Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014—Motion to Proceed—Continued

by Senator Richard Burr

Posted on 2014-02-25

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BURR. Mr. President, may I inquire how much time exists on both the majority and minority sides? The PRESIDING OFFICER. There is 21 minutes remaining on the Republican side, 9\1/2\ minutes remaining on the Democratic side.

Mr. BURR. I thank the Chair, and I thank my colleague for his comments on the Affordable Care Act.

I am actually excited to be here having a debate about veterans and about the promises we have made to those who are reliant on not only the VA but on this institution to actually look at the programs and the services provided, and when we, as a body, see deficiencies, reforming them, fixing them, so our customer--who is that person who made that ultimate sacrifice, who put on that uniform and, in many cases, now has a lifetime disability because of it--can count on that health care system to be there.

I would have expected we would be on the floor debating in a bipartisan way those fixes that were needed to make sure that veterans with disability claims didn't have to wait hundreds of days to determine whether they were going to have a disability that was signed off on and, if so, what the percentage was and that percentage then provided them income.

I thought we would focus on the challenges the Senate has to reform how the appeals process works. Because when a veteran is denied a disability claim or he gets less than he thinks he should have been awarded, then he has the opportunity to appeal that to the court of appeals. The time now for the appeals decision has grown to years. It shouldn't be like this. It is absurd that the Congress of the United States, much less the Veterans' Administration, is content with the deficiencies we have in this broken system.

Instead of being here to look at fixes provided under the Sanders bill, we are here looking at how to expand the population of coverage. We are here on programs that have had little to no hearings. We are here without understanding the intended or the unintended consequences.

Let me share the knowledge I have of North Carolina where we have the largest growing veterans population in America. I don't have the facilities today to handle that veterans population in the timeframe Americans are used to being delivered health care. I could go out and start construction tomorrow, if my good friend the Presiding Officer would allocate me the money, since he sits on the Appropriations Committee, and build facilities, and I still couldn't meet the facilities requirement needed to provide that level of care. As a matter of fact, we have about $14 billion worth of construction currently underway in the country, and on an annual basis, this body-- the Congress of the United States--allocates about $1 billion in facilities construction and maintenance money.

We have 14 years of backlog right now and we are not even anticipating what the effects are going to be of our current warriors who have come out of Iraq, who will leave Afghanistan, who might enter Syria or who might be in a conflict down the road. No, we are here debating in the Sanders bill a massive expansion in who is provided benefits in the VA.

So who is that? It is veterans who have no service-connected disability. It is veterans who are above the means-testing threshold. Let me put that in layman's terms. These are not people who are low income and these are not people who have a service-connected disability.

We are going to have days to debate this bill, and I will introduce an alternative. I will openly confess, upfront, that I don't get into fixes, because to do fixes there has to be bipartisanship. To reform programs in the Federal [[Page S1025]] agencies, Republicans and Democrats have to come together.

We are here today because there was no outreach to attempt to put together a compromise bill. If the conversation we had about a day before we left a week ago, where my colleague said, this is what I am going to do, why don't you sign on, but he wasn't willing to talk about changes--if that was compromise, then he did that. But I don't consider that to be compromise. I don't consider it to be good-faith negotiation.

But that is behind us. We now have this bill to consider, and it is a massive expansion. And what does it do? It basically says to those warriors who have service-connected disabilities, those individuals who are low income--and this is where they get their service, their health care--you are going to have to wait in a bigger line. You are going to have to get behind more people. So what veterans expect, which is that the most needy will receive the services they need, is not what this bill does. It is not at all what it does.

As a matter of fact, section 301 of the Sanders bill would expand eligibility of the VA health care system. It would qualify to enroll in the VA health care as priority 8 veterans if they do not have access to health insurance except through a health exchange and do not qualify for higher priority.

Before getting into my concerns about this affected section and what impact it would have on VA, I wish to comment on how this section has been drafted. The section says: If a veteran qualifies as a priority 8 veteran and has no other option but the health exchange under the Affordable Care Act, they could enroll in the VA.

Let me read that again: If a veteran qualifies as a priority 8 veteran and has no other option but the health exchange under the Affordable Care Act, they can enroll in the VA.

We have just mandated that everybody in this country--except when the President delays the mandate--has to be under the Affordable Care Act and they are part of the health exchange. Here we are saying to priority 8 veterans, if your only option is the health exchange, we will let you opt into the VA. Well, if the health exchange is that good, why would we dare risk all other veterans who have service- connected disabilities or low incomes having to wait behind people who were provided health care out of the health exchange? Some priority 8 veterans may even qualify for a subsidy under the exchange, something they would not receive if they were to enroll in VA health care. I don't know, are they concerned these veterans will be unable to find a plan that meets their needs? Everybody else in America was shoved into it. Why should we be concerned about them? My intention today isn't to open a health care debate. I do have serious concerns about this expansion. Expanding eligibility could stress an already overburdened system. There is a reason why the priority 8 veterans program was halted. The VA found they could not provide timely access to services while sustaining a high level of care. And judging by the well over 30 health care inspectors reports issued by the Office of Inspector General in this Congress alone, the VA is having trouble with the limited group they currently serve.

Here are some examples of the IG's health care inspections report released since January 2013: 1. Three deaths in Atlanta because of delays in mental health care; 2. Two reports regarding delays in GI consults and issues with facilities operating services in Columbia, SC; 3. Emergency department patient death at the Memphis VA center; 4. Two reports on the inappropriate use of insulin pens at both the VA Western New York Healthcare System and the Salisbury VA Medical Center; and 5. Two reports on Legionnaires' disease at VA Pittsburgh and a review of Legionnaires' disease prevention at VHA facilities.

If we expand enrollment, if we expand the coverage, it would surely require an increase in funding at the VA. When we increase the number of patients entering the system, we certainly need to hire additional staff and to provide more space to treat the new veterans. I have already talked about the 14-year backlog we have on facilities now. Without followthrough on secondary cost, we only frustrate veterans when their expectations aren't met, not satisfy them.

I truly believe if we expand government programs we need to do it responsibly. We need to understand the intended consequences and plan for the unintended consequences. We should explore whether the VA can manage the implementation of this expansion. We should explore what impact this will have on the VA's ability to treat combat veterans and veterans with limited incomes and find out what new needs, both in staffing and space, would be created by this expansion.

Unfortunately, we don't know the answers to these questions, because in preparation for this section the majority didn't hold an oversight hearing looking specifically at the consequences--intended or unintended--to expand enrollment of priority 8 veterans. In fact, the only hearing on this subject was a hearing on legislation pending before the committee on October 30, 2013. At that hearing we heard testimony on three dozen bills--clearly, not enough time to examine the details of any of the 30 bills.

From their testimony at the hearing, the VA obviously agrees with me. Dr. Robert Jessie, Principal Deputy Under Secretary for Health, indicated that expanding enrollment of priority 8 veterans ``presents many potential complications and uncertain effects on VA's enrollment system.'' That comes from a guy pretty high up within the Veterans' Administration. They are not necessarily for this.

Finally, I want to address a comment my colleague from Vermont made at a press conference a few weeks ago. He said: We're not going to bring one new person in without making absolutely certain that the VA has the resources to accommodate those people.

As I read the bill, there is nothing in this provision or in the bill itself that would restrict implementation in that way. However, I would gladly support an amendment which would delay this provision until GAO reports that the VA could manage this additional population of veterans.

Mr. President, you might be thinking, as others who are listening might, what does all this cost? How is it paid for? Is the funding recurring or is it one-time funding? Is it permanent expansion? Let me try to answer some of that for you. The way the Sanders bill is paid for is with money out of the overseas contingency operations. That is more money we were going to spend that we haven't spent, that we never had because we were borrowing it, and now we are going to use it to expand this. It is one-time funding for a permanent program. Let me say that again. It is one-time funding for a permanent program.

It is not as though we are going to fund this expansion of priority 8s, and all of a sudden, when OCO money is gone, we say: Oops, we didn't mean it; we are going to pull it back. No, these are going to be in the system regardless of the impact, regardless of the consequences.

So who is adversely affected? Today's warriors. The same warriors who are waiting in line to get health care services are now going to compete for a limited number of slots to be seen by people who might have had private insurance, by people who might have been in the health care exchange, by individuals who are not low income and who have no service-connected disability. Who else? Those veterans with disability claims who are waiting for a determination. I mean these veterans are going to be impacted by this because we will have such an influx of people within the system. Veterans are waiting for disposition of their disability claims, their appeals. Those who have gone back and have waited, they have finally gone through hundreds of days for a claim to be determined only to find out they have to appeal it. Now they are going to go through hundreds of days of appeal, and we are saying we are going to have to start using some of these people to administer new services which far exceed and are outside of priority 8 which I focused on. But we will talk about the entirety of this bill as the next several days go on.

The last one, and I will stop for this afternoon: Who is adversely affected? Our kids, our grandchildren, the ones who sit at home today hoping the decisions we make about future obligations [[Page S1026]] take into account that they are paying the tab. They are the ones who will be here years from now keeping the promises we make, and they are hoping we only make the ones we can keep.

Mr. President, how much time is remaining on our side? The PRESIDING OFFICER. Five minutes.

Mr. BURR. I will tell a personal story about a trip to one of our military cemeteries abroad.

We were in the country of Belgium. I was there for a Memorial Day service. Much to my amazement, there were probably 4,000 to 5,000 individuals.

We got through with the formalities of a very well-constructed Memorial Day celebration. As I wandered through the graves, I found a Belgium couple with their two young children at the headstone of an American soldier from World War II. I asked them one simple question: Why are you here? The Belgium father, younger than I, looked at me and he said: Sir, I inherited this grave from my father. My father took the responsibility for this grave to always make sure it was just like it was the day he got it. I have now inherited that from my father, and my children will inherit that responsibility from me.

I know there are a lot of veterans organizations who hope Senator Sanders' bill becomes law, but I think there are a lot of veterans who are hoping it doesn't: the veterans who need the VA system and count on it for their mental health treatment, for their substance abuse treatment, for their primary care. They count on it for diabetes maintenance, they count on it to stay alive, and we promised it to them.

I am sure future generations will look at the decisions we make this week and will belly up to the bar for whatever it costs, but I think it is important for us to remember our obligations stretch long past our service here. Although it seems somewhat easy to spend somebody else's money, our kids want us to reform this, our veterans want us to reform this, the VA wants us to reform this.

Once we reform it, we can talk about expansion. Until then, it is irresponsible for the Congress of the United States--for the Senate of the United States--to talk about dumping more people into a broken system, to ask those who have already waited so long to wait longer because of our actions.

I yield the floor.

The PRESIDING OFFICER. The Senator from Vermont.

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