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tv   Politics and Public Policy Today  CSPAN  April 22, 2016 1:00pm-3:01pm EDT

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psychiatric disorders. what implications do these findings have for screening ptsd and then to captain colston, how do these findings inform screenings and treatment of service members and what kind of outreach do you encourage survivors of mst to seek care? >> we do, as i mentioned, screen every veteran for experiences of mst in the va which that study would suggest is particularly important. unlike other types of traumatic events, their risk associated with mst for suicide doesn't run fully through ptsd or depression. it exists separate from that which is why it's so important that we screen specifically for experiences of military sexual trauma so that those patients could be followed up in terms of suicide risk directly. >> captain? >> yes, ma'am, i'd agree with dr. street. the suicide risk is increased from sexual assault aside from ptsd. ptsd itself is not necessarily a robust risk factor for suicide. it does have a hazard ratio that suggests that it's associated with suicide but certainly
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sexual trauma is a really big factor. developmental trauma, especially developmental sexual trauma, stuff that i've seen as a sexual child psychiatrist is a huge risk factor and affects the brain as it develops and makes you check the horizon if you're safe all the time. >> although the problems are higher among women, there are given the significantly larger number of men in the armed services, there are similar numbers of men and women who have survived sexual trauma. how do men differ in their response to mst and how do v.a. services meet the needs of men who have survived mst and are treatments for ptsd different for men and women, and if so how, and is there a detectable difference in male suicide rates? >> male and female survivors of mst look more similar than they do different, although men's experiences may be exacerbated in terms of symptomatology although the symptoms themselves are the same.
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male survivors do struggle uniquely with concerns about their masculinity, understanding what this says about their sexual orientation. a lot of self-blame, why was i targeted for this. this isn't something that men usually experience. in terms of treatments, the treatments look very similar. i think differences in terms of male and female survivors really comes in when we think about our social marketing and outreach. we're very careful to have out reach materials targeted to men survivors to include pict e pictures of men as well as pictures of women so men can understand that our mst treatment services are there for them as well as for women. >> i'd say one of the things that we struggle with, the prevalence of sexual assault in women compared to men is probably about five to one. dr. street's data and nate's data and some of ron kesler's data from harvard support that.
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one of the things we struggle with is getting men into care. men are less apt to engage in care for sexual assault and in fact in therapy that's something you may address way downstream. it's not an initial presenting problem. >> it's why i have a concern that the suicide rate might be higher. if male survivors won't report, they don't get any care. anecdotally, i met a male survivor who attempted suicide, was not successful. paralyzed himself in his shooting himself in the spine, and was paralyzed for the rest of his life. he couldn't face his life, his wife, he couldn't face anything after it. instead of seeking treatment -- he actually did but for many survivors instead of seeking treatment, they just commit suicide. >> there's no question that it's a trauma that's very hard to overcome. it's very hard for us to get granular exactly about what the problem is. there's on the order of 300 risk factors associated with suicide. certainly sexual assault is one of them. ptsd is one of them.
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one thing is i think with regard to v.a. care and some of the promising things, we see that veterans who have ptsd have lower suicide rates than other veterans. so i think there's some promising developments in the treatment and in the turnover from dod to va. >> thank you. >> for the record, senator cotton served a tour of duty in combat in iraq. i think you were a platoon leader. is that correct? so senator cotton. >> thank you, chairman graham. i can say that the system that captain greenhalgh described has been in effect for at least ten years, at least in the army. i want to talk briefly about the relationship between traumatic brain injury and posttraumatic stress. one does not necessarily presume or infer the other, is that correct? >> not necessarily, sir. i think certainly if someone has been exposed in a traumatic
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event down range that resulted in a traumatic brain injury, i think the possibility is greater that they will also have co morbid posttraumatic stress with that. i believe a history of tbi predisposes someone to be more vulnerable to psychological health issues down the road. some of that has to do with the chronic effects, if that is a service member who has chronic effects of the tbi developing some symptoms that are suggestive also of psychological health issues, there's a lot of overlap there as well. >> i'd say patients often present to us in an undifferentiated state. they'll present maybe with the problem with suicideality, maybe a substance abuse order, maybe a pain disorder. sometimes it's hard for us to discern what it was. >> is one easier to diagnose than the other to the extent that you can separate co-morbidity?
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>> my background is primary care. i would say certainly we see a lot of behavioral health in the primary care setting but given that we have very strong cpgs for a lot of things that we take care of in military medicine and medicine in general, when i see a patient who has a history that sort of fits within the history of the clinical practice guideline description for a certain kind of diagnose, the tbi is certainly an easy one to try and fit into that diagnostic realm. >> some of it has to do with patients that present in front of us. for walt in a primary care setting, he's going to see a different population than i'll see in a psychiatric setting. one of the things that occurs to me is the science for ptsd is probably more developed than the science for tbi. science for tbi is really in a nascent stage.
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ptsd is a little easier to discern. it's a little easier to discern from a child psychiatry standpoint with regard to developmental trauma just because the prevalence of that is so high. >> the research on ptsd is a bit further along and as part of that we have existing well validated instruments for the screening and diagnosis of ptsd and i think those instruments are being developed for tbi but are not as far along, haven't undergone as rigorous tests. >> so the science for ptsd is further along than tbi simply because of the volume of patients that the medical world has seen with posttraumatic stress as opposed to tbi? >> i think it's a number of factors. the science of tbi has been really hard to get a handle on, just from the standpoint of, you know, it took -- i'll give you an example, sir.
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it took 20 years and $50 billion to get on top of hiv. hiv has been about a dozen genes. the brain uses about 20,000 of the 30,000 genes in the human genome, understanding the way the brain works, especially a brain that's traumatized is extremely hard. with regard to ptsd, we at least have a long history of looking at people who were traumatized and a long history of treatment interventions, so i think the science is more developed for that reason. the prevalence of both of those, the prevalence of ptsd is about 2%. tbi slightly lower. >> we really became aware of ptsd following the vietnam war so we've had that span of history to think about the disorder, the diagnosis and the treatment of the disorder. tbi is something we've become so much more aware of due to recent conflicts in iraq and afghanistan. >> if i can add, sir, again from the primary perspective, there have been versions of ptsd it
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seems from conflicts centuries ago as well, the idea of shell shock and things like that. i think we've gotten a handle after the vietnam conflict. with technology and neuroimaging capability, that has been a phenomenon of our generation so i think there's a lot of potential there. again, from the primary care perspective having neuroimaging support certain diagnostic criteria for traumatic brain injury, i think there's a lot of potential for the science. but i agree, we've been describing things like ptsd for quite a lot longer than we have traumatic brain injury. >> one word i think i heard you use twice, maybe three times was longitudinal. the root of that is long, which is a little worrisome given the number of people who suffer from pts or tbi. obviously when you're conducting a longitudinal study, it takes
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many years to get results. is that something about which we should be concerned now? >> yes, sir but it's the only way that we can do it because these things don't present in silos. pts doesn't present in a silo, tbi doesn't present in a silo. we have a lot of efforts. we have the millennial study and the 15-year tbi study. we have the stars longitudinal study on suicide. we're looking at several hundred thousand patients now to get an idea of where patients are coming from. >> longitudinal doesn't mean we have to wait until the study is over to start gathering data. the 15-year study, for example, has report outs every four years. the next one is due next year. not to mention the constant stream of data and research that is being formulated into papers and publications along the way. that's just a small example. longitudinal really connotes a commitment to a long-term study on this, not to say we're not going to give you answers for 15 years.
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>> would it be productive to expand the data set to look at other occupations that might have similar risk factors like say professional football, professional hockey, boxing or others? >> certainly the brain trust meeting that i described that's happening today and tomorrow is doing exactly that and it's bringing in a researcher from my institution who is one of the first to identify this issue among professional football players and taking that information and applying it to the military and veteran community. for sure these partnerships in which you can identify knowledge that's been gathered in other places and apply it to this population i think are very promising. >> thanks, mr. chairman. dr. street, i think you've touched briefly on the transition from active duty out of service or into the reserves
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or care of the veteran's administration. how well do you think transition is going these days in terms of the computer compatibility, not only in records but also in transition on pharmaceutical drugs, prescriptions and so forth? maybe you can give us an overview because i think you really are in a position to comment on that issue. >> i'm happy to comment from my perspective although my perspective may be a bit limited so you may choose to hear from my colleagues as well. but in my perspective as a practicing clinician, that transition is going well. i think captain greenhalgh said it's going better than it ever has. i know there's a lot of attention to this issue, a lot of new initiatives and in my experience as a practicing clinician i haven't encountered problems with that.
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>> sir, i'd say it's dod policy right now that we do a warm handoff from dod to va. it's really important, those transitions. 1 thing we have done is established coaching and in-transition program where we actually look at people's medical data and go in and say, hey, can we help you with your follow-on appointments? that's been used to good effect in the last year. >> it's always been the policy. it's not always been the executed policy, and so for example on the interoperability of computer programs -- i don't know whether you can give us an up to date perspective on how well that's going. it's been a continuing struggle as you know. >> i don't have an update on the status of that but i'm happy to take that question for the record and we could get back to you with a more thorough answer on the updated status of that integration process. >> i would appreciate that and as well on the pharmaceutical
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drug issue, the transition there has been an issue for some time. let me shift to again the posttraumatic stress, military sexual assault trauma. is that an area where you think more research as well as clinical treatment is necessary? >> i'm a researcher, i'll always say that i think more research is necessary but i do think this is a case where understanding things that are unique about experiences of military sexual assault, ways in which those experiences differ from the military context and civilian context, understanding that has a lot of implications for recovery, so i think our research that helps us understand that process as well as research more generally targeted to the disorder and treatment of the disorder is extremely valuable. >> and it may seem obvious, the answer may seem obvious.
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i think i have an idea about what the answer is but maybe you can talk a little about what the differences are in the civilian versus military sexual assault trauma. >> sure. senator gillibrand earlier referred to the fact that survivors of military sexual assault in some ways look clinically more like survivors of childhood sexual abuse in they look like survivors of adult sexual assault in the civilian world. and i think there's some truth to that certainly in terms of the fact that survivors from military sexual trauma often talk about the experience of ongoing abuse in which they feel trapped and unable to escape because they're not able to sort of leave their position, although there have been policy improvements to make that more possible. they're also dependent often on their perpetrators for meeting their basic health needs or for this feeling that their
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perpetrators are those who are supposed to be watching their back and looking out for them. those differences gives the survivors sometimes a little bit of a flavor that looks more like ongoing childhood abuse. of course also we know that survivors of traumatic stress are often repeatedly traumatized over a life span, so that earlier trauma increases risk for later trauma. many women and men who are survivors of sexual trauma in the military are also survivors of childhood sexual trauma or personal trauma as well so those experiences can exacerbate each other in terms of severity of symptom presentation. >> thank you. my time has expired. i appreciate you taking my earlier questions. thank you all for your service. thank you. >> thank you. i think senator tillis on the way, but senator gillibrand, do you have follow-up? >> one of the issues that some of us work on is rescheduling marijuana to become a schedule two drug so more research can be
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done and so patients that have been prescribed a medication can get access to it more regularly. one of the concerns we've had is because as a schedule one drug it therefore prohibits the v.a. from being able to prescribe it, even though that individual might have been prescribed in their state if the state has passed a law. we've heard from many veterans that marijuana can often be a very useful treatment for ptsd symptoms. have you studied that issue? do you have any insight into that issue that you would like to share? >> ma'am, i can say dod hasn't ascertained the answer to that question for the reason that you -- >> the schedule one. >> one thing that i have seen as a child psychiatrist is, there's risks and benefits to any intervention and with regard to marijuana one of the things that we struggle with is it can precipitate psychosis in some people, especially younger people, people of a military age, so that would be a concern that i would have as we press
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forward on this. >> i know that va has ongoing studies looking at the effectiveness of marijuana for the treatment of ptsd but i know that there have been issues that have come up related to the quality of the marijuana, the consistency of the marijuana, the strength of the marijuana that are unique challenges in terms of studying the effectiveness on that disorder. >> would you recommend further study so we can actually have drug companies study it? and drug companies produce medicines that then could be tested? >> i'd like to see the results of the earlier studies in terms of addressing cost benefit analyses. if early studies look promising, i would make that recommendation, if they showed negative effects, i would be more cautious in that recommendation. >> thank you. >> senator sullivan. >> thank you, mr. chair. i appreciate you and the ranking member calling this hearing. it's a very important topic.
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i appreciate the witnesses being here. one of the things i really like about this committee, it's very bipartisan. this topic comes up a lot in a very bipartisan way. you see members who actually really, really care about this. i certainly happen to be one of them. i think most people who served in the military can recall more than one instance where a troop, a member of their squad or unit has succumbed to the depression and suicide, and i think it's a searing experience of course for families but for the troops and the leadership and everybody else who goes through that. so it's a topic that we need to do a better job at. i'm sure it's probably already been covered to some degree, but
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what authorities would you view from our perspective that you need from this committee or the congress to do more to address some of the issues of the stigma of ptsd or reducing the rates of suicide among our active duty and veteran populations? is there anything more you need from us? >> sir, i think you talk about two things that are very closely related which is reducing the rate -- reducing the stigma and then attacking the problem itself which is suicide. i think with regards to reducing the stigma, we've made great strides over the last decade i think at least in making it not just again a symptom driven approach, the patient coming to the medical provider looking for help with our screening efforts, certainly everybody is asked whether they're symptomatic or
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not. when we go through our annual health maintenance examinations, that comes up as a very prominent topic, that and tbi history, as well as a lot of the technology and the apps that are available, a lot of i.t. solutions where the service member and their family doesn't necessarily have to go to a clinician to ask the question. they can get a lot of the information they need online. i think that goes a long way towards towards destigmatizing. if they can get the answer to their preliminary questions in a nonclinical environment, i think that's certainly one step. >> with regard to resources, i wouldn't necessarily have anything to say about that. i would say that there's a robust relationship between suicide and depression and certainly identification and management of depression, especially in a primary care setting. it's very important strategy and one that we really want to focus
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on, really in public health. >> let me ask another question that relates to my first one on authorities. there's a bill and i'm having my team take a look at it and i've been looking at, i believe it might be senator peters who has put this bill forward. i don't want to butcher it here so we can make sure you get it for the record. but there's concern about claims that there's been thousands, maybe tens of thousands of members of the military who have received discharges that are less than honorable discharges related to ptsd or brain injury type of issues. are you familiar with this bill,
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or are you familiar -- and the bill would ask the military to have a presumption maybe in favor of an honorable discharge. in my military career i have not really seen that issue but i may have been missing something. are you familiar with this bill? are you familiar with the problem, and what's your advice? do you think there's thousands or even more members of the military who have been discharged with other than honorable designation because of activities of undiagnosed ptsd and that their discharge designation should be relooked at and do you any need authority to do that from the congress? >> on the bright side we've already had that authority and we've used it. we did a mental health review where we looked at over 200,000 boards. we did a physical disability review where we looked at a number of boards for just that problem.
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since 2007, patients that we were going to separate for means, be they disciplinary, be there for lack of performance, they need to be ptsd issues and tbi issues need to be addressed before they could be done. we used to separate 4,000 folks a year. for personality disorder separations. that number is down to 300 so about 7% of what it was. there's been a lot of attention to this issue and certainly about three years ago i think we spent on the order of $10 million looking at boards and certainly as senator blumenthal has brought up in some previous correspondence with dod sometimes we're going all the way back. so the boards of correction for military records have looked at cases from vietnam veterans, cases even where ptsd didn't exist as a clinical diagnosis. of course it's hard to ascertain exactly what the circumstances were around something that happened a long time ago without records. >> sorry, mr. chairman, just a followup.
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so you already have that authority? have you seen this bill, and have you weighed in on it? it would be very useful. like i said, something that i'm very sympathetic to. i don't know what dod thinks about the bill. at the same time, it sounds like you're already -- you already have the authority to do what the bill does. i don't know if it has a presumption in favor of honorable discharge. again, i don't know the specifics. i'm sorry, i should have brought it with me. but, have you weighed in or do you need authority or do you think you're good to go in addressing what you're obviously saying is a problem? >> sir, i mean, i haven't seen the bill. i haven't been asked to weigh in but i echo what captain colston said. i don't think it's an issue of the type of discharge that a patient gets. i think it's a matter of ensuring that they get the correct kind of care that they need prior to discharge or even after discharge with that warm
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handoff to our colleagues whether it's honorable or dishonorable, isn't necessarily the driving point. >> mr. chairman, if i may, maybe we can submit that bill and if they had a view on it. >> yeah. it sort of is the driving point. you don't want someone to have an other than honorable discharge who may have had a medical condition that resulted in it. that's the whole point. >> this is particularly relevant for military sexual trauma survivors. they were often diagnosed as having a personality disorder. as part of their discharge after they suffered a sexual assault. with that discharge they weren't entitled to v.a. benefits, so it was a huge problem for them because they have trauma, they're a survivor, they need mental healthcare and they don't have access to the v.a. anymore. we wanted those cases could be looked at again to say can we get this right. >> we'll upgrade the discharge if there's a medical reason that
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was missed or ptsd suffering. captain colston, the reviews you're familiar with, did y'all actually change discharge designations? >> yes, sir. several service members have had discharge determinations changed over the years, and several service members have had their benefits changed, especially the physical disability board of review. >> could you do this, could you have that group -- and i applaud your efforts -- give us the results? of the 200,000 reviews, how many discharges were upgraded and how many benefits were restored? >> yes, sir. the executive agent for that was the air force and the physical disability board of reviews. >> our staff will get on that, won't you? absolutely. senator king. >> thank you, mr. chairman. thank you all for your work in what is a really important area. we see it daily in maine. dr. street, one of the issues we have in our state, it's a very rural state, large, long
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distances. how do we deal with the unique challenges facing veterans in ptsd and other mental issues who -- it's just almost impossible to drive a whole day and drive back and to have effective treatment. talk to me about treating this problem in rural areas and particularly about the possibility of using online resources, telemedicine, those kinds of things. >> the things you suggest are exactly the kind of things that we've been working with, really figuring out how we can harness technology to take what we know are effective treatments but have been used in a face-to-face setting in an office situation and use technology to make those more widely available. so certainly tele helps. but increasingly we've been developing and testing online technology. for example, a colleague of mine in boston recently developed an online intervention for co morbid ptsd and alcohol abuse
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that in early stages has shown to be quite effective. we're also harnessing the use of mobile apps that veterans can use if they have infrequent appointments in between appointments to help manage their symptoms and improve their process of recovery. so we're hoping that use of technologies and harnesses those technologies can help address some of the issues with treatment among rural veterans. >> this is a parenthetical question and then i'll get back to the technology. do we know what works? are there proven treatments to deal with this issue? >> there are, and i think it's such an important message to get out there because i think it provides hope for veterans. we have well established, rigorously tested treatments for ptsd, primarily psycho therapies and the cognitive behavioral that have been shown in multiple settings in multiple populations to be effective in reducing the
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ptsd. >> i think that's important news. >> absolutely. >> this is not a hopeless situation, that there are successful treatments. >> absolutely. >> well, i want to encourage you in the strongest possible terms to pursue these technological advances because time is not on our side. again, in many places in this country people are in very rural areas in alaska and they just don't have access to a clinic or to a group. it's very difficult. dr. colston, let's talk about substance abuse as it relates to this issue. do you -- from my anecdotal data from my staff in maine, there's a lot of overlap. a lot of people who have ptsd end up in a substance abuse situation, either alcohol or drugs. is that true, and how do we deal with that issue? >> yes, sir, there's about a 30% overlap between ptsd and
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substance abuse disorders. one of the really scary things that we're facing right now is the scourge of opiate overdose deaths in this country. >> 47,000 a year. >> yes, sir. just horrible, and certainly as people have transitions into heroin use, more heroin overdoses. >> do you think part of it is self-medication? >> yes, sir. no question. we've seen that with alcohol and all kinds of illicit drugs. certainly now the drugs that are out there are scary. there are drugs that you can take once and end up dead and that's really where the change has been. we recognize that there is an overlap between those symptoms so we have a lot of stepdown care in dod, a lot of intensive outpatient treatment where we treat both your mental health issues which ptsd runs with other things, tbi, depression, substance abuse disorders, pain. we also treat the substance use disorders. with regard to opiate disorders,
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we've got medication therapy. with regard to alcohol disorders, lots of science which supports the use of things like medication assisted therapy for alcoholism or other drugs that work really well. >> so you see this as an important area, that co-morbidity is an important issue? >> absolutely. duel diagnosis work is really where most of our stepdown work is right now. walt sees a fair amount of folks struggling in that regard, too. >> dr. street, are there any v.a. rules that if you're suffering from ptsd and also have a drug abuse problem you can't get treatment or you're excluded, there's no barriers? >> no barriers. in fact, increasingly we're looking at treatments that can treat both of the disorders simultaneously because we know that they're so interrelated. >> final question. i know that a program was created in 2010 to help people moving out of the service
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into -- called in transition i think it's called. my question is, is it working and how do we know? >> we're collecting -- that's run out of my office, sir. we're collecting data on it. we ramped up the program ten fold about a year ago. >> good. >> one of the things that we're trying to do throughout the dod is get outcome measures. luckily there hasn't been in this short period that we've been running the program a suicide in any person who's been coached in the program. nonetheless, we want outcome measures with regard to things like how depressed is this patient, what kind of ptsd symptoms does that patient have, how much healthcare is this patient utilizing. i think as our health systems evolve and we develop registry data, the ability to get an idea of where patients are, we'll get much better answers with regard to outcomes. >> i think we should be applying the same level of resources, money and personnel, to transition out of the service that we've put into recruiting in.
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that's where a lot of the slippage occurs in that -- sometimes very difficult transition. that's been something i just think that's a rule of thumb. let's spend as much helping people when they come out as we spend bringing them in the in the first place. thank you very much for your testimony and for your work. >> thank you, mr. chair, thank you all for being here. first off, i understand -- i'm sorry i'm late. i had a competing -- actually, i was following senator sullivan through the current committee circuit, so i apologize for being late. if you've already answered these questions, i can refer back to the record. one thing i wanted to underscore i think that senator sullivan covered, it's a bill that i've supported, the fairness for vets act. i think you all got into a discussion here so i won't ask you to repeat it but underscore i think it's important and i think it provides value and i believe there's at least consensus among the department that you do as well? thank you. any problems with it?
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[ inaudible ] >> okay. i think senator cotton may have mentioned something about public/private partnerships. we go to the easy one to identify which will be the nfl. based on where i come from, i could argue nascar. but what other sort of network of private partners are out there and what specifically are we doing to really bring in and collaborate, use their expertise, not reinvent the wheel? dr. street, maybe i should direct that to you? >> there's a two-day summit today and tomorrow that's the focus of the public/private issue on tbi, bringing in folks from the v.a., dod, nfl, researchers from the private sector who are particular with those issues to try to really garner innovative technologies from different sectors and apply
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them to this population. it's a good general model. one that va is trying to do more and more of. >> have we gone into any of the maybe research universities that do a lot of work there and find partnership opportunities there? is that another area you're casting in? >> absolutely. where i hail from in boston, we have very close connections with boston university. they've done a lot of work around chronic encephalopathy. many of those hold dual appointments in the academic institution and the v.a. so we can harness the power of some of the best scientists in this country who are doing the work. >> thank you. senator king mentioned the transition piece. i'm on veterans affairs committee and obviously a lot of the challenges we have after a man or woman comes out, they may have undiagnosed tbi, ptsd. i'm trying to figure out how we do a better job of -- there's
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this handoff and sometimes if you go in transition you've got the younger soldiers that are in the back of the room with their headphones on doing their duty and then moving out there they may be in fact people who should be listening and what they're thinking about is moving on. to what extent is the dod -- it necessarily becomes a v.a. role but to what extent is the dod making sure that particularly for ones where you may have evidence to suggest that someone does have something that has not yet been effectively treated make sure that those veterans get vectored in to the care they may need through the v.a.? does that occur or is it because of the finite nature of the transition -- i'm trying to get a better sense of how we do a better job that the v.a. may not know that there's someone out there that may need help. how do you create an alert system or does it already exist to make sure there's a good handoff? >> three things.
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first there's a separation health assessment where we try to cover all of these issues. for patients who present with any kind of condition, we have an integrated disability evaluation system with the v.a. and then an in-transition system to coach folks. it's an opt out system to help folks get that next appointment. i would also say for the sickest patients, we go all the way to, when i was at great lakes, if i had an 18-year-old patient with schizophrenia, one of my techs would get on the plane and bring him to alabama or bring him to texas. that's the level of transition support that's expected. >> do you think that we're doing that consistently? >> sir, i can say we're measuring it right now. i can certainly take that question for the record with regard to how we're doing. >> i would appreciate that. just to get some sense. i'm from north carolina. we got 1 million veterans and a lot of folks who either served at ft. bragg or luzerne that end
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up saying at north carolina. want to make sure we're getting them to the care that we think could help avoid other problems and complications. i work a lot with drug treatment facility down in raleigh-durham. 60% of their clients are people who now have substance abuse problems but it's not clear how they got there, what caused them. some of them are rooted in ptsd so i'm sensitive to this issue to make sure we're capturing as many as possible and getting them into an appropriate care setting. i would appreciate that. thank you, mr. chair. >> thank you. this has been an excellent panel. just to summarize, one in four military members are affected by what we've been talking about today -- trauma, pts, drug abuse, alcohol abuse problems. they've been treated for these problems is that correct? >> yes, sir. we do a dmdc data run. so a defense management data run
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for everyone that's getting out and look and say, have you been treated? one thing i can say is we do a really good job with screening and certainly we've evolved to identify more of the illness that's out there. i think we now have probably the most treated cohort in human history so i think we're doing a good job in that regard. >> that's the whole point. somebody asked this but as i wrap up here and let other people ask additional questions, please tell us what we can do because we're trusting y'all guys. everybody seems to be very focused that the veterans and those serving deserve this. about 80% of the cases are unrelated to being in combat. tbi, one thing about the movie, i haven't seen it, but senator gillibrand was telling me, you can't look at a tbi injury on an mri, not like looking at a broken bone, right?
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>> no, sir. no neuroimaging. >> only god knows how many of this we missed in past conflicts. >> for the mild tbi, yes, sir. >> i'll just add with this and let members wrap up what they would like to ask. i've been to a bunch of refugee camps. i bet most of us have. i can only imagine what the people in these camps are going through. from syria, i was at one in turkey not long ago. the children, the women, victims of sexual assault. one thing as a nation, as a world, there's not a whole lot of treatment for people who have been through conflict. and i just think they're ticking time bombs if we don't get ahead of this. one thing i'd like the senate to understand is that when we provide aid to the refugees, it's more than just food and water and clothing. if we don't have a mental health component, i think we're making a huge mistake. anybody else? senator sullivan. >> i have a followup question. the bill is s-1567.
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fairness to veterans erroneously discharged from the military. that's the name of the bill. if you could take a look at that and see if that's providing you additional authority that you think you need which is obviously an issue that seems to be a pretty big issue if you're looking at 200,000 cases. i just had another question. i'm on the veterans affairs committee and i asked the questions of some of our service organizations when they were testifying recently. on the designation ptsd, there's been some discussion, we talk about the stigma, the posttraumatic stress disorder, so a disorder kind of comes with a little bit of, you know, implications. so some people have mentioned to me, maybe this should be referred to as posttraumatic stress injury. so if you receive this in combat
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and you were injured obviously it's like getting shot, nobody calls a gut wound or getting shot a disorder. they call it an injury. some veterans groups think that might be a good idea. others don't for reasons that it might have to do with benefits and how things are actually categorized in the v.a. and if you don't call it disorder you might lose a certain amount of -- do you have any thoughts on that, dr. street? any of you just on the -- just the title itself which does have certain implications. i just wonder what your thoughts are. >> i'm in favor of retaining the posttraumatic stress disorder title. i appreciate the concern about stigma, but i don't believe that changing the title is the way to most effectively combat the stigma. >> i don't think it would.
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i'm not saying it would, but it might be -- it might help, right? >> i think certainly just to outline my specific concerns, we've made so much progress in terms of our ability to diagnose and effectively treat the disorder and in part that's due to the fact that the symptoms of ptsd look so similar regardless of the source of traumatic stress exposure, be that something associated with military service or something from the civilian sector. i'm concerned that changing the name would introduce confusion that might negatively impact functioning. i agree that the issue of stigma is a concern and needs to be addressed. i'm just not sure that this is the most effective way to do it. >> there is a good point to the use of that term inasmuch the normal course of being exposed to trauma is toward health. a vast majority of people who are exposed do get healthy. sebastian younger wrote a very beautiful article about some of his exposes and the subsequent course and some of the things that we've seen in the military.
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it's tough in the military life, especially when you're coming out of combat, especially during with austere environments. going back to where general correlli was five years ago when he used the term pts as opposed to ptsd there's arguments on both sides. i agree with dr. street that we've got to call it a disorder because we've got to get people services, support and make diagnosis to get paid in the medical record. >> thank you. >> yes, sir? >> this is really just to reinforce what the chair said. one of the things that i'm really intent on is challenging you all to tell us where past congressional decisions at the time may have made sense, may not have made sense, they just had the votes or times have changed, but the sorts of things that we place on you,
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particularly in dealing with this, you know, well intentioned policies that do not add value, they add cost or constraint, we need your feedback so that we're not only adding some new good ideas that maybe take the edge off of some of the old ones that are still in place but really help us do reforms. you got a changing environment. your understanding of ptsd, how to treat it, transition, how to keep track of our vets and take care of them change over time and i really want a committee where they come in here and tell us you need to change this -- or call my office or the chair's office and give us an opportunity to look at some of the things that you're currently doing that are no longer value added and could deploy resources to a better and higher use in your professional opinion. >> thank you, anything else? i move that all outside statements of the record received in advance of the
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hearing should be included in the official record. without objection, the hearing is adjourned. well done. thank you.
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president obama delivers his final speech at the white house correspondents' dinner a week from saturday. coming up this saturday, c-span takes a look at some of his previous speeches from past dinners. >> no one is prouder to put this birth certificate matter to rest than the donald.
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and that's because he can finally get back to focusing on the issues that matter, like did we fake the moon landing. what really happened in roswell. and where are biggie and tupac. all kidding aside, obviously we all know about your credentials and breadth of experience. for example, seriously, just recently in an episode of "celebrity apprentice," at the steak house, the men's cooking team did not impress the judges from omaha steaks and there was a lot of blame to go around, but
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you, mr. trump, recognized that the real problem was a lack of leadership, and so ultimately, you didn't blame lil jon or meatloaf. you fired gary busey. and these are the kind of decisions that would keep me up at night. >> c-span's look at past speeches from the white house correspondent's dinner start at 10:00 eastern. this sunday night on q&a, we talk about the hit broadway musical hamilton and the consulting work he did on the musical. >> he said i was reading your book on vacation and as i was reading it, hip hop songs started rising off the page. i said really? he said hamilton's life is a
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classic hip hop narrative and i said what on earth is this guy talking about? they picked up the fact that they had a world class hip hop on his hands and my first question to him was can hip hop be the vehicle for telling this kind of very large and complex story? he said ron, i'm going to educate you about hip hop and he pointed out that you can pack more information into the lyrics because it's dense and hip hop has rhymed endings and intern rhymes and they started educating me in all these device devices that are very, very important to the success of the show. >> sunday night at 8 a.m. pacific on q&a.
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nina oleson is the taxpayer advocate and heads the internal revenue service that aims to protect taxpayer problems. she gave the report and testimony before the house oversight subcommittee on government operations. >> the subcommittee on government operations will come to order and the clair is authorized to declare a recess at any time. i want to thank you for coming and we have a recess. we are here today to examine the taxpayer advocates, 2015 annual report. the taxpayer advocate is a required to provide a report to congress and must identify 20 of the most serious problem facing the american taxpayer. i look forward to hearing about
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how to better serve the american taxpayer by overcoming the problems on a personal note. say thank you for coming to western north carolina to advocate and it was refreshing and well-received. it shows that you are going the extra mile to get the input. i would like to thank you for your dedication to work to protect the american taxpayer. this was on full display when you came to my district for the town hall and it was also interesting to see the other information that was helpful to understand about tax administration. as far as this year's annual hospital, i would like to note that as we look to spend considerable time discussing the future state plan that is currently being developed by the irs. this plan will lead to a greater
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electronic tax administration for the irs and we have a witness here from my home state of greensboro, north carolina to talk on those issues. these are a positive and important trend for the american taxpayer. we want to make sure that we have the responsibility to ensure that these are done in a safe secure manner that protects the information and rights of the taxpayer. i would welcome comments of the taxpayer advocate on this topic laz as yours and the chairman of the administration advisory committee and the expertise in the area of tax administration will provide valuable insight as congress conducts the oversight of the future state plan. the taxpayer advocate reports troubling trends in two areas for improper payments of the
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earned income tax credit and administering the affordable care act. the eitc is one of the largest tax credits available and the advocates noted an estimated 27% of the 65 bill yo know in eitc claims result in improper payments. and potentially a massive waste. we will look forward to hearing more from the taxpayer advocate about what is being done to reduce the improper payments for the program. regarding the aca and the irs is seeing massive overpayments by individuals of the individual mandate penalty fee. last year approximately 412,000 taxpayers overpaid by an average of $123 per return.
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the irs needs to help taxpayers understand precisely what is their penalty for payments under the aca. the taxpayer advocate noted that the businesses face a complicated calculation to establish their obligations to pay the employer share under the aca. we heard from constituents in my district as it relates to that complex issue as well. the irs has not issued any clear guidance to help them calculate that payment obligation. furthermore, the taxpayer advocate reports that the irs's employees will handle the complex cases lack the specialized training needed to do their job effectively. they imposed a burdensome requirement, but they are not doing enough to help them understand and comply with the
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law. i look forward to hearing from both of the sentences today and i will tank each of you for coming and now recognize the rinking member providing an opening statement instead of mr. conley. she is recognized for her opening statement. >> thank you very much, mr. chairman. good morning to you and thank you so much for being here with us. i first want to thank mrs. oleson for the work they do and being here today. i sincerely believe that the work you both do on behalf of taxpayers and congress is vitally important. especially this time of year when the americans are filing taxes and frustrating and i personally think i have little stomach aches during this time of year. what about you?
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>> i hear from my constituents and people all over the country who find themselves frustrated and stressed. i appreciate the forms you have been holding and listening to stakeholders and taxpayers and can learn the concerns and how to look for solutions. that's fantastic. many of these frustrations stem from having a difficult time getting through to a concern at the irs. whether it's the long wait times for calls or not having a call answered at all. unfortunately this less than robust service is not unexpected. when congress slashes the inflation budget of the i are, s by $1.2 billion, i don't know what we expect to happen to taxpayer services. miss oleson, you address this statement saying the national taxpayer advocate has been recommending against significant reduction in the budget because
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reductions of this magnitude harm taxpayers. because of the budget cuts, budget opposed and the irs cut staffing and has 13,000 fewer full time permanent employees. because of the budget cuts, irs's it systems are obsolete. some of the systems date back to -- i thought this was a typo when i saw it, but it said kennedy administration. these systems are so old that young professionals and college graduates do not want or know how to work on them. the irs cannot find people who code in the old languages that run these systems. this is unsustainable. the irs outlined the plan to modernize the it systems and create efficiencies through counsel and future state ininitiatives. they need to fund the initiative to reverse the trend of degrading taxpayer services
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because of the cuts we made. congress approved 290 million in additional funding for fiscal year 2016. that was a step in the right direction, but we need to make strides, not mere steps. online customer service is not a one-size fits all solution for the country. there millions of taxpayers who do not have access to or feel comfortable doing transactions online still. the irs needs to take this into account. i understand you have some concerns about this plan and i look forward to hearing from you today and the irs needs to take the concerns into account. the irs needs to engage with taxpayers and congress as they develop the future state initiative. you also raise an excellent point when you state and i quote "in this environment of more work and inadequate funding, it
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is easy to bash the irs. this produces a bunker mentality that makes it wary of sharing things with the public until they are absolutely finalized. that means the irs will almost certainly miss things and get things wrong. precisely because it hasn't engaged the public and floated proposals before they become set in stone. he recommended congress served the oversight authority and insist the irs come sooner rather than later to explain the specifics of the future statement. you also state and i'm going to quote you again, "it is important that these hearings be kept separate from the hearings congress conducted over actual or perceived shortcomings." letting us see thoughts on moving forward and not just having hearings about what specifically they are doing. i feel like you were speaking to
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this committee. were you not, miss oleson? i call on my colleagues to heed this advice and bury the hatchet so we can work together to improve taxpayer services for all of our constituents. thank you very much. >> i thank the gentle woman for her comments and i want to follow-up on that. it is very easy when we start to look at problems in the federal government to paint with a brought brush all federal employees. i had the opportunity to visit the employees at the irs as part of a longer process where not only do we visit them here, but throughout the country as we have discussed. i want for the record today for all of those irs employees to know that the vast majority of them want to serve the american taxpayer not only in a
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professional manner, but in one that is indicative of customer service that would be highlighted in the best of the private sector. my hats off to hundreds of thousands of federal workers who show up. i am committed in a bipartisan way to make sure that we address the real problems and focus in on that. that's the reason for this hearing today and at the same time applaud those who day in and day out show up to work very diligently on behalf of the american taxpayer. i would like to say we will hold the record open for five legislative days for any member who would like to submit a written statement and now recognize the panel of witnesses. i am pleased to welcome the national taxpayer advocate at the internal revenue service and mr. james, chairman of the tax administration advisory committee at the internal revenue service, welcome to you
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both and pursuant to committee rules all witnesses will be sworn in before they testify. please rise and raise your right hand. do you solemn blee swear or affirm the testimony you will give will be the truth, the whole truth and nothing but the truth? let the record reflect that the witnesses answered in the affirmative. you may be seated. in order to, lou time for discussion and questions, we asked that you limit your oral testimony to five minutes, but your entire written statement will be made part of the record. i would like to recognize you for five minutes. >> thank you for holding today's hearing on 2015 annual report to congress. in the report, i identify the plan as the number one more serious problem for taxpayers
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and will focus on that issue in my testimony today. i will start with a simple, but foundational question. taxation involves taking money from applying that to the greater good of many if not all. that is an extraordinary thing to ask. a tax system depends on them being willing to offer up hard earned or saved dollars and let the money be applied to everyone's or someone else's benefit. the central question in tax administration is how do we promote that willingness. what do they need to do to maintain and expand the willingness to pay the taxes. the answer should drive both the current and future state of the irs. taxpayers are experiencing many problems because the irs lacks the resources to assist them. we estimate the irs's budget has been reduced by about 19% on
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inflation-adjusted basis. that is huge for any organization, particularly one as labor intensive as the irs. congress has given an additional 290 million which is very helpful and i am hopeful they will continue to ensure our nation's taxpayers receive the assistance they reserve. they have greatly influenced the state plan that envisions how the agency will operate in five years and beyond. a central component is the creation of and reliance on, online taxpayer accounts. the irs believes the accounts will produce cost savings and enable it to reduce expenditures for telephone and in person assistance. the crux of the disagreement boils down to whether taxpayers will use accounts as a substitute for personal service or whether taxpayers will use
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accounts as a supplement to personal service. while i have advocated that the irs offer account access, i believe the irs is wrong in assuming online accounts will substantially reduce demand for telephone and face-to-face assistance for many reasons including that millions of taxpayers do not have internet access and millions with internet access do not feel comfortable trying to resolve important matters over the internet in the face of massive security breeches on online government systems. many taxpayers are not cookie cutter requiring a degree of back and forth discussion better suited for conversation and that taxpayers will insist upon. it is critical the irs not develop future plans based on assumed cost savings that may not materialize. the irs likes to say is needs to provide the same service that
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financial institutions provide to their customers. the results of the most recent survey conducted by the board of governors shows that and i quote here, while mobile banking users are utilizing technological platforms at a high rate and on a consistent basis, they have maintained connections to their banks through the more traditional branch and atm channels. despite this evidence of consumer behavior, for several years now, the irs has reduced face-to-face options and the assistance centers and recently decided to switch to an appointment-only system and all of it taxed by the end of 2016. the tax which was known as walk in sites will no longer accept taxpayers and they are conducting a pilot under which it will not accept tax payments. in short, the irs is failing to
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meet the needs and i find the notion of declining to accept tax payments from taxpayers inexplicable and baffling. the results of the appointment only pilot showed 20% of the taxpayers had to wait between 13 and 41 days to obtain an appointment and 5% had to wait more than 41 days for an appointment. in my written testimony i describe how taxpayers who arrive at a tack without an appointment are being treated. i am also concerned that as taxpayers give up and stop going to the tax because they are not providing adequate assistance, the irs will use the data of declining usages to justify further reductions and in person service. for many years and many areas, the irs made more services more difficult to use and touted the
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declining usage as a basis to cut the service further and eliminate it entirely. to me that's disingenuous. i believe the irs's future state must, dopt as the north star the needs of the vast majority who are willing to comply with the laws. i use the word willing because it includes taxpayers who may not be in compliance. these are taxpayers who want to comply and for one reason or another are not able to. rather than design the taxpayers, we should design the rules to make it easier and clearer for the taxpayers to comply. in my opinion, any future state plan will fail unless the irs changes the focus to prioritize taxpayer assistance and does a better job about what it takes to maintain and enhance
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voluntary compliance. >> you are recognized for five minutes. >> thanks to the subcommittee for holding today's hearing on the national taxpayer advocates. the taxpayer advocate and the office are critical voices to the rights of all taxpayers and the improvement of taxpayer administration. each year they take a productive approach to increasing compliance. the irs tax administration advisory or e tack was formed by law in 1998 to make recommendations to congress on how to get electronic means. we are objective outside digital
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strategy consultants to the irs. in the past few years, we have been focused on two big challenges today. first, the proliferation of tax identity theft and the levels of taxpayer service caused by an antiquated customer service model. they believes that a key solution to both of these is a more innovative irs. much of this is outlined in the future state initiative. to address the urgent problem of tax identity theft, the commissioner formed a security coalition of state leaders. they attack this collaboration and for the irs when working with this important group to find solutions. authenticating identities is foundationally to the irs and they are working towards innovative solutions to the
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challenge. let's take a look at where we are today. for most, bracting with the irs is not quick or easy and it's mostly done by paper and phone. most taxpayers have no idea about their tax information or status at the irs. when they have to interact, they are often greeted with long wait times and extended answer periods. these are big problems. especially for the taxpayers who have to interact with the irs outside of filing a tax return. the irs's current state and the history could leave us feeling quite pessimistic about the near term possibility of modernizing service. the irs has committed to a digitally enabled model with the future state initiative. the irs future state vision aligns with e tack's vision of how taxpayers should be served
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by the tax administrator. an ideal taxpayer experience to fully understand tax obligations and have transparent access to status with the irs and allows the taxpayer to effectively and securely interact with their tax administrationor and the way they want to be served. these are big statements, but not revolutionary. that mirrors the customer service experience that most financial institutions and many other companies are providing today. what will the future state mean for taxpayers? it will mean transparency when there is hardly any today. they will get information customized to the circumstances including their specific responsibilities. the future state will also mean realtime service that allow them to cosecurely interact with the irs online. now what about taxpayers who want or need to deal with the
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irs in person or by phone. these taxpayers are not left behind. it's true that increasing numbers of taxpayers prefer interacting online. when the irs creates digital tools, it can meet the expectations. importantly by doing so, the irs will free up phone lines and employees for taxpayers who really need and prefer human interaction. the irs will meet them where they want to be served. whether it's by assistance center or clinic or through a tax professional. let me sum it up. the future state of the irs enables technology as part of a strategy and the future state embraces the solutions to allow them to maximize the limited resources. it creates targeted capacity to serve all taxpayers the way they want to be served. they endorse the digital service
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components of the state plan. to take it a step further, we od voicated that the irs accelerate the plans, but this won't be easy. we know that the irs has many obstacles to overcome and this includes satisfying all of us that the security of taxpayer information comes absolutely first. on behalf of the e tack, thank you for inviting us to testify on this important topic on the future state of the irs. >> the chair recognizes the vice chair of the subcommittee and the gentlemen from michigan for a series of questions. >> thank you, mr. chairman and probably the three of us being here indicates we don't fear the irs, right? the points you made about the general irs employee attempting
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to do their job. that's the first year that the irs has to implement a number of measures that are targeted with the affordable care act. for example, one of those being the employer shared responsibility payment. they suggested that they don't know which employees will be responsible for evaluating and they probably will not have adequate training if i understand the report. what complexities will determine which employers must play the responsibility payment? >> i think there a lot of questions about what employees are going to be included in some very complex calculations to who
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is and is not covered. that will go to whether the employer will be penalized and the penalty is stiff and steep. our concern has been that we have heard from a lot of employers about the complexity of the determinations and they have not been able to get answers in the way or with the speed that they need to get them. this is a new initiative, but i think this is where transparency and engaging with the population that will be penalized should have happened a long time ago and needs to happen now. really needs to heed them. what their concerns are. >> do you see any efforts? >> people are trying. it's not as open as i would like. i think some of it is that the irs is not the only one involved. they are getting information
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from other areas. the law is complex and there lots of agencies involved. it's getting better, but we want to see more engagement and more guidance even if it's put out there in a temporary format. >> another area with them is the workweek. the hours. 30 hours. the irs from your port has failed to issue formal guidance about calculating. for the employer's shared responsibility act. has the irs offered a reason why it will not help, especially when they can't use the website as a defense to do it the way the irs said they should. is there a reason they won't help them to understand their
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obligation? >> we focused in on that and that's what we heard a great deal from employers. they need to have certainty in a way they will accept and answer as long as they have an answer. there is a domino effect and people have to do their assurance processes and people are doing the best they can and worried they will be penalized and they won't be abated if they show good faith effort. >> they would take what was generic on the website. why would you want to put an employer in position to ask for abatement when they could have avoided it in the 50 place?
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>> on the individual shared responsibility payment issue, you indicated that taxpayers overpaid the penalty. that's with the failure to imply. the average was what percentage of taxpayers? >> i don't know the answer to that. it's in my testimony and annual report. i can get you that. >> 412,000 taxpayers. what percentage? >> i don't know the answer to that, but i can give you that. >> that would be great.
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they were exempt from having health insurance and they didn't ask. they didn't tell anybody and that's also true that the preparers didn't ask. we were able to work with the software companies to get the programs changed for this filing season and will be looking carefully at those overpayments to make sure that it doesn't happen again. >> one quick follow-up question. is it the guidance ambiguous enough that the irs should consider a waiver of penalties until we get the guidance more specific? >> my personal opinion is that this law is so complex that for the first year we should be very, very lenient and only apply a penalty where there is
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truly e greejuous in your face ignoring of basic requirements. this is a learning process and we have to have a partnership with the employer population so that we can identify the issues, get clearer guidance out there and use this filing season as a dry run. mr. the chair recognizes the gentlemen from massachusetts for a series of questions. thank you for your willingness to help with your work. for the affordable care act with the cadillac tax. that applies to generous health care plans and a lot of union health care plans.
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so as a trustee of the health care plan. the tax is about a 40% tax. it applies to both the employer and the employee. congress and the wisdom delayed the implementation of the tax until 2020. however the limit stays the same. thousands and thousands, probably millions of more people will be in that cadillac tax category when 2020 rolls around. on top of that, so for every dollar over the limit, you will pay a 40% tax. 40 sends for every dollar you put into your health care over the limits and it's prorated for the employer and employee. and the employer. and then i read it more closely and the tax itself, the penalty
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is taxed. it comes out to like a 58 or 59% penaltio every dollar spent over that limit. do they know that? >> all of these issues are very difficult and i have not looked at the statute to see if it's indexed for inflation. that would be something we seriously need to look at. we asked one of the architects of this planned and it was not adjusted because they wanted more and more people overtime to be captured by the tax. i am a former union attorney and president. my history i have dealt with a
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lot of union plans not only for the iron workers and the teamsters and the workers. so all of these plans are going to be -- a lot of these companies like gillette and ratheon and the people who sat down with the employees and worked out a plan, the people who did the right thing, they will be dealing with the tax. it's a huge, huge problem and it's multiplied because of the amount of tax and we delayed it. i'm wondering are we educating consumers about that? when it hits, it will wipe out a lot of plans.
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if you are really trying to drive people's behavior, you should be starting the messaging now so it sinks in and they can make the plans to not be hit in 2020. the costs of health care keep going up. do you want them to spent less on the employers and the employees. because of the tax do you want them to spent less on health care. >> from the taxpayer perspective, not indexing it, i understand the policy reasons for why wouldn't. it's like the alternative minimum tax. >> more and more people get it. >> it's irrational when they see that number coming up. they held their with holding and everything like that. you can have all the policy reasons in the world, but it feels profoundly unfair to the pax payer.
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>> any comments on that? >> i think i can echo what nina said and the aca has so much complexity to it. when you are dealing with the irs, what's urgent now and what's urgent now after a while, you look at what's urgent now. you fall behind and when you talk about falling behind and the administrative abatement. they are getting caught up on not voluntarily being caught up. >> thank you. i yield back. >> the chair recognizes the
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gentlemen from georgia. >> thank you, mr. chairman and thank you for being here. we appreciate it and it's important to all of us and all americans. in your advocate report, you list the right to a fair and just tax system as a taxpayer right. you agree to that, right? >> absolutely. >> do you agree that a fair and just tax system is that ensures that the tax credits only go to those who were qualified? >> absolutely. taxpayers need to know that everyone is paying the right amount of tax and that would include not getting credits that they are not eligible for. >> it is fair in a system that tax rebates should not be getting. >> absolutely. >> in the report we rrvesed earlier, the report stated that
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improper payments constitute 27% of the $65 billion that were handed out annually through the earned next tax credit. that amounts to $17.7 billion. $17.7 billion. how do they obtain improper payments? how does that happen? >> they fill out the return and claim the earn income tax credit and the payments can occur for many reasons. maybe they are incorrectly stating their income or claiming a child they are not eligible to claim. it's easy to fall a foul. the percentage of the payments and no one really knows that are
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attributable to out and out fraught. they can say you claim somebody else's child or a pax payer decides that they will claim it. >> let me ask you specifically. is it possible in your research as it indicated that they receive improper payments from the credit? >> it should not be possible. >> i do not see that as a major issue because for the earned income tax. >> not as a major issue, but is it an issue? >> i don't think it is because for the earned income tax credit, you have to have a social security number and use that on the return. >> if someone who is an
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undocumented person files a return, that's identity theft. >> i want to ask you, is it possible for an immigrant who has given or granted protection or protected status for illegal immigrant who granted protected status under pop's status. can they obtain the credit. if they have a social security number under that program that is authorized for work -- >> is it possible to get a social security number that way? >> i don't know under that program, but if they could get a social security number authorized for work, they account claim the earned income credit under the law. >> the answer to my question, the illegal immigrant under president obama's executive
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orders with the credit, the answer is yes. >> if they have social security number authorized for work. that's the requirement that you have to have. a social security number authorized to work. your spouse has to have one and your child that you are using has to have a social security number authorized to work. >> as i understand it, improper payments of the earned income tax credit increased since 2005. they increased from 2005 to the present day. >> there may have been an increase. i thought it was fair. >> is it possible that that increase can be attributed to illegal immigrants? >> my personal opinion is not. that's my personal opinion. >> did the studies indicate and back up your opinion? >> none of the irs studies indicate that. i'm justing you that the sources
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of the error for the earned income credit and the majority of the errors are attributable to overstated income? >> i understand, but i am interested in the immigrants who are getting this and all i want to ask you, my final question is the administration addressing, the irs is addressing this at all? persons who don't have social security numbers and they are looking at that. >> i would hope so because as we started out the conversation, a fair and just tax system would certainly involve that. thank you, mr. chairman and i yield back. >> i thank the gentlemen. the chair recognizes himself for a series of questions and depending on votes, they are supposed to call votes here shortly. we will see if we have a series
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of second questions. with the electronic filing and that being your expertise, do you see it increased the likely head hood of identity theft. i need you to hit your button. >> it's one of the refunds that came about. they boat the irs to the refund and they have the ability to go ahead and as you mentioned in
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your opening testimony, would that exacerbate the chances? >> it could. it may work in the opposite. one thing we don't have is we don't verify taxpayers before we file. anybody can come and go offering the opportunity to take the identity and go with it. >> so in that, you make your living, i guess, with taxpayers being able to file electronically, is that correct? >> i don't file one tax return a year. i don't make my living on that. >> your group does.
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the goal was to get the irs to 80% and we have gone past that goal. >> right. if that is your goal and you have private stakeholders that are making a profit based on that and the potential danger is that because of that new model, we are getting additional taxpayer identity theft, the hard question is what liability or protections does the private sector have versus the federal government. that's the question we have to have. is this all the irs's responsibility or is there a responsibility for the preparer or authenticator as you mentioned? >> it's a shared effort. >> it's definitely a shared effort and that's what the security summit is looking to do. to find where the software companies can put in the additional authentications have
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done that. understand that that detection out the back end of it is ultimately detection. prevention would be a better method. >> i understand that. the last question i have for you is what impediments are you finding that would stop them. >> they are not willing to do so? >> the irs is clearly obviously the tax administrator. them dealing with private industry is obviously they are doing it more and more. >> the future state plan calls for more electronic filing and everything to be online.
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we go to a real customer service rep. they are not willing to help the stakeholders authenticate? that's a pretty bold statement. if it's true, we need to address it. that's a bold statement. >> the irs needs to view it as a partner. >> and they don't. it's a tenuous relationship. you need to look at -- if you want the best technology, looking inside the irs i'm not sure is the best place. >> how can mr. lynch, let me catch you there because i am running out of time. how can mr. lynch and i assist you with the irs to make sure it is a hand and glove approach versus i think your adjective was contentious? >> tenuous. >> tenuous. all right. wrong word, but go ahead.
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tenuous. how can we help you there? >> by encouraging the irs to work with industry. there some barriers to working with industry and on the disclosure rules that make it a barrier for sharing information and there needs to be a true partnership between the industry and the irs when it am cans to all things technology. they can't expect to be a technology leader out there. there is many other companies and developers out there who are technology leaders. >> they are programming with cobalt. i ran out of time. i have gotten questions and i will go to mr. lynch and recognize them for a second series of questions. we recounted the weaknesses with the irs system. lack of personnel that has diminished of recent years.
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lack of communication between the taxpayer and the irs. the risk of id theft through filings and do we have an idea of how many false tax returns get filed every year? >> there are millions. >> we don't need to get into that. the complexity of the system as well. the presumption of com ploins with the more than people and most people try to do the right thing. there countries where that is not the form. i know greece has very, very low compliance with tax laws and
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nobody pays or very few pay their taxes. mostly government employees because the government takes it out right away. i'm wondering with all these obstructions that i am listing here, are we going to see a lower rate and there is a trend that you shouldn't pay off the great and is that something that might result because of the actors? >> i think that particularly last year's filings season when we had such a low percentage of the phone calls answered by the irs, or when you won't take a payment in a walk in, this is sending a message that we are just -- we can't deal with you and a taxpayer would say if you can't deal with me, i won't deal with you. the irs will find you and it will be unpleasant when that happens.
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the technology is so far behind. the data into that account has to come from about 200 different case management systems. there employees who can't see into this system. you have to get the answer to that. this is very, very complex. in the meantime, you have to percentage of taxpayers who don't or won't use these accounts. as we try to protect the security of the taxpayer and we should set very high standards for that verification because we can't have one leak. that would be horrible.
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and the impact on compliance would be huge. if we set it high, we will have people dropout. the irs right now is testing a version of the online account with irs senior management and non-bargaining unit employee. they are fairly sophisticated financially. >> thank you for answering. >> miss oleson, i want to come back to a few things that have been mentioned, but one of the things i heard when you were in western north carolina, we have a greater need for personal contact. even with the online tools that may be here that when that interaction, when there is a letter that comes from the irs
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and there is a desire to have not only a personal contact, but someone who can manage the system and the frustration that i heard in the room was of hours of holding. trying to get a real person somewhere who can answer the question. >> they want to talk to the that
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would be true if they get it electronically or in the mail. they did say they would find the online accounts very, very helpful because then they could look at the background and go online to the clients's account and see what's going on. then they would want to call the irs and use the account to monitor what would happen and say we will do x. it could get rid of phone calls and might get rid of two out of every transaction. they still for that critical, let me tell you this and let me hear from you. they want that interaction. >> obviously part of that is a resource issue. part of it is not a resource issue. it's a commitment issue.
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we all love the fact that we need around appointment and the other part of that and what is perplexing to me that you have a willing taxpayer to give hard earned dollars to the irs and show up and they are saying we can't take the payment because you don't have an appointment. is that not insane? i worked in collections and i won't make you comment on whether that's insane or not. >> i'm fine commenting on it. it is insane and i don't understand the policy. it says to the taxpayers standing there saying what? >> we heard a little bit about a directive memo that would suggest on what as people try to comply where there is this compromise and they are saying
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here's my down payment. in the past it's my understanding in the past if they are not up to speed on all their tax returns, we have take 19 money and held it and said you need to get caught up. when you do, we will be able to agree to this. is it true that now when someone comes in with a check and a compromise that if they are not caught up, we are sending the check back to the taxpayer? is that true? >> the irs released a memo saying if you file and give us your down payment and you are not in compliance with your tax returns, we are sending the money and the offer back and getting compliance. >> i will ask a second time. is that not insane? >> yes, it is insane. >> we have american taxpayers willing to pay their taxes, all be it reluctantly, but they are willing to do it and we have the
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irs who is giving the money back or refusing to take the money because they don't have an appointment. >> yes, that makes no sense. >> that are should be headlines. i don't understand why we would do that. what can mr. lynch and i and mr. jordan and i do with the commissioner to help perhaps see the error of their ways? what would you recommend? >> i think raising this in the hearing as done a lot. i think that the irs needs to do a better skwlob it makes the decisions of analyzing the consequences of these decisions. not just look at we are saving money because we are not handling these in person contacts that are $60. you may have spent $60, but you might have brought in $5,000 by serving the taxpayer in that walk in site. that's not the analysis and that
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needs to be asked for. >> would you be willing to give the committee in the next 45 days or so your recommendation on on what legislative fixes that you would recommend, or actually i'm asking you to do that. so if you would be willing to do that, what i would like to do is to make sure in a bipartisan way, we address that. there are a number of others. i think they're about to call votes. i'm going to recognize the gentleman from ohio for a series of questions. >> thank you. yes. >> thank you, mr. chairman. ms. olson, thank you for being here and for the work of your office. are you familiar with that -- we had earlier this week the g.a.l. here in this committee room talking about the $385 billion annual tax gap that exists. you're familiar with the g.a.l.'s report? >> i haven't read their most recent, but i'm very familiar
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with the tax gap. >> would you agree that's a pretty accurate figure they've put on it? i mean the gentleman here from the irs frankly agreed with g.a.l.'s finding? >> i think that data comes from the irs. >> so it's right? >> so it's as correct as -- it's the known tax gap. there's an unknown tax gap, criminal activity, things like that. but, yes, there's a general consensus that's the figure. >> and obviously all the americans who pay their taxes would expect that all the revenue should be generated and they would get the type of service that, you know, they need from -- or expect from their government, and that's maybe not happening because the failure to collect all the ref yew due? >> we have looked at the tax gap as a surplus on the taxpayers that are paying their tax. >> exactly right. and g.a.l. recommended 112 -- g.a.l. had 112 recommendations to the irs that would help deal with this significant tax gap. and our understanding is that the irs has only implemented 53
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of those 112 recommendations. is that your understanding? >> that is what i think the report said, yes. >> obviously that too seems to be not reflective of what's best for taxpayers, the failure of the irs to implement all the recommendations. and the chairman was just talking about this appointment issue, which i didn't know about, which as you said a couple times, i think, is crazy. i think the term the chairman used was insane. did any of the 112 recommendations deal with that issue? >> not to my knowledge. >> so there should be 113 at least, then? >> sounds like. >> the one thing i'm concerned about is an irs that won't implement 112, now 113 recommendations that make sense, that will help taxpayers, treat them with the respect they deserve, is focused on something that i think potentially can harm taxpayers, harm their most fundamental liberties, and that is this whole geolocation,
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stingray operation. are you familiar with what stingray technology does? >> i have a high level of understanding. i'm not detailed, but i understand what you're talking about. >> yeah, and the witness who was here earlier this week said that he believes -- we posed a number of questions to mr. dalrymple who frankly couldn't answer many of them but said he'd get back with us. but one thing he did offer to the committee was that he believes 37 times this technology, which without a probable-cause warrant was used on american taxpayers. >> by the irs. >> by the irs, yeah. good point. there are other agencies using it too, i believe without 4th amendment probable cause-type of warrants. and that the irs is currently in the process of purchasing an additional stingray unit,
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additional technology at the cost of several hundred thousand dollars. would you believe -- do you believe that's in the best interest of taxpayers? >> i don't know that i have enough information to answer that question. i need to know who is going to use it and what are the protections for using it. and i don't have the knowledge about that. if it were not -- if it were available to anyone on the civil side of the irs as opposed to the criminal side and due process protections and court orders were not -- >> let me ask the question, ms. olson. of those 112 recommendations that g.a.o. made to deal with the tax gap, that we now know should be 113 recommendations based on the discussion between you and the chairman, do any of those 113 recommendations encourage the irs to purchase an
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additional stingray technology unit? >> not that i know of. >> yeah, that's my understanding too. but potentially, at least potentially you would agree with me that the stingray technology infringes on the very taxpayers you're supposed to be advocating for, infringes upon potentially their most fundamental liberties. >> i share your concerns. >> thank you, mr. chairman. >> i thank the gentleman. the chair recognizes the gentlewoman from new york, ms. maloney. >> thank you, mr. chairman. thank you, all of the panelists, and thank you to the ranking member. the irs is developing the taxpayer of the future of virtual taxpayer assistant through virtual online accounts will replace the personal interaction for digital-savvy taxpayers. so, ms. olson, you write in your report that this plan has been driven by a really important consideration, and that is the lack of appropriate funding and
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continual cutbacks to the operations of the irs. in your opinion, does the plan have the potential for making the agency more efficient in saving money for the future? >> i personaldy donly don't thi. i think it will create a lot of re-work for itself. >> and if you were to move forward with this program, is it important or is it necessary for congress to make a lot of contributions or contribute substantially to the cost of it? >> well, it's going to require some significant up-front cost, revamping whole systems. i really couldn't give you that estimate. i think parts of it are in the president's budget proposals, things like that. but it is, you know, just -- because we have systems that are still in cobalt, because we are just very archaic in our systems, to pull something off like this, to have it really an integrated system is going to
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cost a lot of money. a total re-engineering of the irs it. >> most recent annual report to congress from your organization makes the observation, and i quote -- future challenges require digital transformation at the irs and you staid, and i quote, the i irs needs to transform its taxpayer services and compliance, capabilities for the efficiency through digital tools. it's been reported that some of irs' systems date back to the kennedy administration. will those systems support the transformation that you're talking about, mr. buttonow? >> yeah, ultimately. now, this is not going to happen overnight. i mean what the irs needs to do is build -- if they want to have an online presence, an online taxpayer service, they need to start iterating on that now, which means give us a solid plan of what the details are and start improving on each
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iteration. so as the irs develops its capabilities, those systems that support those capabilities will need to be upgraded. >> the irs commissioner acknowledges the responsibility to serve all taxpayers, including those who prefer personal over digital interaction. and i guess i'll ask this question to both of you. is there anything that you would have -- that you have not seen in this plan that you believe should have been included to improve taxpayer services? >> well, again, my disagreement with the irs is that the -- we all agree that an online account is vitally important. my disagreement is the online account is not going to substitute for in-person, you know, or phone assistance, that personal contact. it will supplement it. and as i said in my testimony, the federal reserve has borne that out in its surveys over the last five years, that people who are digital, mobile banking
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users visit their branches, on average, three times in the month before the survey by 87%. i mean it's an extraordinary percentage. people want multiple choices, and they will use the online account. they will also use the phones, and they will also to face to face, and we should provide that to them. and i don't see that in the plan. >> mr. buttonow? >> i would agree with all those statements. this is not a replacement. this is absolutely not a replacement. but we need to go online. the irs needs to go online. it needs to serve taxpayers where they want to serve. there's increasing preferences as the mill yen nals come online. tax professionals want to interact with the irs digitally just for basic information. when it gets to more complicated areas of tax administration, things like compliance, then i think there's a higher opportunity where people want to go ahead and talk with the irs.
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but they should be able to interact with them online also. >> i agree with you. it's certainly the wave of the future. everything's online, particularly with the younger generation. they communicate almost entirely online and read online. they're not even reading normal newspapers. everything's online. so i feel it's a way we have to move and go towards. is the irs moving towards going online or not? >> that is definitely its view of the future. >> mm-hmm. >> but right now can you interact online? >> no, you cannot. >> can you ask -- >> you can find out where your refund is. the irs last october took off the only service it had where you could e-mail a question and have someone answer it back to you. so even as it's moving forward, it's moving backwards. >> my time has expired. thank you. >> i thank the gentlewoman. i thank you both of you for your testimony. they've called votes and we've only got a few minutes left

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