Comprehensive Veterans Health and Benefits and Military Retirement Pay Restoration Act of 2014—Motion to Proceed—Continued
by Senator Richard BurrPosted on 2014-02-25
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
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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
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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.