President's FY 2027 Budget and FY 2028 Advance Appropriations Requests for VA

The hearing will come to order. Uh, good afternoon and welcome to our witnesses as we discuss the Department of Veterans Affairs request for fiscal year twenty twenty-seven and the advance appropriations for fiscal year twenty twenty-eight. This budget request reflects record investments. This budget uh requests record investments in the department. While at the same time, Secretary Collins is also leading a reorganization of the Veterans Health Administration, a new contract for the Veterans Community Care Program and faster decisions on disability compensation claims. Today I'd like to hear how this budget request will support those and - and our other efforts that are at VA to improve the delivery of care and benefits for veterans and their families. This committee and Congress as a whole has repeatedly demonstrated its strong bipartisan support for providing the VA with all the resources it needs to deliver on its mission to care for those who mourn the battle. We've also demonstrated strong bipartisan support for oversight of the department, its programs, and its budget. The VA must continue working in partnership with this committee, with the ranking member, with me, and toward with all of our members toward our shared goals of making certain we both continue supporting veterans to achieve success after their military service. VA's success relies on an empowered and motivated workforce. I know that VA employees are some of the brightest and most dedicated public servants, and I hope to hear today how the VA's budget request will bolster the workforce and overcome some of the hiring challenges that many sectors in our country are facing. For decades, the VA has relied upon providers outside of its own health care system to meet the needs of veteran patients. We finally consolidated the patchwork of seven different community care programs when we passed the Mission Act in twenty eighteen. Mr. Secretary, under your leadership, the VA is now redesigning its community care program to be a purpose-built system, instead of treating it as a secondary add-on to the direct care system. I want to make certain that any changes to the implementation of community care programs lead to improved integration with the direct care system and make navigating both types of care more seamless for the veteran who uses them. I also wanna make certain that any new budgeting for medical care, such as consolidation of accounts into direct care and community care for FY twenty-eight does not diminish the clarity and transparency in VA's future budget requests. Thank you for being here uh to testify on behalf of your FY twenty-seven budget request. I think this is your third appearance before this committee, and I look forward to having the discussion that we are going to have today. i now recognize uh the ranking member of this committee senator blumenthal my friend for his opening statement

thank you mr. chairman i uh appreciate your leadership on this committee and our bipartisan approach to the work of our committee in fact as a result of bipartisan work across multiple administrations and building on the historic achievements like the pack act more more veterans are receiving more health care and benefits than ever before that's a good thing ensuring veterans and their families receive the care and benefits they deserve is a moral mandate part of the cost of war are the cost of caring for our veterans and we need to face the additional cost of war that we are incurring right now in the iran war it is a war it's continuing and service members about four hundred have been injured as well as the fourteen tragically killed there they will come home those four hundred with continuing effects of the injuries they suffered and they deserve fairness and justice as in the major richard starr i've been working and championing this bill the chairman and i i think are working together very cooperatively on it and i think we are approaching a solution but i was heartened to hear the secretary of defense in his testimony just about a week or so ago sitting where you are say that he supports the major richard starr act and i hope that is the administration's position and that we will do it, literally do it, uh, even possibly before the fourth of July. And we're here today because we need a VA capable of delivering on the moral mandate, not only the Major Richard Starr Act, fairness to our veterans so that they are not docked dollar for dollar in their retirement pay for what they receive on disability benefits, but also more broadly, health care, job training all of what we promise we do promise them and a great nation keeps its promises and most especially we need to keep our promises to veterans there's broad agreement secretary collins on many of the items in your four hundred and eighty eight billion budget requests for example the proposed two billion dollars increase in construction projects is needed to improve the va's aging infrastructure i welcome the department's commitment to advancing the electronic health record modernization i'm concerned that the department's continued insistence on pushing more veterans into community care at the expense of va direct care may jeopardize the quality of both and more than eight billion of the ten point nine billion increase for health care services in fy twenty seven is for community care the difference is even more significant in the department's fy twenty eight advance request with the va asking for a seventeen billion increase in community care and near stagnant levels for direct care veterans depend on our va facilities for the gold standard healthcare they need and deserve and the potential shortchanging of those facilities and the staff the skilled and dedicated men and women who serve as nurses doctors schedulers psychiatrists custodians the entire team threatens the quality of care veterans typically prefer to receive healthcare at va facilities and yet the funding request for direct care fails to keep pace with inflation. As we all know, a failure to properly fund and staff VA health care facilities will force veterans into community care, into that system rather than the VA facilities, and that's means that they may be ill-equipped to care for the unique needs of veterans, it may be more costly, it may be less desirable, the budget request also curtails va s world-class medical research program with a twenty three million dollar budget cut including cuts in quote administrative priority areas end quote like suicide prevention oncology and brain health i just wanna say the va over its entire history has pioneered and championed certain kinds of healthcare it's led the nation in fact the world on prosthetics on traumatic brain injury on yes oncology and other kinds of work where it has a very clear mission including brain health and suicide prevention now on the benefits side the department plans to continue its expansion of automation and ai this is seemingly happening without regard for concerns raised by claims processors that it creates and they may create extraneous and incorrect information in fact the office of inspector general recently found that nearly all of the eighty one hundred automated decisions for service connected death claims it audited quote contained at least one legal or procedural deficiency i think that finding of the office of attorney general is very telling deficiencies and errors are common trend in va s recent push to reduce the claims backlog and i wanna focus for a moment on this very important area va s own data indicates it has increased claims production it's producing results faster but it's denying more claims. And the effect is to increase more, increase the number of appeals. So, it's a little bit like we all have children, one of our children saying, " I did my homework faster." And then have a do-over in school when the teacher sees it, because that's what an appeal means, seventy-seven percent increase in appeals. and eleven percent increase in denials why are more veterans being denied in those claim and then having to appeal and clog the va appeals system the board of veterans appeals also reports a twenty one percent increase in an expected number of appeals this fiscal year that's one fifth more and it is more costly to have appeals and have to go through that additional process and it creates more anxiety and pain for the veteran who is applying this would be the first net increase in pending appeals since fiscal year twenty twenty two despite this reality the department's budget calls for significant cuts to the board's budget and staffing there's no way to square the two increase in numbers of appeals cuts in the budget for processing those appeals unjust to our veterans i'm also concerned that this budget prioritizes politics over accountability for instance it cuts the staff at the office of inspector general by one hundred and forty three below fy twenty twenty five levels while doubling the number of employees in the secretary's office. So, we have some issues. I hope we can reach common ground. I appreciate your being here. I look forward to discussing these concerns with you today. Thanks, Mister Chairman.

Senator Blumenthal, thank you. We are joined today by the Honorable Douglas Collins, the Secretary of the Department of Underest Fairs, and he's with uh he is accompanied today by the Honorable Richard We welcome you both and uh secretary you're recognized for your testimony.

Mr. Chairman, thank you, and ranking member. It's good to be with you both again today. I think there's a lot of things. I appreciate uh the comments both uh so far from both the chairman and the ranking member. I think there's a lot of the discussion, especially uh from the ranking member there's a lot of things we're gonna discuss today. Um, in dealing with exactly what you talked about, but also dealing with it from the facts and numbers that we have that are uh actually showing an increase in not only efficiency but also an increase in accuracy, but also getting things done uh more clear. So I'm excited about that. Um, also I'm standing bef- sitting before you the first time as a veteran. Last Saturday was my last day in uniform. Uh, uh, my retirement date was the sixteenth of May. I now stand, sit before you as a a veteran of this country and now in a unique position to continue the work that we have started in making the life of veterans. better. There's no doubt in my mind this is what, uh, I am called to do at this point, and I think having the veteran perspective in our department makes it a, uh, a better part, but also working with

Th- Mr. Secretary, thank you for your service.

Yeah. Thank you, Mr. Chairman, I appreciate all the services that every member gives, and I think it, uh, provides a unique perspective of how we serve here. But also I come here today, as I shared a couple of weeks ago with the Senate Appropriations Committee, I come is almost is at that point, well, is a tale of two cities, a tale of two departments, the one that I inherited and the one we have now. And I think when as we look at this in going forward today, there's gonna be a clear understanding that when we came forth and uh set forth in this uh body and said that the veteran will come first through the VA, it was more than a statement, it was more than a slogan, it was really the focus on how we do everything that we do. We can disagree on possibly ways to get there, but at the end of the day it's always gonna be about what is best for the veteran. The veteran is the mission and the mission is the veteran, that's all we do. And so if it's a choice between a a structural issue at the VA and helping a veteran the veteran's uh needs are gonna win out in that because i believe this committee and all committees expect results for every dollar appropriated and the budget is built around those expectations when we look at this the conditions that are coming before you today and i'm looking forward to talking to you about uh have to do with a workforce and a workforce that has changed uh over the last year one in which it needed to one because when i first got there we had no idea how many employees we had number two we had no idea where they were supposed to be working because we had no manning document for anybody in in military would understand, a manning document is essential to knowing where your people are and where they're not. We didn't have that. We now do. And we're able to now begin to look and make uh arrangements to where we can put the best people at the best places at the best time. Also, I just wanna sit here and say and before we discuss the issues and problems of the VA and I'm gonna hear a lot of those today, and that's fine, that's the discussion we have. I wanna say thank you to all the VA employees that we have, who have made amazing changes over the last year. They have taken a backlog of two hundred and sixty thousand and brought it down to seventy five thousand, average days to complete of a hundred and thirty seven, down to seventy seven at a ninety four percent accuracy rate. And also, at a same percentage of the same ones that were being appealed as the same ones now. So if you have more that are being decided, you have same amount of appeals as you did when you were deciding less. Yes, you're gonna have some possibly some more appeals coming, but at the same point we're actually getting them clear. and actually using higher level reviews to get things done inside the vba, before they have to actually go to the board. The board is a situation I would love to talk to you continually about, chairman and ranking member, about how we can redo some of the board to make it more efficient in getting these claims out. But also I just go to the vha. Our vha, our hospitals are doing amazing work in what we're doing and we're hiring. We got a our hiring process is I'm looking forward to talking about. But also there's two points that I want to point surprise. Just in the last month, we have had a hundred percent rating uh from independent outside source on safety. We're the only integrated healthcare system in the country that can say that, one hundred percent safety rating across the board. We also have the highest CMS ratings, which measures all hospitals, public and private. Our five stars and four stars significantly outweigh any in any of your states if you ask your public and private hospitals. We're by far uh more effective at what we do. I think the issues of community care and direct care are something that we can talk about. One, community care is law. We're gonna follow the law and do that. Also, we're still spending double direct care over what we spend on community care. That's often a subject that is lost when we begin to talk about this. When we talk about community care in isolation, we're still spending double the amount in direct care over what we're spending in community care. I tell you, when we look at this also as we go forward today, there's also an issue when we talk about staffing, we talk about our work, there's something that I brought up before and I'm gonna bring it up again. fourteen percent increase over the last five years in FTEs. And by the way, this budget reflects an increase in FTEs even in our VHA and our health care. This is reflected in the budget presented by the president. But one of the things is, fourteen percent increase in FTEs while we have had a six percent increase in actual contact with patients. No hospital, no other organization you have consistently outranks FTEs or full-time equivalencies and has less patient encounters. I actually have some facilities that have had thirty three percent increases in staffing and negative sixteen in actual patient encounters. We actually have to get this in balance. These are the things that we're gonna be looking at. It's measurable outcomes and measurable resistance. This is what we're going to look at. The budget is four four eight eight point two billion, which is a thirty four billion increase over twenty uh twenty six numbers. Um, and I'd just like to stop here and finish up, because we're gonna have lots of time for questions and going forward. But I would like to thank the ranking member uh for just recently and this is where we can agree, sir, where sometimes we don't agree, but I agree with your recent letter to the editor in which you talked about, which you just stated a few minutes ago, that we are serving more veterans, serving them better, and we're doing it with the capacity of the great emper employees that we have and I'm looking forward to answering questions, we have today. So thank you so much, Mr. Chairman.

Secretary, thank you very much for your presence and while I thank you for your service, let me also say to your wife, thank you for her service in your family's. contribution to the safety and security of our of our nation. Uh, I want to make certain that, uh, if Senator Blumenthal doesn't ask you about the, uh, uh, uh, ask you a question about what he, something he said in his opening statement, I will follow up and do so. But I'm very interested in in in what he wants to point out about pushing veterans into community care. That catches my attention because I've spent most of my time in the Senate, uh, trying to get the VA to treat community care, uh, fairly. uh, and not to try to discourage its use. And so I wanna hear what, uh, you and the, and Senator Blumenthal might talk about in that regard. Uh, and I wanna know the concern about, that he suggests about, uh, reducing the quality of both. Um, I want to, um, ask you, uh, just a couple of questions and then, uh, I'll turn it over to Senator Blumenthal. Uh, I wanna talk about just for a moment, the VA is proposing to move from four VA health care accounts to just two, direct care and community care, doing that in twenty twenty eight. Uh, the rise initiative is similarly establishing two corresponding medical operation centers, one for direct care system and one for the community care system. What do you believe the benefits of this approach are?

Uh, there's a couple, I'm gonna let Richard answer that, but I wanna answer very quickly what you just talked about, and cuz it is a concern. I believe community care is a vital part, it is VA care, I've said this from a confirmation forward, VA care is VA care whether it comes in direct form or it comes in community care. Um, also it is sort of interesting to me, when we make a statement, I know it's not meant to be this way, but when you make a statement that veterans would get less quality of care in the community, you do realize you're actually accusing your doctors in the community of being less doctors. That's, you gotta think about what you're saying when you get that. Veterans do have specific needs, but when we have impact care, orthopedics and things like that, you're saying the direct care doctors that treat everybody else in your community are not up to par. We gotta be very careful at how we word that. But in the answer to your question, this is a really a good part of where we're, Joe and Richard's gonna answer that.

Senator, thanks so much for the question. Um, we've all been part of this debate where, where somebody is saying that direct care is more or less expensive than community care, uh, community care higher or lower quality, and the facts are nobody really knows because we don't track the data that way. Uh, the account structure VA operates on today is a holdover from when we were primarily a direct care system. It does not account for VA being the fourth largest payer in the country behind medicare medicaid and marketplace and in a payer program there are three primary costs there's the administrative cost that's the day-to-day operations of the program there's the contract cost the fees that we pay to our contractors and then there's the actual purchased care cost that's a reimbursement that va makes to providers who treat our veterans that's the only cost we actually show the other two costs are commingled in our other accounts likewise in direct care direct care has three primary costs facilities personnel and supplies. Those costs are commingled with the administration and the contract costs of purchased care and they're also commingled with the cost of national programs, such as housing, such as research, such as suicide prevention, fourth mission, law enforcement, even fire departments. These are all important parts of the VA mission, but they're not health care costs. The account structure that we have proposed in our advance for FY twenty eight, would break out a direct care cost vertical, for the whole cost of care it takes to deliver care inside our medical centers and inside our clinics, and a purchase care vert vertical that accounts for the full cost of that care. Once we do that, we can then measure the quality using national standards, HITIS, HRQ, where we can then account for what we are spending and what we are getting for it. When we do that, the administration and the Congress can then have data-driven conversations about resource allocations, where we should invest in care, where we should drive efficiencies. But right now, based on the account structure, all I can tell you is that it's going to cost more and that we can't manage to it because we don't know where we're managing to.

Thank you. I wanna highlight something Senator Blumenthal said in his opening statement. Uh, I'm a s- I have great respect for the OIG. Uh, they have been very valuable to me as a member of this committee, as a chairman and ranking member of this committee. And they've been very valuable in helping me represent my constituents, my veteran constituents, uh, by providing that kind of investigation that helps me help those people I serve. And so, uh, I would expect, and we have the Chairman of the MilKom VA subcommittee on appropriations, we have the Vice Chairman of the Appropriations Committee here. I hope to, to s- uh, speaking to both of you, I hope we can make certain that the IG at the VA is adequately funded to provide oversight, audit, hotline, and investigative work. And, um, the reduction that's in, the less funding that's in the, uh, budget request seems to me to be, uh, damaging to that, uh, possibility. I'd highlight in Veterans Home Grant Program, uh, there's a reduction of a hundred million dollars in the budget request. uh, that we have a backlog of more than one point five billion uh, of proved priority projects, a priority determined by the VA. Um, and we are making little or no progress in working our way down that line. And I hope that, uh, you have a plan that would help us, uh, allow our state veteran home grant program to provide the money for the states that have been waiting, waiting, and waiting. Uh, Mr. Secretary, any observations?

yeah just real quick observation on those yes we're working uh that's an an issue that we're trying to again work within our budgets but also work with the states and i've had many conversations with state directors and also of in state homes about how they're uh not only they're approaching this issue but we're approaching it from a a community at large this is a health care the the nursing home situation long term care is uh not just a va a veteran problem it's a long term problem for our community as a whole so we're trying to work in concert with how we can make it better for our side getting those grants out as best we can i do wanna say a comment about the ogi we have an excellent oig cheryl mason is doing a great job uh working on this she's trying to clean up backlogs and do that um this was a number and i think richard uh has talked to had agreed to this number but of course always willing to work with this uh team we support the president's budget we feel like we can do everything we need to in that but that was a number that uh was also agreed to by her as well

senator blumenthal

thank you um clearly what's happening with the va on benefits is that there has been a shift in backlogs from the claims front to the appeals in other words the va is simply trading a claims backlog for an appeals backlog and what disturbs me most is that the board of veterans appeals expects twenty one percent more appeals overall they'll be seventy seven percent more and yet it's being cut what is the possible justification

well the couple of things number one the board uh the appeals to the board have actually dropped um they've not increased they've dropped so they went from a hundred and they went from a hundred and ninety to a hundred and two thousand at the board

so you're disputing the board's

so i mean we gotta be talking about the same issues here and again as i go back to discussing that i had And, you know, as we went forward in this, the, you can't look at, I mean, you can try, but the numbers just don't bear it out. Opinions and facts are different here. When you actually get the numbers of, uh, you know, appeals that we, uh, are the number of claims that have been, uh, adjudicated since we've been there from two hundred and sixty thousand down to seventy five thousand that's more by the way that's also taking into account the no total number of claims were over a million when I stepped foot in this office. They're now at five hundred thousand.

Yeah, let me give you, uh, you know, my time's limited, Mr. Secretary.

No, you go ahead.

uh the number of appeals pending has gone from sixty six thousand twenty eight january twenty five to a hundred and seventeen thousand one hundred sixty seven in may of twenty six

you're all talking

the average day to complete them have gone from ninety nine to a hundred and two and the number of appeals received by the board of veterans appeals has increased from a hundred and twelve thousand in uh twenty twenty five to an estimate of a hundred and thirteen thousand i'm sorry uh ninety two thousand fifty seven to a hundred and thirteen thousand um a hundred and eleven thousand six hundred and fourteen and it's projected to be a hundred and thirteen so there's clearly been an increase here and i i wanna move ahead

ok

but i would like an explanation for those numbers and if you have better numbers

yeah no i will and i think senator let me just real quickly i wanna i wanna get to your other question, real quick there is nothing more aggravating and more uh confusing to look at the board's numbers in their three boxes of how they actually do appeals and how they move them, i'll be very frank with you since we've been in the chair they've actually dropped in that amount of days five hundred days according to their own reporting we've actually looked at how they said i wanna get with you on this i think it's worth the topic because i think we actually need to look at how we do our board of bills and actually change the way we do it i think it could be more effective for veterans and for the community so i'm happy to get with you further on that

would you agree with me that veterans who prefer direct care ought to be given that choice

i believe the veteran gets the choice thank you for agreeing with me

and the underfunding of direct care is gonna cause them to seek community care correct

i disagree completely with that when you're spending double indirect care which you're spending on community care

oh that's what is happening in effect in my view because you have cut about a thousand positions of physicians you've cut nurses positions you've cut all kinds of other support positions and then you have failed to fill the vacancies that have resulted from cutting or furloughing or encouraging them to leave. So the workforce has diminished and in turn, veterans are encouraged then to see community care as a result.

That's, uh, again, uh, you're entitled to that opinion and I s perspective, it's just not backed up by basically the facts. And again, let's deal with the fact of, uh, there's, uh, you know, no risk, furloughs, however you wanna call it. There was a reduction, but what we're actually seeing,

reduction by about

we took there was about thirty thousand who took early retirement yes

thirty thirty thousand people thirty thousand people

yes and uh but again

on whatever you want but it was a reduction

well explain to me how our wait times have gone down in vha almost every category

and then and then you eliminated the positions so it didn't look like there were any vacancies

no this uh no

or there is still vacancies but just not the same number

senator the the let's let's get back to the the basis of understanding what we're trying to do you're in the military you're also you know how many employees you have and you know how how you how many you have then. You do not need three press secretaries, and if one left, and you decided to make that press secretary an a a legislative assistant, then you're not actually, you know, cutting, you're not gonna say you're short on press secretaries, you're gonna say I filled the need where I need to have it.

What did you turn those physicians into?

Right now we're waiting to let the actual facility find out what they need, instead of just throwing money and people at them, because during this time right here we've actually lowered wait times in facilities, we've actually got better care.

You don't think they have lost people they need

no but you know you know why

that's not what i'm hearing from veterans

you know why i know that because if they needed him right now they could hire them right now

well

that's how i know that i i mean that's how i know this

david that's not what we're hearing

well you're i'll i'll go with you i've been to every trip and and senator uh you know unlike you i've been to facilities in the past year and a half and i've actually talked to the executive directors i've actually talked to them

i my my time has expired mister secretary but i'm sure we'll be

i have one quick question though one

back with you on that

thought though that you brought up an an an uh a ig report. And I do have to comment on that because you brought up an ig report that was released on April thirtieth in which uh Inspector General Mason called me and told me they were releasing because it was being lost held or whatever in the system. That the decision that you referenced in your opening statement were reviewed from September of twenty three to August of twenty four. Unfortunately you got the wrong secretary here to ask why that happened. I yield back.

Well, I'll I'll have more questions for the right secretary. Thank you.

I don't think he's coming back.

Senator Blackburn.

Thank you, Mister Chairman, and I want to thank you, Mister Secretary, for being here. We are just really grateful for the work that you are doing and when we talk to Tennessee veterans, we hear that you're working to expand that access. you're reducing that backlog, you're improving the benefits processing, those are all steps in the right direction. I also appreciate the efforts that you and Mister Topping are making to modernize the system and strengthen that for the long term that has been needed. And when we talk to veterans, uh, they talk about the steps you've taken to access non-VA providers for - for the veterans. And of course, community care is a big part of this, and I want to know what specific steps you are taking and what that next iteration for community care contracts will be so that it makes it easier for our veterans to access the care they need when they need it, where they need it.

Uh, thank you Senator, and I've been enjoyed, you know, working with you over the years, I think one of the issues that you just raised is how do we make the system better as a whole? And there's a lot of frustration in it.

In long term.

Total term and long term, and we're making it where we go, this is why in just a moment uh, you know, Mr. Topping can tell you about the new community care contract that we just got let, which by the way, we had seventy

Seventy one.

seventy-one bidders. For those of you who remember uh, the mission that we had, two. who are third party administrators. We have seventy-one. That's gonna give us a a whole new networking for your rural states and for some of your areas that have uh uh trouble with uh community providers this is gonna provide a whole new access for what we can do for not only community providers but there's also gonna be um a switch over and uh for the rank and number of the approach, this is something we're looking at rural health care can actually be a model for as well. So we're looking forward to working with you on that. It's gonna be something really good. But that's one step. The next step is EHRM, which we haven't had a chance to talk about yet but we're going to. Uh, we just had a phenomenal rollout in Michigan so far. My only problem I have right now in the VA is I have more centers wanting to go ahead and get ahead of the line um than anything else because it's actually working. But that connection between not only the community and the VAs and electronic health records management is gonna help get our veterans there. The last part of this is gonna incorporate uh scheduling, in where the veteran can have a more active role in their scheduling. We don't have to hire schedulers to do scheduling on nine different screens. veteran themselves can actually go to their computer, go to their phone, and actually schedule either community care or direct care, depending on their preference and time schedules. So there's a lot going on here. Uh, anything you wanna add to that, Richard?

No, sir, I think you said it well.

There we go.

Thank you.

Wonderful. I do wanna thank you, uh, for your work in keeping that McMenville VA clinic open. We thank you for that. Can you speak for a little bit to how community care can help with that type situation because here was a clinic that was going to close uh it was going to close may thirty first you all jumped in the veterans there wanted to retain that access to care seventy eight of our ninety five counties in tennessee are rural so speak to

yeah

how community care can help with that specific type situation

they can i i think it it just provides an alternative, and getting into not only rural areas but Menville is in a way. I do have to say this and we need to make this very clear that Menville um was sub-par in its treatment to its veterans.

Get what?

And I know the veterans were sort of you know close to it, but again when it's all you know that's that's where you wanna be, but it was a it was a contract clinic that was not taking care of veterans as it should. It had been going on for a while, longer than a year or more, and we kept getting uh basically stonewalled by the contractors. So that's why we're actually taking that over, putting VA people in that facility to make sure that our veterans get the care that they need. But I think it also provides us an opportunity to work with communities and their doctors and uh clinicians in different areas uh for those that don't. Uh a statement was made earlier, I think there are some veterans who prefer to get all their care from direct from the VA directly but the younger veterans of which I'm a part of and many of the GWAT veterans will share a different opinion of that. They may get some of their care at VA but they may then want also have care in the community. That's what the Mission Act all provided for.

I do wanna mention my Women Veteran Specialty Care Access Act. And this is something that we're working to improve care for our female veterans because as we see more of them and we've got some that are serving right now in Operation Fury, making certain that their needs are going to be met in the VA and previously we have had a really a big divide in the care that was available to our female veterans.

Mm-hmm.

So I'd like for you to talk a little bit about how you're going to increase that care and then also how community care can increase that care.

Uh, thanks, Senator, I think the biggest thing is is just to uh focus on. We have about a million, give or take, uh, enrolled women uh in our veterans program. There's about two million, a little over two million, uh veterans. totally that would be in uh our service. Um we're also have a program right now to where we have a goal of enrolling the next million. So I mean this is a project to get the the female veterans in. But there's also every our new clinics uh most all of our new clinics are having a women's uh specialty side so that the women have their own special uh side for their s- particular needs uh that including that there's also in our hospitals many of them are retooling themselves to have you know I've been into several of our facilities that retool parts of their departments. to have a women's uh uh health section. But also one of the things that I did last year is I found out that our female veterans were having to go to their primary care doctor, then to go to OB and GY care. That they were having to make a separate stop. There's no female in this room who gets private care who has to do that. They go straight to their OB and GYN doctors. We took that out and said, no, you don't have to go through this, this what I thought was a foolish step, to go through a primary care to then go to your daughter, and it was delaying care. So, um, we took that out. That's being, uh, well received and again female veterans, uh, can also access community care. We've also laid best medical interest, which takes into account the needs of the veteran and the caregivers many times in that situation to eliminate that as well.

Thank you. Thank you, Mister Chairman.

But, you are welcome, Senator Murray.

Thank you very much, Mister Chairman. Mister Secretary, in, uh, December of twenty twenty, actually, when you were serving in the house, Congress passed the Isaacson Roe Veterans Healthcare Improvement Act. uh, by unanimous consent and it was signed into law by President Trump during his first term. Section fifty-one O seven of that law says that the secretary shall provide a form of child care assistance by January fifth twenty twenty six to all veterans during their VA appointments. Last year, your budget requested twenty-two million to open kids' care sites at thirteen VA medical facilities, Congress delivered on that request, but you're only planning to use one million of those funds in FY twenty-six. And this year's budget request has one sentence about the program, which was actually our first notification that the VA kids care program is no longer being implemented. Now, VA's own data shows that fifty-eight percent of veterans with children have no shown showed or canceled their employment. Why? Because of lack of child care. So I wanted to ask you today, what is your plan to restart this program and comply with the law?

Uh, thanks, Senator. We're fully compliant to comply with the law as, as I mean, sorta obviously noticed on the previous administration didn't move forward on this. We're trying to move forward with it. Richard can give you some more information on that uh issue, but we're, this is where it was left with us.

Hey ma'am, you do know we've got two sites up and running, American Lake and Chillicothe. We are pulling in the utilization demand and comes data so that we can drive this forward. We're looking at reimbursement models as well. As we get the data, we can make the decisions and come back, and that'll be in our budget request. But we are moving to implement the law.

Well, well, let, let me be clear. This is a law. It is not a suggestion, it's a law, and we have provided the funding you need to ensure that veterans do have the child care they need to get to their appointments so I just want you to know I'm gonna keep working to make sure we fund this program um and I will be following

I got you.

up to make sure that the mandate is followed.

I appreciate that. We agree that as part again, like I said, this was left for four years, never really done anything with. We're still trying to get it implemented and we're doing everything we possibly can to do it.

OK, uh, moving on, Secretary Collins, la- last month I had a round table with veterans in my home state of Washington. And I heard from a number of them that wait times for behavioral health care can sometimes be up to ninety days. That is ninety days for behavioral health care. Unacceptable. Community care can't be the answer because it often takes community care providers longer to treat veterans than it would if the VA uh remained, if their vet- if that veteran remained with the VA. Those same advocates that I met with told me that it can take up to ten months to fill certain positions and yet VA's budget is requesting six thousand fewer employees than VHA had in twenty twenty five. So I wanna hear specifically from you what you're doing to help address this crisis. How many more doctors and nurses has the VA hired since you took over?

Are you talk- uh, OK, let's, can I, there's several questions there. Which one do you wanna go with first?

Well, you start with where you have an answer.

Um, the, I think the, let me just start off first off at the, at the mental health side. The, eh, there is nothing at this point keeping any of our facilities from hiring the mental health s- the professionals that they need. That can be hired at any point. Our overall VA-wide, our mental health appointments have come down. In fact, they have come down two to three days wherever across the country.

Um, what do you mean come down? Wait times?

I'm sorry.

You're trying to say wait times income?

Yes.