tv Politics Public Policy Today CSPAN July 10, 2014 1:00pm-2:31pm EDT
the services that the communities are providing for veterans. i think now they do. how are we going to -- >> as far as access to fee basis care, we are using models of payment for fee basis care traditional models but expanding contracting services that would be available. el paso, for example, has reached out and formed a partnership with the practice that provides in-patient mental health care to provide more outpatient. >> what about alternative therapies.
are you looking at partnerships equine therapy. i have a great program in my district, a successful program. >> they could partner with programs like that. >> community partnerships, engaged as part of community helping them. are you asking if every v.a. should have equine therapy? >> i want to know how we can increase these partnerships. >> i'll use my own example, i'm really watching the clock here. my time has run out. i'll follow up with my question. >> thank you.
a question for dr. mccarthy following up closely on a few others. what are the waiting times for access to mental health care. >> it's hard to give an tut number given that both members of this committee and i have said i'm not sure we trust the actual numbers. what we now have, though, transparently are information about access. i printed and brought some of that information. what's posted is for every v.a. medical center what the new patient mental health wait time is, the established mental health wait time and then running average over the last month for what that wait time has been. when we look over the last month, certainly for those there are significant improvements over what there had been before. >> ma'am, are those reliable
data. >> i believe reliable. i would not state my life on it. have they been audited by independentities outside the v.a. >> i do not know. we've heard testimony clearly manipulated, falsified. on the 23rd they said the data was not reliable. they talked about what we could draw from that. i agree with colleagues we don't know what the data is. t what do we know? it's clear investigations going on after saying falsified. in particular one whistleblower
in one hospital. i asked the v.a., what is the range of the workload for doctors across the nation. the total range, bottom range, according to one whistleblower in one hospital was lower than the national range. so one independent source verified, what the v.a. is doing to actually assess, verify and authenticate the data so folks on this committee and 341,000 employees at the v.a. can actually say this is where we're heading, this is where we've been, this is how we improve the system. give me a sense of how the v.a. is going to answer the basic question of how we're going to independently assess data. >> our acting secretary talked about not looking at the same kinds of access measures but looking at satisfaction with the timeliness of care, measure of access and timeliness.
>> all done, internally handled by the v.a.? who is coming independently and saying, i don't trust the data? you apparently don't trust your own data unless it serves the purpose. i'm looking at ig report for 2012, the average of 50 days -- average is 50 days to receive full mental health evaluation. i would say today office of the inspector general says we don't know. we use the data from the v.a. now they are telling us today it's made up, could be falsified. unlike many hearing from constituents, called my office yesterday, what you're being told by the v.a. is whitewashing the situation in this particular vision because they are falsifying the data and punishing those that make that point. again, quickly, if you can tell me how you're going to prove to me and members of the committee and american public this is our data and this is how we can improve, improving our performance to meet the needs of
our veterans. >> sir, i believe there are audits planned, not familiar with audits. i do invite you to go to the website and look at the data because you can see it. it's part of our effort at increased transparency. i think looking at how long it took people in the last month to get -- >> i can't believe the data, because it is not independently verified, not authenticated. there's no one on the outside. in my districts, some reports have come out in the last couple of days of how they have double-checked, everything going fine. i don't think they talked to a single veteran. it's not matching up with what the whistleblowers are saying. every time someone comes to our committee and says we have data, might not be good data we've got data. garbage in, garbage out. that's what's happening here. we can't trust that. i would suggest independent, outside assessment, chairman pushing that. that's what needs to happen.
reestablish trust and more importantly reestablish and make certain we're getting the care we claim we're getting to veterans. i yield back. >> thank you, mr. kirkpatrick. >> thank you, mr. chairman. i recently attended a veterans standown in phoenix, a one-stop shot, services our veterans need. they have all kinds of things going on, thousands of people there. off to the side was a room. i looked in, there were veterans sitting there with needles in their ears, the back of their neck. they were receiving acupuncture. i was curious. person delivering acupuncture is volunteering time to be there. to a person, every veteran i talked to said they benefit freddie acupuncture, helped relieve stress, anxiety, asked me to advocate it be an approved treatment in the v.a. system. i'm doing that.
but my question -- i didn't ask whether it was a pts diagnosis. clearly some in the room did, every one benefiting from the treatment. my first question to every panel was this, do you think acupuncture should be an option within the v.a. for medical treatment for every veteran starting with dr. sherin. >> i believe strongly in alternative approaches for mental health issues and pain. substance abuse, i think acupuncture is a powerful technique, so is meditation, so are many other well established treatments. the question, though, that i go back to is that something you build into the v.a. or is it something that the v.a. supports in the community where there are already functioning systems. >> my question simply, did the
v.a. cover it, over it as a treatment. i need to hear quickly. should it be regular treatment regardless where it's provided. >> i would say absolutely. >> all treatments available helping veterans. yes, made available for treatment. thank you. >> lieutenant general. >> i'll fully support also. treatments need to be investigated. part of the cultural shift we're talking about, what this panel is all about. it's the same thing. not evidence-based, not approved. >> take care of this population.
i want to make one amplifying comment. i'm a vietnam era vet." we don't have the same thing happening to vietnam era population. i'm saying one other thing. my father is a prisoner of war, world war ii. suffered entire life from posttraumatic stress. never recovered. he was an alcoholic. all part of what are we doing for all these opportunities we have to bring it together to make it better, take care of the patient, take care of the veteran. >> a big proponent and advocate for alternative medicines.
>> need someone doing it. a lot doing it, covering costs out of pocket. having help with that would definitely be a big deal to them. especially younger vets are transitioning. they have lower incomes as they are earlier in their career trajecto trajectories. >> dr. mccarthy, it is part of clinical guideline, joint guideline for ptsd. >> does the v.a. pay for it? >> some medical centers but not across the board. >> my follow-up question is what would it take for the v.a. to have this be part of the standard treatment offered to our veterans? >> we need to ensure credentialed providers available on staff or v.a. in the community we could partner with.
>> thank you. i'd like to skpor this at some point in more detail. thank you, mr. chairman. >> thank you. >> thank you, mr. chairman. dr. mccarthy, when you talk about rbus relative value units as a measure of productivity, would it be correct that rbus are based predominantly on time spent with a patient, mental health? >> primarily. >> do you feel that's a good measure of productivity? >> we use rbu and take out the part that covers malpractice and overhead cost. it's a part of the rbu, wrbu. not ideal but the best we have. >> a measure of the productivity you're using. do you go and check to see if
those rbus match up with the number of patients seen. in other words, if someone has rbus what would add up to eight hours of patient care, are you checking to see if they have matched that. if they have seen three patients but have rbus that match an eight air our day, eight hours of interaction, are you checking that? >> i can't say that i personally am. i can say that i would hope that folks are matching that up. >> formally that's not being done. >> a relatively new model, rolled off. >> mental health added. make sure it's validated. >> that would authenticate now which isn't being done. the other thing we found not being done is what is cost for
rbu what are we spending for rbu put out in care. that's a key number as far as productivity and efficiency and think we have to go that way. our next question is do our doctors and mental health claim responsibility for their patients? in other words, do you look back and say dr. x had ten patients that attempted suicide and six that actually committed suicide. do you look at those numbers, have patient their responsibility. >> absolutely. we have a very active peer review program where patients are reviewed and reviewed in that format. in addition we go through what we call when those events occur. a very thoughtful approach to each one. >> what happens if one provider
has an abnormally high number? how much -- the documentation and all the other factors around the patient projecting on the screen. the committee reviews actually all the components of the care, looks at the follow-up, looks at when appointments were scheduled and so forth, and then an assessment of did the doctor do the right thing? people are rated on a peer review scale of 1, 2 or 3. 3 is if the case should have been handled differently, 2 if it might have been handled differently, 1 if people felt it was meeting the general standard of care. if the provider has a level 3, they are counseled about that, and if there is more than one
level 3, there is an intervention program followed and a program put in place. >> any firings taking place? have you ever let a provider go? >> i can't say i've let a provider that had mental suicide issues go, but just a performance review. >> when i was employed, i was always very careful about those who received no mail during an entire year. and i always tried to encourage people at home to send this soldier something, and i wondered what happened to them when they went home. which leads me to -- i just want your opinion real quick on the idea of when you're getting a garden reserve go home. active duty, go back to a base or post, an opportunity for a consultation for the guard and reserve of what are you doing when you go home? what activity are you engaging in? because to me the worst week was the first week home when i did nothing. then i went back and saw
patients again. so do you think that that would be beneficial? because you're not coming home to parades and there's not a lot of jobs. >> i think i may have missed the question. what we try to do in the community is actually to generate lots of opportunities, and one of the key features of opportunities is -- involves kinship, support relationships, community. we look at individuals in terms of their well-being. and in order to have well-being, yeah, you need emotional health, you need physical health, you need intellectual health, you need a family, you need a community, and you need spiritual health. those are the targets we look t at at the volunteers of america, and one thing we're trying to push out is a lot more recreational type activities that bring people together and help knit the fabric you're
pointing out. >> you see the great value in that and i appreciate it. i yield back. >> thank you very much. mr. o'rourke, five minutes. >> thank you, mr. chairman. i also would like to thank the panelists for their testimony today and their service to our veterans throughout the country, and as i represent the veterans in el paso, i would also like to thank before plbrit aain who se a command center there, and most importantly in talking with veterans, it was very successful. so i want to thank you. i want to thank dr. mccarthy. she mentioned the mobile vet center and other resources that are being directed to el paso, all of which i think should tell us that we had a problem in el paso that we're now be lalatedl trying to correct and fix. and during that time when especially access to mental health care was so problematic,
i had the opportunity to meet a young veteran named nick damico and his mom bonnie who came to a town hall meeting of mine. and nick was having a hard time accessing mental health care services at the el paso va and shared that with me and my team, but also was there to hear veterans who served as far back as korea and vietnam and the gulf war share their frustration with not being able to get into the va. as he was driving home with his mom bonnie from our town hall that night in september, he said, you know, i'm having a hard time getting in and i'm a young, new veteran. some of these guys have been trying for years and can't get in. and four or five days later, nick damico killed himself. and i've got to connect the lack of access, the delay in care which turns into denial of care
to nick damico's death. it is at least partially responsible. and yet in that time, the el paso vha and the national vha was telling me that things were under control, and as recently as may 9 of this year, the director of vha told me that there was zero days wait time on average for a veteran seeking mental health care access in el paso. what i take that to mean is no veteran waited more than 14 days to do that. the discrepancies between what we were hearing from people like mr. damico and the va were so great that as i told this committee before, we initiated our own survey of mental health care wait times. found the average wait time was 71 days. found that, as dr. matthews told us earlier this week, more than 14% of veterans stopped trying to seek mental health care because it was too frustrating, and 36%, one-third, couldn't get an appointment at all.
is to i want to ask y so i want to ask you, if you had known the average wait time was 70 days, or as the va found last month, 60 days, but certainly more than 14, we have the worst wait times for access to mental health care for new veterans, the worst as of june. what would you have done differently? you said in your opening testimony, we are fully committed to providing accessible care. you obviously did not have that in el paso. if you had known this, what would you have done differently? >> congressman o'rourke, i had the opportunity to visit el paso. i had a visit there in june, the 16th and 17th, and i know at some point we're going to talk to you about that visit. what has happened in el paso is tragic. there were five psychiatrists that left all at once. that left a huge hole in the ability for them to be able to continue to provide mental health care. >> here's what i'm trying to ask
because i have limited time. what the va was telling me and perhaps you and the veterans in el paso was one thing. which turned out to be untrue and was very different from what reality was, which was that there was terrible, terrible access to care for veterans who could get it, and one-third couldn't get into mental health care at all. so if you had known that in september of 2013, what would you have done differently? >> i would have assisted you with huge infiltration of resources but also telemental health services. i continue to provide care, even while i work at the va office, by telemedicine, and that's the kind of help we can provide for those who have a hard time recruiting. >> you would vexpanded capacity people like nick could get in to see somebody.
so given the fact we were not told what the real conditions were, and certainly the va in el paso and the va in washington, d.c., the director reported different numbers to me, to the veterans in our community, who is accountable for that? what are the consequences? who is responsible? >> i'm not prepared to answer that question; i'm sorry. i'll be happy to take that one for the record. i don't have a name. >> that is my case in point. you can't tell me who is accountable. there are no consequences for veterans dying. nothing is going to change as long as we still have the same mentality and culture at the va, which you exemplify today in your testimony. the fact that you cannot tell me who is accountable for this, that there are no consequences, that if you agree if you had known the truth, you would have done something different and arguably people would have survived who are now dead, and yet there are no consequences. i appreciate the surge in resources, the additional provider, your flight to el paso in mid-june, but unless we
change the culture at va, this is going to be a temporary fix that will not last. mr. chairman, i yield back. >> thank you very much. mr. jolley, you're recognized for five minutes. >> thank you, mr. chairman, general steele, thank you for being here today. why are you pessimistic about the va embracing art as a -- >> great question. >> it was your statement, not mine, by the way. >> no, it's a great question that you ask me. i just think from the experiences, sir, that we've had in regards to trying to bring it in as an alternative therapy, along with these other issues that we're talking about alternative therapies, i believe, because i'm an eternal optimist, that the pessimism i have about the va, they will be pulled into it because of what's happening here and what we're able to be successful with in the department of defense in the military right now, because they
are clamoring for art therapy because it works, particularly in the early stages of the special operations command, those lawyers that are having multiple deployments that are going back, they've come, they sought art therapy. it's been very successful, returns them to the fight for admiral craven and the special operators. i believe that whole mechanism within d.o.d. will result it into eventually being mainstreamed into va, if we pool all these together in alternative therapy. >> dr. mccarthy, is there something that stands in the way? you have a major research university partner ready to collaborate with the peer review alternative therapy. what stands in the way from the va embracing that, generally? is it bureaucracy, is it procedure, is it regulation, is it funding, is it institutional bias, is it not invented here? >> i'm sorry, i don't have an exact answer to that.
i would really be happy to review the program and understand it and then understand what the barriers might be in order to make the implementation. i personally don't know. >> sure. and i guess i'm just asking a general conceptual. we hear all about these alternative therapies that are available, these non-pharmaceutical therapies that are available that work. in my previous profession, i tried to work with the va research department on a regenerative medicine proposal that was discovered at a non-va center, and i came up against a bias of extra research, not wanting to be too tied to extra research and therapies. just asking an assessment, why not art, but is there an institutional bias against extramural research and solutions? >> i would not say there is an institutional bias. what i can say is that va funds
in particular, intramural research are sometimes funded internally, but to fund that is to partner with someone in the va and then it would become intramural and that would provide funding. >> is there any protocol on how the va counsels a patient on pharmaceutical therapies or non-pharmaceutical therapies. are there va regulations that address that? >> congressman, that's an important question. i think the standard within mental health care for va treatment is to provide care that makes sense for the veteran. we offer a recovery model which would include evidence-based range of psychotherapies,
psychologies certainly supported by alternative medicine approaches, but it's to be an integrative package of care that makes sense for that particular veteran in their life. it's not bias toward any one of tho those. >> when it does come to some of the pharmaceuticals, the first 30 to 60 days, and again, i'm not a doctor but i know it's kind of critical when you begin a regimen, or when you switch medications because of d.o.d. to va. is there more oversight or care provided to the patient? is there a different follow-up to patients in the first 30 days or 60 days that they begin a pharmaceutical regimen? >> i can speak as a psychiatrist. it's clearly the expectation that people are monitored more carefully as you're making changes, either initiating a therapy or making increases in doses, yes. >> thank you. one last question, dr. steele,
quickly. u a distinguished d.o.d. career now working within va. are there areas where d.o.d., va, the transition, all of this together given your career of experience and now with a research university, one or two things quickly that you would say could be game changers? >> accountability and acceptability are the game changers. the separation from active duty to the va system is such that it needs to have all this cohesiveness to make sure everything is transferred over. if we can get legislation that does that and ensure there is transparency in openness, i think we have a great chance to have a major game change in all of this. >> thank you very much, mr. chairman. i yield back. >> thank you, mr. walsh.
you're recognized. >> thank you, mr. chairman, for holding the hearing again, to each of you. i was going to say, dr. mccarthy, i was going to say it's not personal, but then i got to thinking, there is nothing more personal in this. we had daniel and brian and clay, and this is pretty personal stuff. i guess the thing i'm most amazed at is i'm amazed at the lack of anticipating what you're going to be asked when you come here. it's a lack of reflection on this. i could have anticipated what he was going to ask, you can probably anticipate what i'm going to ask because i ask of it every one of you who sits here, but it might be symptomatic of why would we go to that trouble, why would we look, and my answer is if this maplace is working correctly, we should be mirroring and channelling that. i guess it's disillusion again. i'm with you, i'm an eternal
optimist. nothing matters but results. nothing matters but we get this fixed right. the american public is fully behind getting this right, and we just have to figure out how to do that. again, what i caution you all of is people have sat there and offered up good suggestions. we even got so far as to getting things in place. dr. carroll, you get to answer a few questions now. here's what the law said for you. the research shall be conducted under the suggestion and consultation with the department of health and human services. what have you done with them? >> sir, we are in partnership with the department of health and human services and d.o.d. and through the national action alliance on suicide prevention. >> what's come out of that in concrete results and implementation that went forward. >> we have -- education that the suicide prevention coordinators provide at every va medical center, they provide it to
veteran service organizations, to veterans groups, to veteran providers as well as all va and vha and vba. >> how do you measure that? you're responsible for doing this. in carrying out the plan, the secretary should provide outreach to veterans and veterans families and providing information to veterans of iraqi freedom and endurg freedom. they shall include the following, help families with veterans understanding issues arising, identifying signs and encouraging veterans. you just saw a family who said they didn't hear a damn thing for you. would that not be the measure? >> we have failed these families, sir. there's no question about that. our suicide prevention campaign last year was called stand by them. it was specifically aimed toward veterans and people in the community to stand by veterans and to reach out and to support them, to look for the signs of suicide and to encourage to get them into care. our suicide prevention
coordinators at every va medical center do at least five outreach events to community organizations, veteran service organizations every month. >> what does the peer support counseling program look like? how much training are you doing and how much are you encouraging outside people to come in and do peer support? >> peer support is one of the most important things we've done in va mental health care. we've hired 914 peer support counselors since last year. they are veterans recovering from a situation in their own lives. we are there either trained or certified as peer support providers or we will pay for that training. they are employed across va medical centers. we need more of them. we want them to be in primary care as well as mental health programs. they are a transformative source in our mental health care program, sir. >> i fall under this camp and i
think dr. sherin made the case. we certainly aren't going to do it all alone. there are 30,000 non-profits to help veterans. they simply aren't very well coordinated. doctor, i would ask you that at what level of confidence are you that this time we'll get there? i have a provider in the community that was fees-based. he mostly treats vietnam veterans. this guy is beloved in that group there. he canceled his contract in the milgd middle of that after 30 years. so i have veterans who say, why did you cancel this? this one was working, now i have to start all over again. so this new model that you're odd advocating, which i think many of us intuitively know the way to go. >> there is. the va hasn't led the way in the effort, but the va is doing this internally. this is happening within the walls of the va.
the concepts we're pushing is to go beyond the walls. if we want to promote integration, we need veterans working with each other in the community. >> some of the things i read that the va is doing, those could be applied the same way and already are? >> that's right. >> i yield back. thank you, chairman. >> thank you, mr. waltz. very quickly, and thank you, members, for being here. under threat of subpoena we finally got from va that the 2013 mental health employee survey, and if i can, i want to read just a few excerpts and ask if you will comment. leadership is disrespectful, autocratic and uncaring. they are clear that they are getting bonuses is the type priority if we want to keep our jobs. this is the worst leadership from director on down that i've ever heard of. next one, poor leadership and administrative skills causing more confusion and disorganization at times when my superior does not fully find out
all aspects of the issues before issuing a decree, and the third one, no effective leadership in mental health for psych nurses, abusive management, practices such as control, choosing staff, performance roles, note transparency. comments? it took a long time for this committee, number one, to get this information. >> and i apologize for that delay. i don't know what held it up. >> oh, i do. continue. >> i have had a chance to review some of the aggregated data from that -- >> you have not had a chance to review it. >> i have. that survey consisted of items that could be rated as well as the free text comments, and some of what you shared is the free text comments, but there are some aggregated results that are significant from 2012 to 2013 as we hired more individuals to be part of the team. people did focus on a real sense
of teamwork to be able to provide for the veterans. could i also add that i would just like to respond to mr. o'rourke that i would like to restate my answer to your question about accountability and who is responsible. i think we at va are all responsible, and that includes me. and i apologize for not saying that beforehand. but when you reframed that question to me, it became clear that i answered that wrong, and i'm sorry. >> dr. carroll, you made this comment skrjust a second ago talking about peer support is one of the greatest things that you did. did va support that? >> support it financially, sir? >> no. the concept. >> yes. >> they did. you fought it every step of the way. you fought it every step of the way. this committee and other people said, you need to bring these folks who have experienced this
in their own lives forward, and va fought tooth and nail against it. >> i regret that, sir, since i have been part of the central office team since 2007, we've been looking for ways to move this forward. >> i don't believe if you ask my member who has been sitting here for an extended period of time, they will tell you that va has, in fact, fought bringing them in because they claim they didn't have the right credentials, they were not specific, you know, to the treatment, and, in fact, you just highlighted it as one of your best successes. >> thank you for your partnership in that. >> with that, if there's no further comments or questions, i thank everybody. we thank the witnesses for being here today. i ask unanimous consent that all members will have five legislative days in which to revise and extend and add extraneous material. once again, thanks for the
all of today's hearing is available on our website. go to cspan.org. we've also been asking you to share your thoughts on social media about how veterans' programs can be improved. taking a look on facebook, steve says, stop trying to disqualify people from getting help. we go in to get help, not being made to feel like we're dreaming up symptoms. mary ann posting, stop
overmedicating veterans. they need more therapy and follow-up care. terry writes, give a vet an insurance that pays any private doctor or hospital anywhere in the u.s. and make sure vets are interviewed once a year to keep tabs on quality. and barron expressing a similar view saying, expand coverage to a specialist of their choice if the va specialist is not within reasonable driving distance. well, our live coverage continues this afternoon with a hearing looking at the flood of migrant children crossing the border and president obama's $3.7 billion request to happened he will that issue. jeh johnson and health and services secretary sylvia burwell testified at 2:30, and we suggest you use facebook and
>> thank you. and let me remind you also that moderation in the pursuit of justice is no virtue. >> senator goldwater's acceptance speech at the 1964 republican national convention this weekend on american history tv's real america sunday at 4:00 p.m. eastern on c-span3. house democratic leader nancy pelosi told reporters today that she's not in favor of altering the 2008 immigration law but said it is not a deal breaker. the law dictates how the federal government deals with unaccompanied children from non contiguous countries. pelosi said the president's $3.7 billion supplemental request for
dealing with the border should be brought up and voted on immediately. >> good morning, everyone. >> good morning. >> some good news this morning from the commonwealth fund. she talks about the progress of the affordable care act of which i'm very proud has already lowered the uninsurance rate among young adults between 19 -- well, overall, these are young adults between 19 and 64, between 20 a-- 16 and 26%. the cdc expects the government to spend $50 billion less in medicare this year than it expected to four years ago, thap thanks in part to the affordable care act.
that means 100,000 less beneficiary this year and per beneficiary by 2019. other good news is when the president was sworn into office when the stock market was about 7,000 and now over the 4th of july it reached over 17,000, more than double increase. unemployment is down from around 10 when he took office, 6.1% now and going in the right direction with a positive jobs report. the deficit is less than half of what it was when the president took office, so all of this going in the right direction. instead here, we have the wrong direction being advocated by republican colleagues despite all the progress that's made. by no means are we satisfied
because america's working families are still not enjoying the benefits of an economy that works for everyone, so we have important work to do. but we're going in the right direction. and response, the republicans want to sue the president. they have been resisting initiatives that are enormous job creators. they have a highway bill that takes us into a rut rather than something our economy can ride on in a very positive way, and we have that opportunity to do so. the exim bank, they don't want to reauthorize and fund, and that is responsible for hundreds of thousands of jobs in our country, too. the tria, which is about terrorism risk insurance, very important to growth in our country and investment in our country. and, of course, the immigration
bill, which for all the right reasons we should be doing in terms of who we are as a nation and our values. but the business case for it is a very strong one, that's why the business community is so strongly for it. for california it's agriculture and hospitality industry, now every state in the union shares in those industries and others would benefit from passing comprehensive immigration reform. on top of which a cbo tells us over a 10-year life of the bill, we would reduce the deficit by nearly a trillion dollars. so in addition to the bible, the faith-based groups that support this, the badges, the law enforcement leadership that supports the legislation, the third b, the business community case for that and what it means
to our economy are strong. wrong direction on the part of the republicans. we have two issues. i mentioned the highway trust fund which will expire. they are talking about a bill until next year, just try to kick the can a little bit down the path a little bit instead of embracing what the outside, what the business community, what everybody is saying that we need with t need. what the society of civil engineers says is a deficit in infrastructure and our economy. the response is so small, as i said, to put us in a rut rather than onto a road of economic growth. and then, of course, we have the supplemental, which is the subject at hand, something which should be brought up immediately, voted upon and
recognized as the emergency that it is. during the break, i visited brownsville, texas. it's a challenge that we're facing there, little children coming across the border. it's not a question of the border not being secure, these people are turning themselves in. they're not being captured, they're turning themselves in. so whatever you think of it, there is a humanitarian need. no one speaks to it more eloquently than the national catholic conference of bishops and their report on it. nobody has stronger presentation on it than the u.n. commission -- hot commissioner on refugees calling these children refugees. the bishops talk about baby jesus being -- fleeing violence. that's how they begin their
report. and at the end of their report, they say to send these children back would be like sending them into a burning building. well, in the meantime, we have a challenge that meet. the supplemental takes us a long way toward meeting the humanitarian challenge that is there, having due process to send those back who should go back, and also help with border security which is our right as a country to secure our border from others who might exploit the situation that is there taking advantage of the good nature and the compassion of the american people. so this suppis usupplemental is everybody knows is needed. hopefully it will dawn on the republican leadership in the house because that's where an appropriations bill must begin that we should proceed forthwith. we can have the debate as to what we might want to add. i'm very pleased that the
supplemental has the $600 million for wildfire -- the funds that are needed to fight wildfire and prevent. i wish it weren't needed, but since it is,+t i'm pleased that the administration included that in their request. so full plate of what is happening. please take any questions you may have. okay. we'll go here. you know, i always respect the regulars. >> on the supplemental, one policy change that was not included in the request that the white house has signaled it supports is altering the asylum and adjudication rules for a lot of these children from the noncontiguous countries that we're talking about. will house democrats be willing to sign onto an alteration ofs# those rules so that it's, i don't want to say easier to go back, but in the end allows for the law to send more of those
children back to where they came from because that seems to be a big part of the debate here. >> well, i really do think all of this has to be done on a case-by-case basis. if somebody has a well-founded fear, they are a refugee, the purpose of the legislation that you're talking about altering was to address the trafficking issue. as you know, that law was passed practically unanimously in the house and the senate, signed by president george w. bush, one of the last bills he signed as president of the united states. a bill about values to stop the trafficking. so, quite frankly, if they wanted to make it uniform, i would have rather they treated the mexican kids the way they treated the noncontiguous country kids, but, you know, really what's important is to get the supplemental. what price we have to pay to do that we'll see in the course of the debate, but i would have hoped that they would not have
made that change. i don't think -- it's not a deal breaker. >> okay. and that's part of the question because as you know, republicans have said if the president wants has to be policy changes, and this was one of the areas they glommed onto, not necessarily to make the noncontiguous policy the same as mexico, but to make it easier for border patrol or customs or whoever to turn them around. >> well, again, what i would like to see, rather see than that is to have a country processing in the countries where the violence is taking place, in honduras, and guatemala, and el salvador. instead of families sending their child across the whole cm7úu+hjt mexico to come to the united states, why don't we have in-country processing so we can say you really don't have a well-founded fear -- it's not going to work for you so don't risk your life on something that
you are not understanding. in order to do that and live up to our values, we have to have due process. you have to have representation. as you know, if you were in a similar situation, you'd rather have a lawyer plead your case than you plead your case. i mean, maybe. no offense, but you would rather have somebody who knows the law deal with it. some of these children not only don't speak english, they don't speak spanish. they speak indigenous languages and the rest. if we're going to address a humanitarian crisis, we can do so in-country. we can look at the mexico border with these other countries and see how can we say at that point can we get the cooperation of those countries and mexico at that point. if you think that somebody told you that you're going to get into the u.s. and stay, make
sure you take inventory of what your case is, and it's not worth a trip -- let me tell you, i saw these children. i mentioned it to you last time we met. or did we? have we talked about this? it's so heartbreaking. one of my colleagues said there was nothing to compare to it emotionally for him than to be there when his father died. it's heart rending, and it's about the children, and as ik(q said, read the national catholic conference of bishops, they're so eloquent and beautiful on the subject, and i met with many of the advocacy groups there and the bishop of brownsville, the conference report is written by the bishop of el paso. it's beautiful. but make no mistake, if they want to say, well, contiguous versus uncontiguous, that's the price we want to exact, what's
their point? just to lessen the due process that? kids would have or is it o send a message to those countries to say, don't think that this is going to be easy. whatever message we can send to keep people home who shouldn't be trying to get into the country under the wilberforce law, but the fact is whoever is there is there. whoever is here is a challenge to us, and we need the supplemental because these kids are in these detention centers. they're not a good place for children to be for any period of time. by law it should be 72 hours, but in fact, unless there's absorbative capacity, you would have to see it to see how
necessary it is to get the supplemental funds to get them to the next stage and then hopefully in a short period of time either sent back or sent into, if they qualify, into a situation here. but we don't want the message down in those countries to be you can come, it will take six years to resolve your case, and at least you have six years. no. this is going to be expedited and the supplemental helps to expedite that because it has the resources in it to do it. so any question the people have about they should go back, i want this to go faster, the answer to all of the questions is the supplemental about i care about the children, the supplemental. i care about them going home, they should have due process, it's in the bill. i care about securing our border, it's in the bill. so it's about the department of homeland security, and by the h%
way, the border patrol is doing an excellent job. they deserve great kudos for what they have done to deal with this maybe three times more than last year, 29,000 last year, probably over 90,000, more than three times this year of these children. so it's department of homeland security of which the border patrol is a part. it's the department of health and human services which has a responsibility under the wilberforce law to take these children in 72 hours, more or less. unfortunately, in some cases more. and the law is the 72 hours, and it's the department of justice to do the -- have more judges, more due process. so it's -- the supplemental goes a very long way to resolving many of the challenges that are there, including sending an important message that america is a great country and our
greatness is about being humanitarian and stopping trafficking and all that, but also we won't be taken advantage of by using that good bill, our good nature for people to exploit the situation. >> there was -- especially when you first became speaker, there was a contention in the democratic caucus, very vocal, of impeachment against president bush. we're hearing the same call. how did you go about your decision to say that was off the table at the time versus what we're hearing now from the hard right and the republican party pushing the current speaker to move articles? >> the argument against president bush was about a president and an administration that sent us into a war based on a false representation of a
threat of weapons of mass destruction in iraq. that's a major accusation against the president, and i, myself, said that at the time. you know, in 2002 when the bill came up. the intelligence does not support the threat that the president -- not the president, his administration is contending. having said that, it's not about impeaching the president. it's about putting the country through that. i thought what the republicans did to president clinton was shameful, irresponsible, and he did was stupid, but it had nothing to do withf"b< public py and his office, his responsibility and his office. i do think people could have made a case about president bush, but i did not want to go down that path because of what
it would mean for the american people. we've just tried to impeach -- well, we did impeach but did not remove from office one president in a very irresponsible manner in my view on the part of the republicans in the house at the time, and i thought it was time for us to address -- try to end that war, which we voted to do, and the president vetoed our bill, but to deal with it in a policy way rather than take us down that path. so for even the republicans now to be talking about suing the president, what are we talking about here? let's get to work. we are legislators. they're not effective legislators, so they're changing the subject all the time. but the fact is, and it comes to executive orders, president reagan had 381 executive orders. president george w. bush had
291. president obama has 181 with two years to go in his term. so this is, again -- it's a distraction. it's an i don't know how to do what i'm supposed to do here so let me think of something else them to be suing the president, and the reason, to get back to your question, i did not encourage those who wanted to move to impeach the president although they had an argument was that it wasn't something that i wanted to put the country through. it's an opportunity of great magnitude of what we are here to do to meet the needs of the people. it's a cost to our reputation in the world. we get a new president and we'll find a reason to impeach him. although i would say that the case against what the republican administration did taking us into war and what they knew was serious than anything that bill clinton did in his off hours. >> i want to go back to the
question todd asked. i'm a little unclear here. this is an issue that's dividing your caucus where you have folks like representative gillar partnering with john cornyn about switching that 2008 law so it would extend past you can't and mexico to these countries. you have folks who don't want that changed at all. they like it the way it is. where do you fall on that? are you more -- >> let me just totally disagree with your premise that it is dividing our caucus. one of our members has a different view. for most members they're just finding out a lot about the distinction between contiguous and noncontiguous as the american people may or may not even be aware, but it isn't dividing our caucus,yñ and it isn't -- what is important is that we all want to have the supplemental passed.
should any law be subjected to review as to whether this is a good idea? when i was there, when i was in brownsville, the people there said to me, can you make the law the same for the mexican children so that they're not summarily sent back? so my inclination would have been, as i said to you, is to take it in the other direction of case by case who is worthy of consideration. when i say worthy, who meets the standards of being able to stay here. but that isn't dividing our caucus. our caucus -- understand this, they understand this is a humanitarian crisis. it isn't about politics. isn't about anything like that. you can have a different view about the value of a provision of the law and, as i said, it's not something that would be a deal breaker as we go forward. it's not something that the catholic conference of bishops, the humanitarian -- anybody who
really cares about what the priorities should be right now, should it be a priority -- that's the face saver for them, let them have their face saver, but let us have the resources to do what we have to do. one dissident voice does not make a divided caucus. unanimity is not ever our goal. consensus is. >> are you okay with the change occurring if that meant having a larger bill? >> i don't think it should be a priority, but i said it's not a deal breaker. what's important right now, time is important, and time means if we can pass this very soon. quite frankly, i think that the republicans would like to do worse, so if that's the path that they take, as long as we have the supplemental to have the due process, to haveñ÷ judg, to expedite the proceedings, then, you know, let's mitigate
for that change with increased resources for due process and for more judges. >> where do you fall on it though personally? >> oh, i don't support it, but it's not -- again, it's not like -- no, in other words, there's an emergency -- there's a burning building. we have to put out the fire. i'm not going to have a conversation about the color of the buckets that the water is in. it's -- this is very big in terms of these children. you probably know by now that when it comes to children from my standpoint, i'm like a lioness. just don't mess with the children, okay? you want to talk about contiguous or noncontiguous, talk about it all day but give us the money to deal with it and let's mitigate for what, inf my view, negative aspects that change might have on those kids by expediting the process of reviewing their cases on a
case-by-case basis and there are criteria within the bill that are very clear. this didn't say everybody come running here who has a problem wherever you are. it has very specific standards that somebody would have to meet in order to qualify for that. so that's not the story. that's not the story. one person in our caucus has a different view, maybe a couple due, but if i waited around for unanimity, we would never move. consensus is what we strive for. yes, sir. [ inaudible question ] are you aware of this controversy and how would you vote on this bill if it came to the senate floor? >> let me just say the choice we have because it's all about choices here. when you're an advocate 100% is your goal. when you have to make a vote,
the bill that we have is one that passed the senate in a bipartisan way. i think that has a big value, and if we were able to pass it, send it to the president,ev gett on his desk, there are aspects of it i do not like, and i did not have in the 2007 bill we passed in the house of representatives, i'd like to see that bill. so a question of timing. right now we could get this bill and then deal with some of the concerns that are in it which have been inflamed by the supreme court decision of last week. and that's really what has -- so i'll be in consultation as i always am with my members and also our friends who advocate for this. we came in and we said we were going for four things. one, an all inclusive hate crimes bill, all inclusive. they said to me you could get a hate crimes bill in a minute if you took out transgender. i said i might be able to get a bill in a minute but we're not going to get a bill in 100 years
without transgender because transgender must be in the bill and we got that. one of the next priorities was enda and we passed it in the house at that time. then the groups came later and said we'd rather do don't ask, don't tell which was another of the priorities. we either do don't ask, don't tell as a priority which we effectively did and that's a tribute to the leadership of president barack obama. because he really was a great leader on that subject. as were many of our house members who voted courageously on it. for some of us it didn't take any courage. it was a matter of great pride. fully inclusive hate crimes, don't ask don't tell repeal, such an exciting thing. now back to enda, and this is what the senate can pass. so the choice is do we go for this or should we -- i have a
plan. i'm not going to tell you right now, but i have a plan on this because this is really very important to me and it always has been. i can't even believe that it should even be necessary to have -- to still need such a bill, but it is, and in states where it exists, it has not had any of the consequences that speaker boehner said, job killer, whatever, this, that, and the other thing. no, it has worked very well. we want it to be a national law, and so we're going to carefully review what the options are. they could include do we want to give up on this because we have some republican co-sponsors on a bill, overwhelming sponsorship among the house democrats. we have an opportunity there. or we can go to a place where we might not have republican co-sponsors without the clause. i don't even know how to
characterize it because i don't agree with it, but nonetheless, we could go to that place and be starting at an earlier place not knowing if that could pass in the senate. but those are -- you'll see. [ inaudible question ] >> i would love to see -- it's such a hypothetical that they would even bring up a bill here. why don't we just see what our options are, and i will tell you where i was -- i am on it. i supported the bill. i was celebrated as the tammy baldwin and others who had been advocates of this when it passed the senate, and i do think it is a good result. it's not 100% result that we would like, but, again, it's a legislative process, but i respect the concerns that advocates have put forth about it.$ so we'll see what our options are and part of seeing that is counting the votes. what do we have on the republican side in the house if we change the bill and go to
another place? and that's really where it lies because we have the democratic votes. can you tell me how many republican votes we'd have if we changed that, the bill we had in 2007, which was minus the conscience clause? you recall at the time it was all transgender. that's why we couldn't pass anything in the senate. so we want transgender in, they want a conscience clause in. i don't know what it is about conscience that would be biased against people in employment, but nonetheless, i appreciate your interest in the subject. it's very important to me and to our country that we -- and, again, why is it even a debate that we would remove discrimination on the basis of sexual orientation and identity. i don't even know why it's a debate, but, again, it is, and that's what we have to deal with.
it always comes down to the same thing, the votes. yes, a=ma'am. >> one more. >> i want to follow up. just to clarify, are you saying that at this time that you personally would support that bill if it came up? >> what difference does it make? it's a question of what our caucus -- >> because of what you have to say on this issue carries a lot of weight. >> i have asked 200 of my members to sign on as co-sponsors. the groups were all for that -- not all. there were some who didn't, but by and large the community supported that. so, yes, i mean, i think it would be a great advance if we
could get that bill, but there's resistance now because of a change in the dynamic in terms of fear of the court and really we should be afraid of this court. the five guys should start determining what contraceptions are legal -- i mean, let's not even go -- it is so stunning, and then, of course, this is more like the wheaton decision a few days later which was also
problematic. but, you know, that court decision was a frightening one, that five men should get down to the specifics of whether a woman should use a diaphragm and she should pay for it herself or her boss. it's not her boss' business. the business is whatever his business is, but it's not what contraception she uses. so the court decision is -- you know, we're all taken aback by it. we'll meet and build our consensus around what we would do, but before the court decision, yeah, i would say i would have voted for the bill, as i celebrated its passage in the united states senate because it's a giant step forward. again, not what we want, but what we could get passed, and that's what legislation is. and at some point as leaders, you have to make a decision to say should we just get nothing
around here because this is the order of the day. the agenda is nothing and the time table is never. or do we put the pressure on to say bring the bill to the floor, it's going to be on the president's desk in five minutes and we can have -- again, i'd go back to the voting rights -- the civil rights bill. you know the story about it. they couldn't contain the voting rights act. they had to save that for the next congress, but they were able to get the civil rights bill and that was an important decision that was made. we can't get it all, should we go for the civil rights act and then get the other parts of civil rights, the voting rights act. it was only a matter of months and they got it. and by the way, they're not bringing up the voting rights act. i mean, that passed almost unanimously in the house, unanimously i believe in the senate. over 400 votes in the house when we passed it in 2006.
it became effective 2007. the court said it was obsolete by 2012. it'spv ridiculous. we should have been able to correct that instantaneously in the congress. we have a bipartisan bill to do it. does it do everything we want to do for voting rights? no. is it a bill that can pass? yes. it's bipartisan. it's a bill that can pass and it's a standard the republicans should be able to meet. it doesn't take them to a place that they could never want to go. they've already been there in large numbers. so understand where we live and what's going on here, and if people don't like that, they should just work really hard in the election to persuade democrats and republicans -- well, the democrats are there, but persuade republicans to be for them on this in order to get their support in the election.
unless there's a political price to pay, people don't change where they are. they don't rethink what the situation is. so, yeah, i'd love to he soo the cleanest bill possible. that's what i passed when i was speaker. >> but for you personally, this bill is better than nothing. >> i think so. i think so. >> okay. >> i think so, yeah. again, i'm speaking from the stand point of a legislator. now, i used to be on the street. i was an advocate. i had 30 years single payer, single payer, single payer. public option i never heardóz o. single payer. and we have a bill that, you know -- everybody has to make an accommodation because you know what? we only represent one district. in my district is probably the district that opposes the senate bill more than any district in the country, but nonetheless what is the opportunity cost?
what happens if we don't pass anything? is that a good outcome? that's what we have to decide. but people have come a way on it. the senate, i think the senate republicans who voted for it did so in good faith. i don't know if that provision -- maybe with more education, maybe the point is if the advocacy groups want to political way, because public sentiment is everything, and they have to persuade not only their legislator but the american people. did you know that people in our country are discriminated against on the basis of whether they're lgbt community members or not? most people don't probably think that that is the case, but it is the case, and we need the bill, and, again, it is -- again, i'm speaking as a legislator, not as
an advocate. i don't want to diminish the accomplishment that the senate made. i don't want to diminish the fact that we're able to get some republican co-sponsors on this legislation, but i also value the collaboration and the hearing from folks, if not this, then what is the path? if not this, then what is the path? and understanding what the commitment is all around. our democratic votes are solid i'm not -- i just want to get republican votes right now or else win the election and then have a bill, but you still have to deal with 60 votes in the senate, and people -- you know, that's hard for people to understand, but it is the case. in any event, let's get the supplemental passed. the fact is the jobs -- the american people are concerned about their pocketbooks right now, and all these great job figure that is i mentioned about
the stock market going from 7,000 to 17,000 under -- with the ingenuity of the american people and the leadership of president obama, with the deficit in half, with unemployment from 10% to 6.1% and going in the right direction, with all the health care costs going down, unemployment -- uninsured people's numbers going down and the rest, we need to do more to create jobs. the highway bill is one important way. reauthorizing ex-imbank is another important way. passing immigration reform is an important way. we can sit around and talk all day about contiguous and one thing or another, but the fact is we're spinning our wheels because nothing is happening. so we're having a theoretical discussion unless they really decide to bring something to the floor, and i think that the
obstruction and the do nothingism is something that we really have to address more than what my personal view is on the subject. my personal view on the subject probably can't pass the senate, so there we are. but thank
you all very much. >> thank you. also spoke to reporters today saying that he would not be giving president obama a blank check in reference to the president's request for $3.7 billion for border security. the speaker also said there would not be a long term highway bill but the house would seek to extend the current program for 6 to 12 months. >> this week we're passing two more bills that would encourage businesses to invest and to create jobs here in america. of note, we'll send a bipartisan job training bill to the president for his signature. i'm particularly proud because i worked on this issue as chairman of the education and workforce committee and i want to thank
virginia fox and john klein for getting this done. it was an important step,s- onf actually many steps that have been taken to reduce the bureaucracy and number of job training and retraining programs and providing more flexibility so that the american people who want additional skills and education have better access to these programs. it's another example of what we can accomplish when senate democrats will work with us to address the people's priorities. now, compare all this to the president's tone deaf celebration of our struggling economy yesterday. i want to talk about being out of touch. middle class families continue to struggle with high prices on everything from gas to groceries to health care. and because of the high cost of living, they're falling further and further behind. some 288,000 americans found jobs last month. that's a good thing. but let's have a little dose of
reality. the same report showed that more americans gave up on their job search than those who actually found a job. this has happened for 49 of the last 50 months. more people have given up looking for work than have actually found work. and as the ways and means committee reported yesterday, it's the worst job recovery in our history. clearly, we could do better. that's why house republicans have passed nearly 40 jobs bills that are currently being blocked by senate democrats. we've seen enough of senate gridlock and the president should join us in pushing the senate for more action and i think middle class families deserve it. along our southern border, we have got a true humanitarian crisis under way with children caught in the middle.x5 unfortunately, it's a crisis of the president agencies own making. his actions gave false hope to children and their families if they enter the country
illegally, they would be allowed to stay. our priorities are clear, take care of these children, return them safely home to their home countries, to their own families, and secure the border. i sent a letter to the president last month laying out some specific actions that he should take to address the crisis, including sending in the national guard. the national guard is uniquely q these typesuard is uniquely of humanitarian crises and utilizing their expertise would free up border agents to focus on their job of securing the border. now the president said yesterday he'd consider doing that only if he gets more money with no strings attached. in other words, he won't do it for the kids. it's all about politics. the president assured the american people the border was secure, but clearly it is not. chairman rogers and the members of our working group led by kay
granger are reviewing the administration's request. i can tell you this though, we're not giving the president a blank check. and beyond that we'll wait further discussions with our members before we make any final decisions. >> there's been some calls from the hard right in the party to impeach. you were pretty>( emphatic on wt you thought of sarah palin's suggestion but when you hear this from folks in the party, what do you say to them? do you just shake your head, roll your eyes? how do you talk them off the ledge? >> i told them i disagree. >> i mean -- >> it's as simple as that, i disagree. >> and they take that and leave it or what? >> they go on. >> your working group last night made a statement in which they said they believe the 2008 traffic law needs to be revised. do you agree with that? >> i do and i think the president agrees with it as well. >> mr. speaker, you said you don't want to give the president a blank check, but do you expect that house republicans will pass
some sort of legislation to deal with this crisis even if it's something the president says he would veto? >> i do believe that the house should act this month. what that action would be i think is yet to be determined. we've got the chairman of the appropriations committee doing his due diligence and the members of the working group looking at options and those discussions are going to continue. >> changing the trafficking law, which the white house has also said it favors, not in the proposal they sent you, however -- >> wasn't that convenient? >> we're talking about it now though, so that's okay. how far does that have to go? do you want to see the noncontiguous countries the same as mexico or doesn't have to go that far? >> we'll let the working group work out the details, but i think we all agree that the noncontiguous countries that now
we're required to hold those people, i think clearly we would probably want the language similar to what we have with mexico. >> mr. speaker, do you agree with senator lindsey graham who said yesterday if republicans do not go ahead and approve this funding, we're going to get blamed form perpetuating the problem? do you think you have to approve this funding? >> listen, this is a problem of the president's own making. he's been president for 5 1/2 years. when is he going to take responsibility for something? >> mr. speaker, madam leader said that the gop highway bill would put the country into a rut. there's a bipartisan proposal coming out of the senate for the senate highway trust fund of possibly raising the gas tax. would you support raising the gas tax? >> i have never supported raising the gas tax. we're not going to get to a long-term highway bill here over
the next couple months. that's why the ways and means committee in the house, senate finance committee in the senate, are working on a proposal to extend the current highway program for another 6 to 12 months. i believe that the house ways and means committee is acting as we speak and i expect next week this issue will be on the floor of the house. >> you said the --ñe [ inaudible ]. what will they're going to do on the export/import -- >> you can watch the speaker's briefing anytime online at cspan.org. we leave it to take you live to capitol hill and the president's $3.7 billion request to congress to address the issue. homeland security secretary jeh johnson and health and human