality care and operations of a facility of this scale and scope needs to start early. In William Beaumont, the VA hospital that will be adjacent to this new VA facility was four hundred million dollars over budget and was three years delayed. Thankfully that's not the case uh with this facility, but as you can imagine, veterans have apprehension about making sure that that the new facility is opened on time, on budget, with adequate staffing. I am so proud that the fiscal year twenty-seven MilKom VA bill included my provision, that directs the VA to brief Congress on activation planning for the new medical center. Secretary Collins, will you commit that the department will work closely with my office and this subcommittee as activation planning for this facility moves forward.

Of course.

Wonderful, thank you.

Can can I bring up something here though?

Yes, absolutely.

It's you's are right. Yeah, and I do appreciate you looking at this, this may be something we could actually because you've experienced it. Construction, I brought this up on, uh, this is my tenth or eleventh time on the Hill. I'm undoubt somebody told me that there's only, I think Scott Bisset and Pete Hex is about the only two that's been up here more than me. But I bring this up every time. And you do, yeah, I appreciate you so much doing this. Construction at the VA is a Bismarck. It is awful. It's terrible. I I can't come up with it. Uh uh my thesaurus runs out of words. And the reason is is because over the years we have tried to piece mill stuff, place it out, and we'd give two hundred million here, two hundred million here, two hundred million here, two hundred million here. And at the end of the day we got a fifteen year project that cost one point six billion. Example, you know, we're so we one of the things I did was change that. I said let's look for a major like hospital construction, which yours is ongoing, which by the way is about forty nine percent completed,

Mm-hmm.

and we're completing that out. But when we look at this, we're putting in the facilities to be built with all the money up front. So that we're not coming in and giving the land one year, the paving one year, whatever else one year. So that's one thing that we're changing. The other thing though that we're also changing and we would love to have help on, is we're internally changing, Richard's over this, I don't know if you all know this, Did you all know that the the everybody's heard of national building standards, right? We all know what national building standards are. Somewhere in the VA though for a number of years ago, we decided those weren't good enough. So we added an entire VH VA on top of it, which makes stuff that's going on in El Paso costs more and is basically not functional. We're taking that out. We're taking that whole thing out and making it go into the standards that Mayo and everybody else uses. The other thing is is, and I'm and I I say this with love and trepidation, But many times, just like the wait times and how wait times got started in the VA, the construct- some of the construction delay, there's two front, one is set aside as number two, the other one is the big one. And that is that we put the Corps of Engineers in the middle of major projects

Mm.

after Aurora, which Aurora was a debacle. But we put our Corps of Engineers, Corps of Engineers does not wanna be here. They do not wanna do our stuff because what happens, we do our planning and then they get in and try to do planning. So that's what's slowing your project up. That's what's slowing I mean, I appreciate what the Corps does. I mean, but they don't need to be in my buildings for hospitals. They don't need to be in my buildings for clinics. So that's gotta be statutory. I can't get rid of them. As much as I would love to, Mr. Chairman, I can't get rid of them out of my system. That's a statutory issue. But you have highlighted perfectly what your veterans need and what you're committed to. And I appreciate that.

Thank you, Mr. Secretary. I'm um just uh I'm overtime, but um my team and I are actually working on reforming mil con funding also wanna work on reforming uh va funding because you're right this projects are costing too much they're taking too much time it's unconscionable all of that essentially creates a delay in great projects and it gobbles up money from other projects that uh need funding and resources so would like to work closely with you um on that because that is

yeah

a fundamental piece of the work that we are doing in my office. So, look forward to working with you on getting that done. I know I'm out of time. Mister Chairman, I yield back.

I would like to just say, I wanna follow up with Mister Chairman, is look no one of you are exactly right on all this, but I'm gonna say that meets money up from other, we're seventy year old. Our facilities are basically seventy year old, that's our average age. But here's something else, just to give everybody on the committee and the staff especially to hear this. Saint Louis, which is a facility that's already been done from last year, one point six billion roughly to build a new facility. uh that they're doing out there um it's smaller than in my hometown and uh especially if you're familiar gainesville northeast georgia medical center built a larger facility with ors ers same kind of format did it for eight hundred million in twenty four months it's gonna cost six years and one point six billion in st louis that's the problem we have right now

right i would still argue that's a loss it's a loss

Thank you, Mr. Chairman. Thank you, Secretary, for being here with us uh this morning. Always enjoy our time with you. Um, when you first assumed the job, we sat down uh at length in my office and um you laid out a vision with um how you'd like to see the the organization change from having been on this side of the dais. And uh it was a pretty daunting task. You've got the the largest uh agency outside the Department of War, and bureaucracy never changes easily. Uh last year uh when uh there was a lot of uh angst and consternation about changes that were being made and doge cuts and things like that and and revealing the the the challenges you know once you uh were able to lift the hood and see what was in there. But I'm I'm really encouraged by the results we're seeing so far. You've shared some of those, but I do think some of these bear uh repeating, just for people out there who are wondering are we really making that progress. But you know enrolling a hundred and forty thousand new veterans last year in twenty, twenty six, that's a big deal. You opened thirty five new facilities. You've you've alluded to some of the challenges with the construction side. Uh the backlog is a huge thing. That's what I I was hearing uh, more than anything else when I first came into this role, but reducing that by seventy percent of folks waiting, uh, to get their benefits. And then, you know, the, the veteran homeless situation we face in all of our communities across the country, but permanently housing nearly fifty-two thousand, uh, last year, that, that's the highest in seven years. The CMS report, that's great results. It's not good enough just to compare yourself to, to VA but also how we stack up on the outside. But I am curious at this point, uh, you've talked about construction challenges. uh, electronic health records, what have been, what are a couple of the things that have been most surprisingly stubborn and obstinate to change and um, you know, what are the biggest barriers from from the next level of success? When you're back here next year of course.

OK, here's where here's where I'll get in trouble. Um, the biggest barriers I found is there are some people who are wedded to a broken system. They liked the way it was. Um, and and I'm saying that in general. I'm not gonna be specific, but in general, There's a lot of people who have become used to the VA being bureaucratic and non-responsive. There's actual organizations outside this building, members and and people inside the VA. That they know it only one way. And so when you start changing things, and making it better, more efficient, getting those things done, there's a lot of resistance from both outside and inside. Uh, there's nothing more fearful than the, be on the tip of the spear and the point of change. Mocky belly. That's exactly what's happening right now. So the mind has been amazing that when we go to things that should have been changed for thirty or forty years ago and all of a sudden now we're just saying we're bringing it up to is well well we've never done it that way before. You know you haven't because it's broken and you like it broken. So I think what we're is overcoming that as best we can with communication. We're never gonna be perfect. Nobody is on this side of heaven. But I think we were making progress in communication. I'm trying to change an organization. And I said this yesterday in the senate. One of the, and the second thing you talk about surprises, one of the big surprises I had was that we had a VA's workforce that had been so used to be to being told how bad they were, and how much things were wrong, and being slapped on the hand, and saying, you're not doing what you're supposed to be doing, my patient, my veteran didn't get seen on time yesterday, he waited two weeks, why did this happen? They got so used to hearing that that most of them just repelled back. They didn't wanna answer questions. They didn't wanna step forward. They didn't wanna have uh discussions. Because at a certain point in time, if all you're told is how bad you are, they never get told how good they are. I've got the best workforce in the country. And right now they're responding, but they're not used to being able to go and make leadership changes. They're not used to have an executive director who can actually go out and make the changes get rid of people put people in the right places make the staffing change, they need to. They've never had that ability. We're actually giving that to them now. It's gonna take a little while for that cloud to lift. But it's that cloud lifts, I've been in facilities for the last three months, you can see the difference. I had a s- I had a chief of staff at an unnamed who looked at me last year, and I'll be frank with you, she looked at me and I told her some of the plans I had. She looked at me and gave me that look that my kids and my wife give me. Yeah, right. That just that, that resting face that you said, no, that ain't right. I was with them recently. Yeah, I I'd have thought there was a new person. And she act- and she actually said, I didn't believe you.

Um,

But it is working.

I'm encouraged just, you know, I'm eager to hear how that continues to progress. I'm also interested on the the issue of veteran suicide, PTSD, all of us who have served painfully know all too well uh the tragic consequences we continue to live with. Uh I've been encouraged by the what we've seen with the psychedelic treatments. I've known a lot of people who've left the country and done treatments outside, or have done things unsupervised, illegally, but but swear by it and and I was encouraged that we've gotten some money in there for trials. I'm interested to know if we have any early feedback, what you're hearing from that, and if that is a good thing, if it turns out to bear the fruit like we think it might, what's integration gonna look like? What should we be doing from a congressional side to help pave the way for making that part of the the treatment protocol?

I think continuing to lead the way, you know, and just making it very known, uh, it's, you know, as again, uh, I I was just sharing the other day, this is my first time appearing before committees as actually a veteran. I retired last Saturday,

Hmm.

um, after twenty-five years in the Air Force.

Congratulations.

And so, sitting here is a little bit different now. Cuz I wanna say, " I'm still in the Air Force." "No, I'm a veteran." So, uh, I'm I'm my disability claim done quickly. But, yeah, I think the biggest thing is is looking at that is I know what other veterans are going through and I've been there a rack I I was there and I seen what's coming. And the psychedelic, uh, is a uh, uh, someone who sees the results. If it works for a veteran, it goes back to my main premise. If it's working for a veteran, then we're gonna we're gonna find every way we can. Some things that people may not know is we were already doing psychedelic, uh, issue. We did with MDMA. ketamine we've done it with uh psilocybin we already have those in fact we have a new study that is started right now MDMA uh that is sort of out of this whole process it's an all veteran that we're doing our own which i'm very excited about the results have been really good they don't work a hundred percent but they work a lot um and i need to get this out in public Ibogaine is the one talked about a lot Ibogaine still got to go through the FDA they still gotta formulate the room and the plan to actually how we would uh do that Uh, so it's not available right this minute. We're hoping within the next twelve months, you know, or as this progresses to get those out as quickly as possible. The VA is working hand in glove with HHS and FDA to make sure we have proper protocols and everything in place because we don't have this longitudinal studies on how it affects in that particular case but we're committed to making sure that we're gonna follow through on the President's EO and also the the more that we've already been doing.

Thank you, Mr. Secretary, and I I'll go back to him.

thank you mr. chairman thank you mr. secretary uh before i ask my questions i wanna share some observations a progressively growing number of va front-line physicians are becoming very alarmed about current threats to veteran care

yeah

the alarm is not due to concern about losing jobs the alarm is due to the imminent irreversible damage to a sacred mission that has become obvious to those with inside knowledge the reason va physicians are alarmed is not because of public reporting or perception. It is because they're witnessing the sabotage attempts firsthand. Mister Secretary, those are not my words. Those are the words of a primary care physician who has worked at many different VA systems over their career. A doctor who wrote to me after watching your testimony before this subcommittee last May because they were in their words dumbstruck by what you said. Mister Secretary, when I raised my own concerns last year rather than pick up the phone and call me, have a meeting, anything constructive, you tweeted at me. I have this tweet, Mr. Secretary, if you wanna reflect, refresh your recollection. You accused me on social media of, and I quote, spreading disinformation, end quote. So let me ask you directly, is this VA doctor with inside knowledge of the system you run also spreading disinformation?

I don't know what he's talking about.

you don't know what he's talking about mr. mr. secretary last

i can't i can't i can't answer i can't answer your question i don't know what he's saying

last august your own inspector general found that ninety percent of va medical facilities reported severe shortages of doctors and eighty percent reported severe shortages of nurses that's your ig then last year thirty thousand employees left va through early retirement deferred resignations or burnout and two months ago the new york times reported that va eliminated fourteen thousand unfilled, unfilled medical vacancies. Fifteen hundred physician openings, forty-nine hundred nursing openings. That's five percent of VA's entire medical staff. And critically, seventy-three percent of those positions were not, were not COVID era leftovers. They were occupied positions during the past year. So let me ask you a simple question, Mr. Secretary. Did the President authorize the elimination of those fourteen thousand open medical positions?

I'm not sure what the president has to do with this.

Mr. Secretary, I'm asking a simple question. Did the president did the president reclaiming my time, No, the pre- the the president told me to take your picture. Mr. Secretary? Did the president know that you were going to stop looking for No, why not? doctors and nurses to fill fourteen thousand open positions? It's a yes or no.

No, because it's not what we did.

Mr. Secretary,

I mean, you can continue you continue your discussion,

just one year ago

but you're not even on the right path at this point.

Mr. Secretary, just one year ago, ninety percent of VA medical facilities had a severe shortage of documents.

And so did every OIG report before then that said the same staffing shortage,

Since then, since then, since then,

even in Europe.

reclaiming my time, Mr. Secretary, since then thirty thousand employees have left VA

I'm Yes.

and you now have stopped looking,

That is not true.

before you can You have s-

Don't, don't, don't, don't.

You have stopped looking for fourteen thousand positions.

Do not, do not go. We are looking everyday for positions that we need. Now you can make a political point, that's fine, and you can leave that in there for a tweet,

Mr. Secretary.

but you're not gonna put out this information.

You're the one tweeting, Mr. Secretary.

You're doing it again. You're doing it again.

You're the one tweeting. Mr. Secretary.

You're doing it again.

It doesn't add up.

it does add up

reclaim reclaiming my time how can you have a severe staffing shortage in twenty twenty five according to your own ig then lose thirty thousand people and then eliminate vacancies and somehow magically fix the severe staffing shortages found by the ig it doesn't add up mr. secretary let me change topics cause i don't think we're gonna agree on this

well no not when you look at the results that we're seeing and what we're saying and what we're having

the facts mr. secretary you're this doctor told me after watching after watching your performance last year this doctor told me

what are we sabotaging what is we what are we sabotaging

that the reason va physicians are alarmed is not because of public reporting or perception which is not great it is because they are witnessing the sabotage attempts first hand those are those are

of what what are we sabotaging you can't use sabotage as a as a cruel offense

maybe you should maybe you should listen more to people who aren't trying to tell you what you wanna hear maybe you should listen to those

maybe you should go and visit as many hospitals as i have and then we can do this conversation

i will visit any facility with you any day i have been a i have been a va

come on

my entire career, sir. I fought for veterans for six years on the Veterans Affairs Committee.

Thank you.

The legislation that the gentleman from Florida discussed before, that was my bill, the Isaacson Roe bill.

Yes. Congratulations.

I will put my record, uh, defending veterans in this country against any member of Congress. And I'm telling you, sir, you need to listen to more of your staff and more of your doctors. This situation is not what you think it is. It is not the rosy picture that you think it is.

I mean, Oh. it's not what you're presenting either.

Mr. Secretary, many of the VA many of the VA many of the VA staff

The elite acknowledges you may have wrong.

with are telling me about understaffing burnout morale is not what you are saying many believe your restructuring is a predicate to privatization including the people who led the last restructuring initiative in the first place veterans i have spoken with wanna know why there's not enough money for fully staffing va health care to care for the veterans so many of our uh constituents are and so many of us care about and i just ask you and the administration sir don't tweet at me And don't just listen to the people who tell you what you wanna hear. It seems to me, sir, that you are not getting the information you need because the people surrounding you, like so many in this administration, are absolutely scared to rock the boat. Mister Secretary, listen to those with whom you have a different view. Thank you and I yield back.

Uh, I mean, continue with the disinformation. I mean, I, if I can't respond that's fine if that's if that's the point

am i allowed to respond to that

no you i'll respond right back we can go through this while because i'm not gonna i'm not gonna let you sit there and do stuff that you want

i can't you just you just name one name one fact in what i said that was disinformation in any way one fact

what do you i mean well number one that the staffing shortage is sufficient our wait times are going down our veterans are getting the care that they need

all of it is publicly reported sure it's all publicly reported and you know that

right

uh you also know that that twenty five o i g was on twenty four did you have did mcdonough in here talking about this no

he did he answered my calls

and i did too when did you call me lately When have you called me? You call me right now, it'll ring right there.

You two videos are falling for hearings. Thank you, Mister Chair. Uh, I'm gonna respect the clock. So if I cut you off, it's because I've ended my five minutes, but I'd like to give you one minute, Mister Secretary, to respond to Mister Levin.

I think the problem here is, is that some person, one individual, and I don't doubt this doctor, has their own opinion. But they're not entitled to their own facts. They can have their own opinion, not their own facts. And the facts is when you look at our system, our wait times are going down, our hospitals are are operating, we're getting more efficient, we've opened two million more appointment times than was even last year before when I came in. We had eh the the situations in our hospitals are going, opening new facilities, doing more treatments, we're having more treatments for uh our veterans, for women and other healthcare. We're actually providing more t- care in the community than we have been obligated to under Mission Act. And again, am I gonna have people in the community and even some of our own doctors who don't like what's going on? I think I said that earlier. Yes, some do not like change. Some believe that the staffing, but um, explain to me something when supposedly it was great before, that all of a sudden we had uh backlogs of two hundred and sixty thousand, we had wait times going up. You can't tell me that money and people are the issue.

Alright, thank you. That's the one minute retort there. I wanna change subjects to something a little more um less stressful. Uh, wanna talk about real estate. I am the chair of the Real Estate Caucus here on Capitol Hill, former realtor. Wanna talk about the VA loan uh programs. I think it's one of the most successful tools uh for the VA that it's ever created, uh giving veterans uh a chance at homeownership of zero down. But when veterans fall into financial hardship, uh the system should work to help them preserve that opportunity. And that makes encouraging workable alternatives. I appreciate the department's willingness to engage on these issues, and I recently sent a letter uh outlining several ideas to improve outcomes for veterans and taxpayers. Um, over the last ten years, HUD, USDA, and GSEs have created significant taxpayer savings by strategically pricing assets at foreclosure to encourage third-party sales. Unfortunately, the VA has not kept pace, leaving over seventy percent of foreclosed homes in the VA home loan program to become Real estate on the inventory. Not a great deal. What are we gonna, what are we gonna do to change this, sir?

Well, that's one of the reasons VAST was done away with, cuz it was, this was just not something the VA is equipped to do. That's not in our portfolio to handle and actually it'd be liability for the uh properties that we have. That was one of the main reasons following the lead of Chairman Boss on HVAC and others, that we needed to get rid of that problem, which was not statutory to start with. It was just invented inside the VA um MVBA off of this. So the biggest thing is now finding a workable solution to all the things that I'd mentioned earlier. but also having now the partial claims which will be implemented by June fifteenth.

I wanna talk about the VA uh home inspectioners, they call them appraisals. As a former realtor, I don't know if you know how this works, but if you're selling a home and you're a listing agent, you have a fiduciary responsibility to the seller. And that means if you get multiple offers on a home, you're gonna take the cash deal first usually, then conventional, uh then FHA, USDA and VA is dead last. Because the more stringent appraisal or inspection process, I think that is wrong. I think veterans are being discriminated against. I've talked with Chairman Bost about this, to where we have to make sure that if it's a federally backed mortgage, whether USDA, FHA, or VA, we have the same standards. So veterans are not penalized. Um, I, I, I don't think you can require a, a, a seller to accept a certain Mortgage, when you list it on the MLS, you can put what type of mortgage or financing you will accept in the offer. But I think it's wrong to discriminate against veterans.

I think, you know, I'll have to go back and look exactly where the, the, uh, process is. It's not something I looked at in the last little bit. But I mean, some of this, and I'm not gonna say it is or isn't, some of this may be statutory and how we have to deal with those, and then some is policy. If it's policy, then we can always look at how we can better, uh, facilitate those. But if it's statute, it's gonna have to come from you.

Well, I would like to work with you and Chairman Bost as well

Yep.

to make uh effective positive changes for our veterans, because I think the VA loan program is worthy um and it's helped a lot of people get into homes. I have personally sold homes uh or or been uh have been the buyer's agent uh to help veterans get into a home and I know what a blessing it is to be able to, to have your own castle after you've uh served our great nation. Uh, with that, I'm gonna do something unusual. I'm gonna respect the clock. I'm gonna respect my fellow members and uh yield back twenty three seconds, Chair.

Thank you, Mister Chairman and Ranking Member, Mister Secretary, it's good seeing you again and uh Assistant Secretary Toppings.

Good seeing you.

Um, I have um, I wanna talk about my district uh construction also and we,

OK.

I think we've heard that from uh my good friend uh Miss Escobar and I wanna talk about northern part of my district san antonio uh that i think you're familiar with and in the southern part in laredo texas i also wanna thank the chairman and the ranking member in the committee for allowing me at two uh provisions to deal with those two um uh the san antonio audi murphy uh medical center and the laredo v a clinic modernization and expansion uh areas and uh first i wanna talk about audi murphy um we understand as you know audrey murphy is in a military town usa san antonio texas um uh that's a major va hospital with uh more than four hundred beds uh serving veterans from not only to san antonio but all the way down to south texas as the population in san antonio is one of the fastest growing area more veterans are relying on that relying on that system for specialized care Uh, RVA region is now the fastest growing region in the nation with more than seven hundred new patients entering the system every month. And as you mentioned, you know, we got hospitals are pretty old. Uh, our hospital was built in the seventies and certainly uh, nineteen seventies, and certainly doesn't reflect the modern facilities uh, that we need today. Uh, that puts a lot of pressure on facility there in san antonio and basically the um um the va has started the um uh the planning efforts uh uh uh they done the feasibility study as you know uh we're in the environmental impact uh statement i i'm familiar with the environmental statements they take uh quite a while but as far as we know there's been no negative uh public uh feedback on this so everything's uh moving along and i would just ask you to do whatever we can to work with richard pettis you know sanatorium community uh to move that facility as as fast as possible

uh we'll be happy to and richard can give you an update on on that from the budgetary sample

uh representative uh thanks for bringing that up i think one of the questions that you know we had yesterday was that we didn't bring our investment in direct care the president's budget uh has historic investments in direct care again two to one on direct care a hundred and twenty billion dollars in direct care and then ten point four billion dollars in construction the majority of that is in the clinical services uh of that ten point four new medical center in indianapolis new medical center in manchester new hampshire um land acquisition in san antonio that is well underway on the environmental work um west la housing facility infrastructure expansion five expansions on um national cemeteries eight hundred and sixty one million dollars in minor constructions six hundred and seventy thousand in clinical facilities five billion dollars in maintenance uh on our physical infrastructure uh on our hospitals in addition to the five billion dollars we're doing this year and two point eight two point four eight billion on lease improvements um all of this obviously subject to the appropriations uh by congress and approval by congress but if you if you fund it we will build it sir and so thank you for the question we're ready to go if you are

ok well we are ready and uh we certainly will uh ask you to work with the san antonio uh community they they're all ready to work with you they're trying to move everything providing the land uh as you know so uh as you go through this environmental statement i would ask you to please move on that as

your folks your your folks have been wonderful partners and if appropriate we are ready to move in fiscal year twenty seven on that acquisition

ok we will do our part uh second of all uh laredo everybody talks about the border different reasons it's one of the safest areas according to fbi statistics but i wanna talk about the va uh clinic there some years ago we were able to appropriate the dollars working with uh senator k bailey hush uh hutchinson uh we're able to do that we got a new clinic it was a small little clinic same thing along the border it's growing very fast uh we added the the provisions and and again consistent with the department's strategic capital investment planning process uh, is ask you to look at uh, look at the Laredo uh, clinic's uh current facility, uh, see what the capacity is. And again, following the process, we'll work with you on, we'll do our part, but we would ask you to look at the Laredo facility construction and expansion that we need to look at.

Yes, sir. We've got it.

OK. So again, on behalf of the uh veterans in uh Laredo and the surrounding areas and also in San Antonio, we wanna thank you. We look forward uh, i'll get the number uh from my friend uh that you gave out and uh and certainly look forward to having that conversation so thank you and uh god bless uh both of you

thanks

but i'm gonna be very fierce on the five minutes and i would also respectfully request our members of to this panel we've asked a question or gotten in an argument give the uh person a chance to answer if not i'm gonna cut you off alright i'm gonna start out i'm encouraged to see the budget request include significant investments in va infrastructure as well as recent announcements of six hundred million in infrastructure improvements through the non-recurring maintenance fund i was especially pleased to see some of these resources directed to directed to temple texas we all understand that by maintaining the va facilities and replacing outdated equipment are critical to ensuring veterans receive high quality uh and timely get

excuse my

and timely healthcare. Can you briefly discuss the infrastructure needs of the department and what you're seeing across the country and highlight where some of the additional investments from non-recurring maintenance funds may be directed.

Uh, thank you, Mr. Chairman. As you know, we've got a backlog of maintenance in our facilities. average physical plant in VA is more than sixty years on our facilities. Uh, and we've been addressing that. This year we are spending five billion dollars in maintenance. This includes the temple facility where we are converting two hundred and four beds into private patient rooms as well as a full electrical rebuild rebuild of the facility. Uh, our FY twenty-seven budget proposal includes an additional five billion dollars and maintenance to tackle that deferred list, in addition to new construction projects that we just shared too. so sir we're tackling it we're moving forward the budget is a historic investment uh in our direct care facilities we thank you for your support

thank you sorry miss washington schultz

thank you mr. chairman um secretary collins i think you can hear from mr. levin's questions and others that have raised the issue of the difficulty that the department is having in ensuring that hiring for the critical positions that that that hospitals need clinics c box um is a challenge so uh i would just encourage you rather than digging in and suggesting that that is misinformation or disinformation that you look into it very specifically and granularly because i am not hearing anecdotal evidence evidence once i go to a va facilities across the country and they're telling me the same thing

that's fine uh we will and we're it's you and i problem and we're good

so so it is not it is i i don't think the gentleman from california means any disrespect at all um suggesting that facts that he is presenting to you at a hearing are misinformation or disinformation is inappropriate

i'll i'll discuss that with the gentleman as well but also the oig report he does reflect reflects what the is doesn't reflect the actual shortages i think that's the problem

ok i i uh ok i i'm just telling you

i appreciate it thank you we're good

that i have heard the same thing and so i would

me as well i mean it's not it's not something we haven't heard

i i

i just don't think it's predominant

ok well it it appears to be deeper than you than than than you believe um community care april first mek and marindra law and i sent you a letter which we have not had an answer to yet it is may twenty first and may twentieth whatever date it is um twelve and half hour mark up last night i'm not sure which end is up um but we don't know or understand why costs in community care have increased so dramatically we need to better understand those key factors and look it fuel when you have a three hundred and sixty seven percent increase in the cost of community care when previously it was nine million dollars a year and we're at uh we're at forty two million now um that that looks like a march towards privatization and i understand that the mission act has led to an increase in the reliance on community care but no one predicted it would lead to this level of cost growth veterans prefer to get their care at the VA. So I'd like you to lay out the the lay out for us here, what exactly is driving the increase in cost of of community care, what are you doing to contain these costs, and when will I see a full response to the letter that that uh Ranking Member DeLauro and I sent you in April.

Um, first on that one, I I was brought to my attention today, I've I've asked myself already this morning why that wasn't already answered, so we're getting that.

Thank you.

Number two, I was I think we're just kind of respectful to disagree that most every veteran wants to get their care directly. OK, there is a difference here. I think we need to look at every time a lot of times I speak with.

I mean, surveys say that repeatedly.

Well,

I'm not I'm not snouting on.

surveys, it depends on a the GY veterans not as much, and I think that's one of the issues that we deal, but I but again, there's differences there. I wanna lay out the numbers, Richard can lay out the numbers on what's happening and why we're also asking uh, for the split of those two accounts. I think it will account for some of your questions.

Ranking member, I want you to know how much we're spending on community care. I want you to know of community care cost and I want you to know the all-in cost. what we currently report is the cost of purchased care that's only one of the cost of community care there's also the contract cost and then also the administrative cost our account structure is a holdover from when va was primarily a direct care system with a little bit of purchased care our proposal is to break these out currently my community care costs are commingled with my direct care costs are commingled with my national program costs it makes it very difficult for me to give you direct data on where the spend is where the increases are and even one of the questions i think that came up yesterday too was direct versus uh versus community and then the percentage growth we are trying to show you the all in cost that's the account split proposal what we are doing to manage those costs for the ccn next gen which we have talked about that's the ability to require uh and report on quality the ability to pay for value not volume the ability to use program integrity tools to make sure that we're paying appropriately

mmm

but even when we make those investments we make those payments in florida alone it's two point eight billion dollars that we're spending on community care that's not money that disappears in a corporate america or somewhere else those are monies that we invest in for the doctors for hospitals many of these in rural areas

reclaiming my time reclaiming my time for a moment the problem is is that in most cases uh or many cases it takes longer to get appointment in the community than it does to get one in the va and there are countless surveys that are done that uh in in many many instances the length of appointment time is longer in the community uh and there are surveys all over the va outside the va i've never heard anyone say until you did just now uh that would suggest that veterans don't prefer their care at the va and if they do prefer their care in the community um why do we have a va uh i mean we we have a va because we wanna make sure that veterans are taking care of veterans uh that

i think we're always i apologize i apologize i thought you stopped i thought you stopped

no no mr. secretary please don't interrupt me i did not um at the end of the day we need if if we if we have a va which we absolutely should that is comprehensively caring for our veterans where they prefer to be cared for then we need to make sure that most veterans are getting their care in the va my time has expired but mr. chairman i am gonna have other questions i yield back

mr. bishop

thank you let me go back to the workforce and staffing. Uh, you have uh emphasized reducing unnecessary bureaucracy while protecting mission critical roles like doctors, nurses, claims processors. Uh, can you tell us what the categories are that are increasing, uh, and what categories are decreasing, and how, what metrics we will be able to get from you, uh, to know that the reforms uh that you are proposing and that actually degrading the care uh delivery uh can you provide for us or will you provide for us um uh vacancy rates for the physicians the nurses the mental health providers the schedulers carrying processes yeah uh and the construction project management personnel uh by their respective uh visions uh yeah that's actually very important that certainly transparency and that uh update would be very helpful to us yeah yeah um yeah if you would commit to do that for us.

um and stick with it exactly

yes i mean we can provide that it's about a ten percent vacancy rate which has been about a historic at the va is is really where we're still at right now um and we can provide you any breakdown that you would like to have on your visits or any of the any of the facilities across the country uh going forward um and i think one of the things we've i think we go back to without you know discussion and and there's there's always different perceptions and and i think from the ranking member's perspective, I appreciate her perspective. Um, there's uh, the biggest questions that I get, and it's just again, she, you get different questions than I do, I'm I'm sure and just as you would as well. But when I'm speaking especially like to VFW groups, I, you know, other like this, the ment- the moment we mentioned um, they enjoy, they love, most of them love their VA care which is great, but when we talk about uh, the community care there is also something very important to them, and it's what most of your constituent calls are about. Um, So, I think this is, what we're trying to do is make sure the staffing is appropriate for where we need to have it. It needs to be in a in a level it need to have and not what a projection could be or what you want to have it's what is actually meeting the need where we're at. So, any information you need of course we'll get to you uh uh further than that, but um that's protective.

W- we uh Mister Secretary, we continue to get feedback from our veterans and from our constituent service people that tell us that uh certain specialties uh that veterans need they can't get appointments um they can't get them at the va and then of course they're having difficulty getting them uh outside of the va and uh with all of the emphasis has been given on downsizing in terms of the staffing um and providers uh within the the va i mean i i i'm i'm just concerned because that's the feedback that we get and it's not just our concerns as members it's what we're hearing from our constituents and what i hear from my case workers and what i hear when i go to the uh the va and to the uh i mean to the uh uh vfw and the american legion and the other uh veteran service uh organizations uh they are telling me that uh their members are having some some specific uh problems with with with with uh specialties uh nephrology for example is a is a real real problem uh so i i i just would like for uh to get some reassurances that veterans and female veterans will be able to have the specialty care that they need uh without concerns of uh of not having outside providers willing

yeah

to uh uh to accept veterans

yeah i i congressman i agree with you and um we're i mean the one things i've never said is is that we're not outside the uh integrated health system of our country we have the same issues that columbus medical and all the others have as well in hiring specialties i remember my brother uh who is not a veteran it took him almost uh four and a half months through his regular uh private insurance which is the georgia health state health insurance to get an appointment um, for a issue that he had. And this was in the, uh, process. They, doctors and nurses in Northeast Georgia, Northside, Piedmont, everybody else has the same issues as trying to, uh, continue to, to feed the need in our communities for doctors, nurses, and everything else. We're at that same boat of having, uh, to compete with them. So, uh, again, it's not surprising, I mean, I don't deny that in certain areas, in certain areas it's a little bit harder to hire, especially just as it is for the community as well. But we're, we're concerned about it, we're, and we're working toward moving, and making sure those, uh, are protected and hired.

Thank you. My my time has expired.

Thank you, Mister Chairman. Um, Mister Secretary, regarding community care, the conversation, uh, the the dialogue you just had with our ranking member, I associate myself with um the issues that she has raised. And I also want to say that my colleague, Mister Levin, raises issues that I have also heard about. I think it's really important that these conversations be an opportunity for the department to look holistically at at what members of congress are hearing from their own districts. I wanna pivot um and uh shift gears to an issue that is important to my veterans in my community, which is home ownership. Last year, you described the VA home loan program as one of the most effective federal programs in history and I agree it is one of the most important benefits that we can provide to our veterans. It's helped millions of service members and veterans achieve the American dream of home ownership which is increasingly becoming more out of reach for most Americans. In El Paso alone, there have been more than seventeen thousand VA home loans over the last five years. So I I think that you and I agree that helping veterans successfully a- access the benefits they've earned is a core responsibility of the department. But I think most people would be surprised to learn that fewer than thirty percent of veterans are even aware that the benefit exists. And fewer than fifteen percent of eligible veterans actually use it. And for many who do, the home buying process can be complex and involve actors who are not always neutral or independent sources of guidance. I think I know the answer to this, but do you agree that veterans should have access to clear, trusted and unbiased guidance when making major financial decisions, like buying a home?

Of course, and it should come from the VA as well.

Excellent. Thank you. So, I and I presume that protecting veterans from fraud and predatory financial practices is also a shared priority for us. Is that correct?

For yes, personally, and in effect, yes.

Great. And Secretary Collins, do you believe that there would be value in improving access to trusted, independent guidance for veterans using the VA home loan benefit?

I probably do agree, but can you expand on that just a little bit, just so I'm understand what you're saying?

Well, I'm getting there. I think I think you I think you will agree with me.

OK. I I know you're doing that. You're leading down the questions, yeah. uh listen uh whatever you had i'm i'm pretty sure we're gonna be pretty close on this

ok and and would you support a program to provide veterans with independent va home loan navigation services to better protect them inform them

inside the va

yes so i'm my team and i are working on legislation called the va home loan navigator act which would do this would help protect our veterans, ensure they have access to the information they need, so that we can get them into the homes that they want to live in. This bill would extend the trusted model used for other VA benefits to the home loan benefit. It would create a voluntary network of independent accredited housing counselors. They would help veterans navigate the home loan process from start to finish. buying a home, resolving loan issues, preventing foreclosure, free for veterans, and fully independent from lenders, servicers, and brokers. I understand you have not had a chance to review the text. We're working on this. But based on what I believe are our shared goals of improving utilization and the VA, uh, of the VA home loan benefit and protecting veterans from fraud, I'd like your commitment that the

not a problem well i would work with any member on technical assistance on bills that you come up with

great thank you so much mister secretary this is a priority for us and we look forward to working with you mister chairman i yield back

thank you

i noticed the the distinguished ranking woman is here this morning it's good to see you it's good to see has been a while

well thank you very very much i apologize well it's right and welcome Well, good to be here.

Well, it's good to see you again.

I'm delighted to have you here.

Yeah. We used to have lots of fun now on the board again. We shared a lot of same experiences. It's good to see you again, though.

You're here. Good to see you.

I hadn't seen I hadn't seen you in, god, like it's been five years, I guess.

Right, so, really, uh, we welcome you to the committee. I apologize for being so late, Mister Chairman, our ranking member, but, uh, there are two appropriation subcommittees that began at eight o'clock. So, uh, it's a busy time.

It's a hard-working committee.

It's a busy time, but good. Let me just, um, uh, I just wanna mention one quick thing here, that the bipartisan support to make um uh this is uh it's personal crucifix and approved emblem on headstones for catholic veterans so uh i strongly uh you know support anything you may be able to do to expedite the process uh on the approval process on that so that would be

not a problem i'll go with sam uh under secretary of p n c a will make sure that

thank you thank you let me just talk about the uh uh uh compensation and and pension exams and disability claims um va has emphasized progress reducing the disability claims back line i agree that veterans need faster decisions um speed only helps if the exam supporting those decisions are timely accurate and fair um for for many of our veterans the cmp exam is where their claim process either works or whether it breaks down so problems with short uh short notice scheduling long travel distances inadequate exams or contractor errors can delay claims lead to appeals penalize veterans for circumstances outside their control um let me ask you about the clarity of the rules for the cmp exams and where you all are on that including advanced notice reasonable options for where and when the exam happens review of the veterans records before the exam and protections so that veterans are not penalized when they miss an exam for reasons that are out of their control

right remember you you have hit something it's come very close and personal for me cause i i'm i'm gonna take it a step further and you may not believe I'm gonna go here. I'm at the position where if I could do away with the C and P exams, in majority of the cases, that's where I'm going.

Mm-hmm.

And the reason I'm doing that is is because what I have found many times, the C and P exams actually are just sort of either reinforcing or approving what we already see in the record.

Mm. Mm-hmm. Mm-hmm.

This is what frustrates veterans.

Mm.

When they put their disability claim in and they have to write down everything that they've done which by the way we're within about uh maybe this summer of having a four week a four page disability claim. instead of eighteen so my hope would be is to make it simpler but also if we already know you have the service related then why are we sending you out to a a cmp exam which can be objective subjective depending on which doctor you go to the i mean we've just seen problems in the system for a long time you and i are in lockstep with this i'm actually probably taking a step further than where uh you maybe thought i was going with this cause i just don't believe our cmp exam system is helping us at this point

right cause i cause i wonder how you even you track the exam and what what they

it's very difficult it it's one of our biggest sources of complaints

right

uh that we have and so i'm looking to see if we can just do a you know how much can we cut it back

what's the process for doing that what what would be the process for moving it

right now i have margaret evelyn who is over vba we're looking at this in combination with some of our folks at vha to determine because there is some you know there is some actual requirements that you have to meet i mean that's nobody that's one of the things that that

right

you know there's always a discussion of fraud in the system and i hear this all the time unfortunately on social media and everywhere else that veterans are getting this because and they didn't serve it no that's a very simple ass thing if they serve they have the service later they're gonna get

mmm

so i think putting those two together and finding a solution

what would be the basis on which you make the determination

you by the record the medical record from that we have the medical record is

medical records

coming out and also this uh the uh statements from you know that we allow for uh independent evidence and things like that i think we make it too difficult to get

mmm

what they've earned and because there's some obvious things i mean some people

mmm

i'm not gonna say they won't try to you know use proper words or whatever and i get all that But at a certain point in time, these are veterans that have earned benefits. They need to have it a simple process. Um, one that we, and if you give me just a second here, medical, uh, military sexual trauma is something I'm also really concerned about, and it's CMP exam time. We're making them relive this, both male and females, too much in our application, Oh, really? and I'm looking to, uh, to come, to reduce that to where they can only have to talk about it basically one time. Mm. Um, and then we can go from there instead of them having to relive that issue. So this all works into the CMP exams issue.

let me quickly i'm running out of time here uh veteran suicide prevention

yes

um uh really is there's the request is seven hundred twenty seven million for suicide prevention outreach um the department says that many veterans who die by suicide were not recently engaged with va care what are the programs that changes the outreach efforts to really reduce veteran suicide and the metrics you use to determine those efforts if they're working

uh thank you uh i think this is one of my departments

Right. Well, Well, that's the, that's the, that is critical, that is critical uh, uh, so that, so that, you know, you know, the outreach there to get to people who are in crisis here. and the outreach there to get to people who are in crisis here. So, uh, look forward to working So, uh, look forward to working Continuously working.

Thank you. It's always good to see you. Take care.

Thank you. It's great to see you.

Yeah, thanks for the call.

Thank you, Mister Chair.

Thank you and I uh promise my friend the Chairman I will respect the five minutes and I I thank him for all his work. Uh, Mister Secretary, I understand fully the IG report reflected fiscal twenty-five documented through direct conversations with VA front-line staff about the actual needs at their facilities since then, the VA has lost roughly thirty thousand employees and now VA is eliminating fourteen thousand bacon positions i'm simply trying to recreate the timeline and explain to you what i am hearing not just from one person but from people who worked at va for a long time and they are working in fear as this one doctor put it of additional sabotage but moving on i look forward to further discussion with you about it now that i've got your number mr. secretary but moving on we keep hearing

always good habits

thank you sir we we keep hearing from the administration about the need to

wish it might have to get changed now but other than that i'll give you the change

alright there you go sir hey i'm right right right there with you we keep hearing from this administration about the need to save taxpayers' money we wanna be good stewards of taxpayers' money the president wants taxpayer money for building a ballroom at the white house and now he wants a commemorative arch i'm sure you're familiar with this at the entrance to arlington national cemetery and he is relying on and i'm being honest about this in a a authorization from nineteen twenty five from a hundred and one years ago i'm sure you know veterans groups have raised serious objections they've said it turns a sacred place of mourning arlington into a backdrop for a political monument they've said the money would be better spent on the living veterans who need care right now and i certainly agree mister secretary have you personally met or spoken with any of the veterans or veterans organizations who opposed this arch and i know you can't speak with the actual litigants but i mean any veterans who oppose this cause i certainly have

no because basically arlington is not under my purview uh arlington is under my purview but nobody has talked to me about it

well it's nothing to do with mr. secretary it has nothing to do with arlington being under your purview i'm not asking for your opinion of the arch i'm asking whether you've listened to any of the veterans you're the secretary of veterans affairs have you listened to any of the veterans who oppose it

nobody's brought it up to me

well i would say veterans are publicly objecting to a monument the president wants to build and you are not speaking with them haven't sat down with them will you commit to speaking with some of those veterans before another dollar is spent on this project

this is not my project if somebody wants to bring it up i'm happy to do it i'm running a department that work that handles veteran healthcare

i think that's yes you will meet with veterans who oppose the project

i mean

I'm not talking about the litigants now. I don't wanna get you in any trouble there.

Well, I'm not going I would never meet with litigants anyway,

I just

but I mean, if somebody doesn't like the arch, which is not again, uh, anywhere in the scope of what we're discussing here today,

Yeah, I'm not asking Miss Miss Secretary,

I I don't understand.

I'm I'm just asking whether you'll meet with the veterans who oppose the arch. So we use that.

I'm meet with that, I'm meet with all veterans that want to come to our office.

OK, that's I'll take that as a yes. I'll take the win there, Miss Secretary.

Any way we can get it, Miss Levin, we'll be good.

I'd like I'd like to turn to the veterans and spousal spousal transition assistance grant program. So in twenty twenty, during his first term, President Trump signed into law a bill I led on the House Veterans Affairs Committee. uh to establish a program to provide grants to nonprofits providing transition services for veterans and their spouses in twenty twenty four va awarded five year grants to thirteen organizations across the country including one of our local nonprofits the thirteen organizations received the first year of their funding and started serving veterans in their communities they recruited participants they set up metrics to track their success but this past september when these organizations were supposed to receive the second year of funding they received no funding and they moreover they've heard nothing i can understand if these delays were the result of the government shutdown at the time but that ended six months ago many of the grant recipients have put in their transition services or put their transition services on pause because va has failed to provide the funding it promised for grant program two through year five the mr. secretary of congress has directed va to establish this program the subcommittee has shown its support time and again including in the committee report and in our bill uh and my staff has been asking about this in good faith sir for several months and haven't gotten answers so secretary are you ever gonna fund these grants

uh i'll let the my cfo discuss it

um so that grant program uh tremendous success we had ten million dollars and we spent ten million dollars

i know i know it was a success but i'm asking are the so the you're saying there's no more money

we have no we have no additional funding for grants

ok that's totally contrary to the will of our committee and and my understanding of the the uh budget as it exists uh what account did va use to fund the first year grant allocations and if va as you claim doesn't have enough money to fulfill all its obligations why didn't you request additional funding for that account in your budget request you just said it's a great success

so i'll take it i don't know which account uh but i do know that the ten million dollars in funding we have for that program have been spent uh and has been granted

alright so you just said it's a great success but our grant recipients are out in the cold they haven't heard been heard from or haven't heard heard from you guys we have to work this through cause that's not the intent of the appropriations committee it certainly wasn't the intent of the authorizing committee and i helped write that bill so this is an unbelievable disappointment to those nonprofits all around the country and we're gonna have to work this through and now that i have your number mr secretary we will we will get back to you on this thank you mr chairman

thank you now the breaking members requested one more question

thank you

please please take it include your closing statement when you get your questions

you got it i don't have much of a closing statement so thank you mister chairman um we'll we'll close where we began with the uh vha reorganization uh we initially received an eight point an eight page powerpoint presentation yesterday um i i assume in response to our request we got a twenty three page document outlining your justification for reorganizing the vha uh that's something that we should have had from the beginning um i mean the clinton era reorganization which was the last time vha reorganized was over a hundred pages um the law requires that that would be the first document that we receive before any reorganization occurs

we

and we're still reviewing it because we just got it yesterday but your staff told us in past briefings that one reason the reorganization is needed is to ensure clearer and consistent policy across all medical facilities you've also cited several gao and ig reports another example of why we shouldn't be cutting them that highlighted these challenges however no report that i can find mister secretary recommends a reorganization as the solution so why did you specifically decide a wholesale reorganization was the solution rather than dealing with the challenges one at a time or in chunks and what's your plan to measure veteran impact how will you know that this reorganization works and that veterans are better off as a result when we have no recommendation uh for by any independent entity for reorg and we really have very little information that explains why it's necessary

uh i'll be just short and to the point there's there's been suggestions and around the edges reorganization for this department for twenty plus years so some taken in pieces but i i looked at this as a position in which there is not a band-aid needed there was needed stitches and not only is it not even stitches they made me need to be more cause you can't fix This is the problem that's been at the VA for a long time. We try to fix one piece without looking at the total piece uh of the project. VHA just got to the point where um, especially this higher li- the leadership structure was not sustainable for the, uh, veterans, and how I know this is, is working and gonna work is that the local hospitals, the local clinics will have the ability to help the veteran that walks through the door. That's the, the metric that we use. We don't use metrics of anything else except is it affecting the veteran and getting the care that they need. Mm-hmm. And I think this is gonna do that. Um, I think we can have the continued conversation, especially because I think this is gonna help our direct care more than anything else because the actual folks, uh.

What's your plan to measure veteran impact? Saying that you wanna make sure it's all veteran focused is great,

I I Well, I mean, we have

but what's the plan?

Yeah. Well, yeah, I think it's it's that's what we always have,

That measure?

from the the our our satisfaction scores, which by the way are eighty-three percent of the highest they've ever been from our veterans giving their own impact.

Do you have Forgive me, I I I I'm sure.

Um.

Do you mind, uh, deferring to Mister

I saw

mister topping if he has some

to be I'm a I'm a I'm a

details on on the measurement aspect of veterans satisfaction and impact

uh and that's what I was explaining I mean as we as we have this all and also we'll measure through uh better policy through our wait times more opening up more facilities opening up our our surgery boards

plans tools

what what I'm not maybe I think cause I wanna make sure I answer your question

structure oh uh the way we measure things is we have plans specifically laid out on how a measurement tools that are used

we're gonna continue to use the same measurement tools we currently use to measure patient satisfaction, quality rating, cms rating, star rate all of those that are currently there there's no need for new there's no need for new metrics

and how will you tie those how will you tie those to the reorganization i mean you have a reorganization you use you have measurement tools

mmm

your reorganization measures the general satisfaction but how are you going to measure the whether the it the reorganization results in improved veteran impact and benefit

well i think it's one in the same it's it's air and breathing so i mean at the certain point in time i mean the way you measure that is are we getting the tools needed to the local uh positions and local doctors to do what they need to do

ok i i'm i don't i wanna be respectful of this chairman's request for me to finish uh in my five minutes but um i mean we'll have many other conversations about this but we need granular detailed justification we need to make sure that we understand how it is that you are going to directly measure reorganizations impact on veterans whether or not that reorganization resulted in improvement of the care and quality of life that result from the treatment and the impact of the va s reorganization so i look forward to continuing to talk with you about that um i have other questions for the record mr. mr. chairman that we will and i mean this is uh the the the entire process of caring for veterans um is an ongoing one but when we identify problems that cause we're you know all representing our own congressional districts i i i i trust and and hope that you take our feedback seriously um not question it uh as as being wrong or somehow you know designed to target you um this is my closing mister chairman uh um mister secretary and uh and i i know i'll have many other opportunities to talk with you about this but uh the ongoing communication and the granular detail necessary for us to make sure that you know we are able to make the decisions that inform how much funding we provide you and the structure of how that funding is uh is appropriated is gonna be really incredibly important veteran quality of life and impact is our top priority as i know it is yours thank you mr. chairman and i give back

thanks

mmm

we uh you know what this is a good discussion uh i think we are glad that you came both of you to give us good information uh we have we have questions we i don't care how many people you deal with the more people you deal with they gonna be we used to say in in juries you could have a car crash and one witness would say it was a blue car and other witness would say it's a green car that's not the issue the issue is the crash well it's the same thing here people have their own conversations i am perfectly aware as you change life of government employees clear down to the commissioner's court in the local somebody doesn't like it so but you're trying your best i appreciate what you've done members if you have other questions you can submit them for the record and uh please submit them to the subcommittee staff within seven days and we will communicate with you on that with that i think we're gonna adjourn

excellent thank you so much for your time thank you