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tv   Veterans Affairs Sec. Wilkie on Presidents 2020 Budget Request  CSPAN  March 26, 2019 8:12pm-10:14pm EDT

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welcome everyone to the committee today and thank you secretary robert wilkie in particular and all of the staff. you will hear a lot of questions and hopefully you will give us a lot of good answers and we will hopefully get some good results and move in the right direction. we have the committee and we had a good year last year. we got a lot of things squared away that needed to be addressed for some time. you said -- we gave them to you and we will look for the results to share and that is what we will be reviewing. we are making sure we are making progress with result not just promises. i think we will be able to do that. this is an important meeting this is our annual review of the budget. the present budget came out a few days ago and today's budget
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is a significant one and a significant increase. we have a unique situation. we get more money than anybody in increases every year. however you want to calculate it money is not our problem. we've looked out for our veterans and we know we are paying for benefits they've earned. i am proud the presidents budget is up 9.5 and $220 billion and that is a huge budget i want to speak about how we came to where we are. the first thing i want to do is thank the -- i changed the way we do this meeting. they used to come in with a second panel in the first panel was the secretary in the second panel was all of the dso's.
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that took a lot of time and diminished the value of each person's testimony. we just finished with all of the dso's over the last five weeks anyway so they need to submit their testimonies and writing and the questions they want specifically answered in writing that we get those. they submit submitted some terrific questions and prompted great thought on the part of the members as we reviewed those questions i want to thank the va for the time they put into it and make sure you know just because i didn't include you in terms of verbal testimony at this meeting i want to see what we heard from you gets done. the other thing i want to do is
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talk to you about two requests coming up. i will try to keep my promises i tell you and we have done amazingly well at that. that is because we had cooperation by all -- the senator mentioned and asked for a discussion on toxic exposure and etc. and we will have a meeting on toxic exposure. it will come later in the year after we have begun to swallow --. my understanding is that -- >> that would be my recommendation. >> the va has recommended that and i appreciate that and i've offered that opinion as well. if that happens we will be in the process of beginning to swallow a big bite and chew it and dissolve it and get it. i was happy to learn from the
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secretary that 51 people have already been treated that would have been eligible -- [ inaudible ] >> 51,000. >> 51,000 and i appreciate the secretary of the va doing a thorough job in anticipation of what this committee and the other committee of the house did on coordinating. hopefully that will continue. the other is access [ inaudible ] the big fellow to my right has made it clear to me that access is a big thing and it's a big thing with me to. the recently published comment rules and standards for access once those are finished alaska kansas in north dakota and south dakota georgia montana and everywhere the more rural veterans and more rural areas as quickly as we can the
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doctors want to be a part of it and we have a third party administrator working to make sure we have a good repertoire of doctors to meet standards just terrific. i want to focus on access at our next meeting in april 10th is that right? >> we will focus on access standards. i want to encourage everyone to be there because we do if we do one thing this year we get that working. [ inaudible ] that have the most problems and we can get it working right for the va and veterans and right for us then we will be taking care of our biggest single problem of operations out there which is veterans benefits. with that said i will end my remarks -- i will let you -- [ inaudible ] secretary. >> thank you mr. chairman. i don't want you to beat you to the punch but i want to welcome
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robert wilkie and mr. rychalski to the hearing today. i look forward to learning from you today and i want to thank your team and thank you for what you guys do every day. the chairman talked about access and access standards we talked about a lot today. we talked about privatization and i don't believe any of you wants to see that happen. it is something i am very concerned about because the big boss talks about it all the time. in the end we need to make sure as the dso told us during a joint committee that they prefer the care you provide. that is a good thing. i think that is a very good thing. that means you're doing things right. we will talk about a few things you may not be doing so right today and i apologize ahead of time. we need to make sure we live up to the promises as you well know mr. secretary, those were promises we made to them.
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-- this committee has heard from the va about what it means to be successful. we have engaged with dso's as we did the last couple of weeks to see what they wanted and i will tell you this committee listened and we acted leading the way on a number of monumental reforms that quite frankly a lot of people didn't think we could ever get done but we did last congress on behalf of our nation's veterans. this is an important part of our job providing you with the tools you need to do your job. i'm deeply critical of those -- and the resources for executing your lives and that is where as i said already my concern is. in my view the level of -- vacancies and critical infrastructure needs to be matched by the department. i've talked about my parochial interests in montana and i will talk about it again today.
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fort harrison today has one primary care physician today and a part-time doctor who sees a handful of patients. i have people there with no primary care doctors or clinicians and where that care is only provided to telehealth. telehealth is a great innovation and it does great things for folks that have mental health issues but it cannot replace all types of healthcare. you get the frustration. the va primary focus seems to be expanding eligibility and investments in community care and i don't want to be it at the expense of capacity building initiatives. i don't want our investments in community care to be at the expense of capacity building initiatives. as you and i have discussed there is a role for the private sector especially in a rural state like montana and i'm sure
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senator sullivan would agree in alaska and other states too. i think we have to be careful that we don't take the department down a dangerous path and when it comes to veterans you can outsource the care but not the responsibility. when they are sent to community care without first knowing if that care can be provided in a timely manner and if it is quality care we will pay the price for that later because quite frankly the veterans will come back and say why. i think we need to hold our va providers to one set of standards and the community care providers to that same set of standards. -- if it has lower quality and less timely and we certainly can head down that path without a cannot head down that path without a firm grasp of what it will cost the taxpayer. we received multiple estimates on how it would cost to
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implement access -- budget request and none of those estimates matched the number that finally appeared in the budget request and as we go forth i would like you to clarify that if you could why that is. it is not clear how that estimate came about and it is also not clear whether the technology needed to implement this program will be ready in time for the implementation. i have been receiving conflict he reports about the readiness of the stool. i am frustrated that we continue to hear about it solutions that may not be executed properly. that is a huge chunk of money in this budget and if it's not spent properly we wasted taxpayer dollars and have it delivered services to the veterans that they've earned. the va has struggled for many years in the field of it and on the high risk list this year again. i recently had a great meeting with jim mcnair that there is no it representation here today and so i hope that is not a reflection of how this issue is
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being prioritized. i know the table is short so you have to pick and choose. what we have seen that rollout impact veterans and replacing an antiquated system that can't afford to be plagued with shortcuts. by the way we are here today as a direct result of it failures in arizona. this is a big thing and we need to work. you got a great team around you mr. secretary and i've said it i think you are a great guy and the right guy for this job and i am glad you are there but we need to find out the details of this budget and as we move forward i certainly do not want to see va care dollars transferred to community care because we ran out of money in that budget. with that i will say thank you all for being here and thank you mr. chairman for the opportunity to speak and i look forward to this hearing. >> thank you senator for everyone's benefit here i think i heard without exception that our hearings with the dso's we
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aren't going to privatize you could've said that 100 times. i have no interest [ indiscernible - low volume ] let's just put that sign behind the bathroom door rather than the front door. let's talking about making the be a the best we can make it and john is right they like their va which is why they call it my va they just wanted better with better accountability and better results. with that said we have the best value could ever have in terms of secretary of the va. robert wilkie i did not know until he was appointed i guess this is the first time we have met. i learned quite quickly he has a good bedside manner and has a resonant voice and he is very easy-going. he tells great jokes [ indiscernible - low volume ] all the way around but the good thing is he has a good personality and demeanor and he likes his job and he hold
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himself accountable and i appreciate that. i think with his type of persona we are already seeing improvements and results. we have a long way to go, we do a lot of things well and we are proud of those things. we want to take some of those problems and make them better and get those solved. i think robert wilkie is a man to do it and i am pleased to work with him and john tester on this committee, we will never finish the job but continue the job of improving the veterans administration for our veterans. with that said the fact that you are a good southern boy and military background we have a great secretary of the veterans administration and i am proud to introduce him for as much time as he might consume [ inaudible ]. >> first of all thank you for
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the courtesy and thank you for the kindness you have shown me. i am going to take a point of privilege and thank you and senator tester for all of the support you've given me. as you know i came to this having been the undersecretary of defense for personal readiness. i was raised in a military world. my service compared with my ancestors is a credibly modest incredibly modest but i am privileged to see the military life from many angles. there is no higher honor than to be sitting here before you. i am pleased to have with me and i will start on the left side, john who is our budget guru and our chief financial officer doctor richard stone who is our executive in charge and our most recent award
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winner who has just received an award for being the government's best senior executive and that is doctor paul lawrence and i thank them for coming. when i last reported to this committee mr. chairman in december i said the state of the a is better and i believe -- va is better. i believe from the statement you made you believe that as well. i count that to the support of this committee. early this morning i addressed the house doctors caucus and i said the changes made in va were not driven by the executive branch. the changes made came from the two authorizing committees. i argue it is the most transformative period in the history of this department going all the way back to omar bradley day. i don't believe we are any longer on the cusp of
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transformation, we are in the middle of it. before i talk about that i do want to talk about the trajectory the va is on. in the past month the last few months we have had some excellent news. in most of my career in and out of government the va has always been rated 16 of 17 or 17 out of 17 in terms of the best places in government to work. the partnership for public service for the first time we are in the top third and we are actually moving in a higher direction. if we have customer service amongst ourselves we will provide good customer service to those we are honored to serve. as the senator implied that the medical care va gives is good or better than any medical care in any region of the country and we are proud of that.
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last the journey journal of the american medical association says the wait times in the four most important categories of medical care are as good or better as any in the private sector. that is an indication as to where we are headed in our department. me major drive of transformation is the mission act. it simplifies and consolidates the community care programs into a single streamlined simple to use program. it expands the choice program and the caregiver program and provides new urgent care benefits as well as other access improve. regulations setting new access standards inch or greater choice that veterans will be completed in june. we have proposed a 30 minute average drive time standard for primary care and mental health care and a 60 minute average drive time standard for specialty care. we have also proposed appointment wait time standards
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of 20 days for primary care and mental health care, 28 days for specialty care from the date of request with certain exceptions. i want to also begin to address the privatization argument. obviously i come from the conservative republican side of the aisle. the issue that has been raised many times about privatization is just not borne out by our budget by the directions of this committee. i am here to say as senator tester said that the care in the private sector nine times out of 10 is probably not as good as care in the va. one of your colleagues gave an interview in one of the states newspapers saying he was disappointed in the wait times for certain services at the va in one of his major metropolitan areas. the wait time was 12 days for va. in the major metropolitan area it was 78 days.
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that also is an indication that we are moving in the right direction you appointed for us and the direction veterans deserve. things are not always greener on the other side at the same time we are trying to move out in making the va a modern healthcare administration. no longer will we have an ad hoc supply chain. we are tying in with the department of defense and their systems for medical supplies. the days where va doctors have to run across the parking lot to medstar to find equipment have to be over if we are going to continue the road of improvement. the other part of our major transformation is the electronic health record where we tie in with the dod the minute that young american walks into the military entrance processing station so that we have a complete picture
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of that veterans health. the chairman mentioned burn pits, for the first time when this is online va doctors will be able to see everything that happened in that soldiers life from exposures to toxic things overseas and toxics in the continental united states. we will then know better how to serve that veteran. i have been asked to lead the national suicide prevention task force which is one of three areas that va is moving out on in response to this committee as a senator mentioned it is the opioid epidemic and how we begin to change the way we treat our veterans when it comes to the use of opioids. homelessness is another area and finally suicide prevention. in the past year we have hired over 3900 mental health professionals and we now
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provide same-day mental health service for veterans in need. as part of the continued transformation we are also engaging in the creation of a modern hr system. right now there are 140 hr offices across va. we are consolidating those down to 18 and for the first time bringing in hr professionals to create a modern human resource capability that will send doctors, nurses and healthcare professionals to those parts of the country where they are most needed. as for the budget. the chairman is right, $220 billion budget, that is a 9.5% increase over what va had last year . that is $97 billion in discretionary spending, 123 point to billion dollars in mandatory spending and funding for 393 full-time employees
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which is an increase of 13,000 four those working at va. that means that for the mission act 19% of the funding will go to community care but 81% for va care. 1.6 billion to the electronic health record, 184 million four modern integrated financial acquisition management systems and 36 million for us to continue to adopt the defense medical logistics standard support system. a .1 billion to continue the improvement in customer service. the directive for those in va and 547 million for women's health and one .6 million 1.6 million for capital investment. the last item on my list is to continue my pledge to you that
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we are joined at the hip with this committee and with the committees of the house of representatives. we all have the same mission in mind and again i thank you for your courtesy and i thank you for allowing me the honor of serving in this capacity and look forward to your questions. >> thank you mr. secretary we appreciate that and we appreciate your acknowledgment of what we said about the amount of money we are talking about. we are not complaining about what we are spending it on we are looking for answers to spend it better and see our veterans get better services. we have a good budget to work with and we are looking for results which raises my first question i will ask. the private sector today in healthcare one of the questions -- trying to measure outcomes for everything from reimbursement to being worse than anything else, when you refer [ inaudible ] how do you
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measure outcomes? do you take them from the senior person in charge or evaluations or randomly? how do you gauge your outcomes for the services you provide? >> a combination mr. chairman. i look to the veterans first. i have been very aggressive in the eight months i have been in this chair and reaching out to veterans in terms of surveys and in terms of interviews. what i have seen is that our customer satisfaction rates are moving in an upward direction where we have i think an 89% customer satisfaction rate amongst veterans. in terms of other metrics opioids is the outstanding example. how are we changing the way that we approach this national tragedy? we approach it in changing the way we treat our veterans by providing things that would
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have been -- of something like my father 30 or 40 years ago with alternative medicines. tai chi, acupuncture, yoga. we are on the cutting edge both of alternative treatments to our veterans and on the cutting edge of telehealth as the senator said and we are on the cutting edge in terms of tackling the national epidemic of suicide and homelessness. the answer is it is a combination of things but for me most important is listening to what our veterans say. >> on that answer let me say this, it includes funding for retiring two it systems that currently exist at the va, you have not talked about this before but it seems like to me the va is a place where you collect software and systems. people have bought things over the years and they have piled
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up, they don't talk together work together and we are not getting our bang for our buck. you're obviously trying to clean that up and can you talk about his recommendations about retiring those [ inaudible ] getting improved and better? >> i told you eight months ago that the overall condition of va's it system was bad. as a result of that this committee is looking at as the senator said a massive increase in our budget. for $.2 billion i believe. that money in the past has been spent on redundant systems going down the same road that led to the failure of the forever g.i. bill as well as other systems. what we are doing and you i believe will have the cio appear for testimony in the next few weeks is we are beginning to migrate legacy
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systems out and bring the va in line with the rest of america through the cloud. we now have 8000 employees who are dedicated simply to that transition. we will ask for a bit of patience on some of these but the migrations of the cloud is the wave of the future and it is the way we will maintain i think the trajectory the va has has undergone in terms of its overall customer service. you are absolutely right. the reason the forever g.i. bill crashed and burned is the directions from this committee were placed on a old system and it was bound to fail which is one of the reasons why i stopped this going down that same road and pivoted so we could make sure our veterans got their checks.
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>> let me say one thing and i will ask another question the making state and. i will make an admission too. the state of georgia brought me in when they lost -- schools in the middle of an election cycle to take over the board of education in georgia and the department of education y2k. i had a good company in terms of technology and stuff like that and i learned you can buy every trick in the book when the salespeople start talking to you because they have the advantage and you don't know or unders and [ indiscernible - low volume ] -- clouds and i want [ inaudible ] i just can't find it anywhere. anyway my point is this, so many times when we go to clean up a system of technology information we find more stuff to clean up the mess and we have a bigger mess when it is over than we had before. is the workability and and
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operability of the system so let me encourage you to make sure we have the right people that know what they are talking about making the decisions or recommendations that understand technology the way it can and cannot -- every promise that comes through the door because that gets expensive and it can cause you a lot of problems. the va is so big and our employees are so large the budget is so big you are talking about any little problem at the va is a big cost particularly if it is the it system. i encourage what you're doing and appreciate what you are doing. >> thank you mr. chairman and secretary thank you for being here. -- we have a high percentage of veterans in our state that want to be de-privatized. i've heard that haven't heard that from you all and i don't think you do either. your request is 44% decrease in
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funding for construction programs which was in the budget but you also been it. i know that we are investing heavily in community care let me give you a few examples. the rule rural mobile unit in clarksburg is totally an operable. our medical centers haven't had an increase in residential rehab centers since the 50s and 60s. most of our facilities require basic maintenance and deferred maintenance for roofs and hvac all of the above. i am worried that even though our intent is verbal a verbal agreement we have that we don't privatize because of starving some of the things and people with a rather not go to that because it doesn't have proper services. they don't have updated equipment and it leads me into another question. there are over 40,000 vacancies
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at any given time at any given moment at the va. this morning there were moral hundred 30 positions 138 positions posted in my state. i have practitioners in martinsburg and we are hurting all over the board. even though the intent might not be there it looks like the signs were moving in that direction because of demand for from our veterans. if they are getting the care they will say i need better care and the facility is not worth even going to because it is not in good enough shape. you can see the concern mr. secretary of what we have and what we have answered to. they are overwhelmingly supportive of the va. >> let me take your comments. first i would be lying to you if i told you that we are anywhere near turning the
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corner on capital investment. my estimate is that we need $60 billion over the next five years to come up to speed. that is an incredible number. let me tell you what else we are dealing with. more than half of the buildings i am responsible for age in range from over 50 years to 100 years. this committee has provided a way forward. we are now engaged i believe it was senator moran's idea with market assessments of our national infrastructure and human resource needs that will then inform when they are done with this committee told us to create and that is the asset infrastructure review commission to bring our facilities up to speed where the veterans are. again this is a monumental problem. my first job is to do as much
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as i can to ensure the basic health needs of the veterans are taking care of and unfortunately their cost- benefit analyses that need to be made. i can come to you and say give me $60 billion to repair all of those facilities. as for the human resource side you are absolutely right. let me tell you where we have been and where we are headed. my first week in office i had two senior leaders give me two different numbers as to how many employees we had. that is outrageous and i asked a military question, where is your manning document? that document is one where you have your requirements and you have the people to match them. we never had one. finally we now have a modern hr team in place that has come on in the past few months in my direction. i have consolidated in the process of consolidating 140
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individual h our offices hr offices into 18 so we have an even distribution of resources across the enterprise. we have asked for the resources to hire 13,000 people and as senator tester knows my emphasis as the head of the va has been for rural america and native america. those two sections that provide the highest per capita number of men and women in uniform and for the native populations that the population it provides the highest number of medals of honor and combat declarations so it is a conflict problem and as i said i would be lying to you if we are anywhere near turning the corner but i understand.
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>> they say can't you at least take care of what we have? that is the biggest concern and i would hope you all would understand that they are scared that they are being set up and that this thing will go private because demand will switch. demand will switch if facilities are not adequate because of the service they need. >> mr. chairman -- >> that means we have to be much more the senator is here and he has one of the fastest- growing veterans populations in the country. in fayetteville my hometown which sits underneath fort bragg two massive va facilities, the new one is leased, they don't have to worry about hvac or the lawn, it concentrates on taking care of veterans. we have to be more creative in terms of two things.
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we need to get more incentives and i want to come to this committee and talk about it something like a veteran peace corps. to give professionals into areas like rural west virginia. , western north carolina and provide the means to serve those veterans in communities hard to reach. the highest percentage of services of anyone in the country. >> senator kramer. >> thank you mr. secretary for being here. thank you for our previous discussion and i will ask you and you can do further questions to others if it is more appropriate. you mentioned, you talked a fair bit about alternatives to pain management. alternatives to opioids and you
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talked about some things like acupuncture and other types of care. but you did not mention hyperbaric oxygen treatment. chamber treatment. and particularly for pain, it is supposed to be quite effective for posterior medics best, brain injuries and things, to veterans and athletes and others. i wonder why and what you think the potential is for that. >> it is certainly was not for a lack of appreciation of the treatment. i pledge to you that i will be out in fargo to look at the headquarters of one of america's largest hyperbaric chambers. now we have to be more creative particularly as treatments become more complex for more complex injuries. particularly injuries of the brain. we are not even at the sputnik
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stage when it comes to exploring the brain and how it response to trauma and how it recovers. dr. stone is probably the better expert when it comes to the actual medical conditions that the treatment addresses. >> certainly as a practitioner who spent much of my career doing management of hyperbaric oxygen and using hyperbaric oxygen to heal the brain and do some of the work that you've been discussing is work that has been studied for at least a decade. in both the dod as well as nba. what we know is that hyperbaric oxygen chambers have a dramatic affect in improvement of individuals with ptsd as well as brain injuries. we don't understand is what the addition of oxygen to the presence in that changer does.
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so there have been multiple studies done by all three uniform services. as well as by the va demonstrating that. we look forward to further research on it. brain rest, that remains one of the mainstays at this time. and certainly going into a chamber whether silence has great value. whether the addition of oxygen under pressure remains intimate. >> it will be interesting to see carry out because my understanding is the presence of more oxygen could have the alternative impact. of course it is stimulative i would guess. >> senator i agree with you and as a protection or in the presence of trying to penetrate oxygen into wounds, that is exactly correct. >> we would love to help you with that experimentation but we can talk about that later. the other thing i want to mention because you mentioned it both in testimony and your answer to senator mention.
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you talked about 13,000 more people. you are in the people business and it requires practitioners to do the work you do. and you did very well. they do it very well in fargo and i'm pleased and proud of the service they provide. but it is getting harder to find good people and attract them. particularly in the economy like north dakota has as you are aware. it is even elevated there. the challenges, it is amplified in an economy and in the region . probably like other rural states. that said, can you elaborate on specific programs whether it is loan repayments, what are the tools that you have available or that we can help you with to attract and maintain and keep good people? >> i will say the chairman and ranking member inserted into the mission at the first monumental step in addressing the needs of rural veterans. by giving us the authority,
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extra authorities on relocation pay. reimbursement and the ability to pay off medical school loans. up to $200,000. those are absolutely needed. my goal though is to try to create even a more robust relationship with our universities and also with the armed services. the general radley goal was to have at least half the doctors and nurses coming off of active- duty coming into va. general madison and i spoke great deal about that and we are telling doctors when they decide to leave active service, come to the va and continue your service to those who have worn the uniform. i want to go back to the future on that but this committee has given us a start particularly
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when it comes to rural america. >> thank you. >> mr. moore and blumenthal. >> i hesitate to interrupt but i will. >> thank you secretary walkie and your team for being here today. i want to congratulate you and thank you on your decision that you would not be appealing the ruling of the court in the blue water navy case. i think your recommendation will be key.
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i would perhaps with all due respect mr. chairman express on my behalf and i hope on behalf of the committee on veterans affairs that that recommendation be adopted and endorsed heartily to bring fairness and justice to bluewater navy veterans. it would culminate a greasy that has been bipartisan involving almost everyone on the committee. it has been a team effort and i'm grateful to you for making the recommendation. i also want to submit for your consideration the agent orange exposure fairness act that would extend the basic principles of the court decision. and suggest also that there are other toxic chemicals and poisons on today's battlefield that are worth the research and attention that the va should
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give them in deciding what kinds of benefits and disability compensation our veterans deserve. the potential for poisons on the battlefield is one of the great challenges of our time. and one of the areas of unknown consequences to our heroes. and as the father of two veterans who have fought in recent wars, and a friend of many, i hope we can carry forward the spirit of that court decision and of your support for it. i want to move to the veterans affairs healthcare system. especially in particularly the va facility in west haven. i think you are familiar with my letters to you on this topic. i understand that sterilization
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process is there essentially have been stalled so that the operating facilities are at one third of capacity. to put it very bluntly, two thirds of the veterans who need surgery at the west haven facility are either sent elsewhere or surgeries are delayed or possibly denied. that is because the sterilization capacity is limited. the surgical facilities are closed for about three months because of flooding and are back open now but the tools and equipment used in the surgeries cannot be properly sterilized. a mobile trailer is planned for one year from now and that is way too long. a permanent facility, 5 years from now, much too long. i would like to know, what is the plan mr. secretary for
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expediting the availability of that surgical capacity, in other words the sterilization facility. >> i know how important west haven is. dr. stone is supervising that. i do want to step back though and say, i agree with you. some of your early statements about not going through what we went through with agent orange. we saw that in my family. i worked for senator tillis on the burn pit registry legislation he and senator club char introduced and passed. it is important to me and i will let dr. stone talk about west haven. >> i appreciate your role and activism in this. the recovery of west haven clearly, the goes back to the fact it is an allergic older facility. as we work to recover that
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facility, let me reassure you that the surgery team performed in that facility and sterilization is a safe process. >> i don't doubt it is safe and i want to emphasize the physicians and staff are doing their best. they have one hand tied behind their back. in no way are they compromising the safety or effectiveness of the surgeries they do. i think the va here is feeling them by feeling to expedite the sterilization processes which limit their capacity. >> my understanding is that the mobile trailers with ynez water and sterilization materials artist installed by june of this year and the meter hold up was because of utility issues on that end and area as well as the building of the trailer.
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the actual funding of a new sterilization facility will take 3 to 5 years. that said, my expectation is that as soon as the mobile unit is installed we will begin to recover the surgery that needs to be done at that facility. >> will go to 100%? >> that is my intention. absolutely. >> can you make that commitment? >> absolutely. >> i will make it. >> thank you mr. secretary i would like to continue our conversation. my time has expired. i think the chairman for the possibility of expediting a more permanent facility by appreciate your commitment today. >> chairman, thank you and senator tester for conducting this hearing. mr. secretary thank you for being here. i joined both the ranking member and determining the expressing my gratitude for your continued service to those in uniform and i appreciate the job you are doing at the department of veterans affairs. i will have a chance with the
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appropriations subcommittee in a few days to work conversations about the spending and budget recommendations. i have a couple of things that i think are timely that i want to ask you today while i have this chance. first of all i would like to highlight for you in 2014 we authored legislation and are working with senator brown of ohio and furthering the legislation with the national academy of medicine. they were required to do a analysis to determine if there is any medical and scientific evidence related to or if there has to be further study on the relationship between affliction and problems and challenges that follow generations of the servicemen and women as a result of that toxic exposure. we look forward to continuing to find the answer to that
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question. there will be another generation. it saddens me because i can imagine anyone serve the country thinking may harm their children and grandchildren by the service but that very well could be the case and we are working to get the medical and scientific evidence to demonstrate that. also want to highlight a piece of legislation that senator tester lead and i look forward to getting input from all of my colleagues with the leadership. >> that is reserve and guard issue. >> there are two of them. that is one of them and in addition to that the commander john hannon with environmental health and suicide prevention act, john scott hannon being a veteran who lived in the state of montana. for my two questions on the timeliness of this hearing, staff of this committee, the house committee and the staff of our individual senators on the committee met with your staff in regard to the veterans hearing aid access and assistant act. for as poorly and we get along
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this is another one he and i sponsored that was passed in july and december 2016. the take away from that meeting, first of all i should indicate the legislation in 2016, the law mandates the department of veterans affairs determined criteria for hearing aid specialists. with the goal of integrating them into the care of veterans at the va. but the unfortunate circumstance is that since 2016 we can find no evidence that the beach a took any steps to mandates that. the meetings i think i would describe the take away as little interest in meeting that mandate. the reason we ask for a response from the va officials by today's hearing knowing that you would be here and we received none today. perhaps dr. stone, he appears to be interested in talking about this conversation.
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>> senator, thank you. i appreciated and i was unaware of the letter. if we have not responded you have my apologies and we will correct that today. >> i intended to send a letter. it was a conversation with officials at the va saying the secretary is going to be here. could you please get back to us by tuesday in other words we need to arrange the topic with the secretary. >> you happen to be looking at a hearing compromised veteran from my combat service and i'm appreciative of what the va has brought to me and my family. as i sought care for my hearing loss through combat. so am well aware of the issues that you bring up. let me say to you that last year we performed over 1 million visits for hearing compromised veterans. with our audiologists and technicians. we have continue to grow that and refer out about 38,000 visits a year. and we appreciate the legislation on hearing aid specialists. the question is, do we need to
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move into the specialist area? clearly, you and i may have a different understanding of the role of specialist. today i have enough audiologists and enough technicians in order to provide that vast majority of care that is needed. including less than a 10 day waiting period in order for veterans to come in for care or for appliances. in addition we have and under two week waiting period in order to take outside prescriptions and sell them on behalf of the veterans. >> let me suggest this that senator tester and i staff could have this conversation. i am an employee of kansas on saturday, for days from now. there two days of service and fairly a physician has a mid- level petitioner. the department, the eastern division in kansas has announced the closure of it.
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one would expect me to be angry about the closure. i am hopeful that with the closure and conversations with the va that the mission act now provides additional opportunities for care for veterans because we go from a today with virtually no physician and one mid-level to an opportunity for a multitude of community resources being available to those veterans in the area. i'm going to meet with your folks in kansas. they're joining me on saturday and what message would you like me to deliver about the opportunities that the mission rva can provide? >> the mission act is about veterans and centered care. it is not about protecting the institution or guarding the status quo. it is about giving the veteran the option to be the garden of his own or her own future. and for rural america, offering
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a wide as aperture possible of access to medical care, meeting the attention of this committee and as long as we keep veterans health at the center of everything we do, the system will work. >> i will convey that to the veterans that join me saturday. mr. chairman, thank you. >> in keeping with our bipartisan committee commitment i'm going to excuse myself a minute and send it over to senator tester to continue the hearing and it is his turn to answer questions. >> thank you mr. chairman. i assume that means i can expand the time i used. >> thank you all for being here. once again, i hesitate to talk history with somebody who probably knows history far better than i do. especially military history. but nonetheless this is pretty elementary. in the 1930s, this country did
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not want to go to war. president roosevelt turned car factories into airplane manufacturers to prepare for war. then came the bombing of pearl harbor and we were ready for war. pretty simple, pretty ingenious. everybody on this committee, i believe has said no privatization. the president had said something different. you have said no privatization and your staff has also said that. the questions are asked here today and i've talked about our vacancies. that needed improved. blumenthal talked about west haven, one third capacity and senator moran, even though he's not mad about it talked about close because of lack of staffing. everything i'm hearing and everything i'm seeing says
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something different. then i look at the budget and the budget and you said earlier that you needed billion dollars in capital investments. the budget request for major and minor construction was decreased by 43% for major construction and 50% for minor construction. and we're talking about the needs out there. by the way we could go down the list and montana, it is pretty reflective. i was at the meeting six days ago when you guys said you can't get the money out the door but nonetheless, you talked about six to billion dollars in capital expenditures and reducing those accounts by 40 and 50%. putting all that together, how can we justify that? >> senator tester i could probably shed some light on that. first let me say that the department cfo, i feel dirty
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not asking for more money to be honest. >> i don't care if you asked for more money but if you've got $60 billion and needs over the next 5 years and we are reducing the same accounts to meet those capital expenditures, something doesn't jive. >> let me explain. the fact of the matter is we do have a requirement. there's no question that we have older facilities and is essential facility. the fact of the matter is we have very quickly executed our shovel ready projects and they are in the works. we are at a point now when you divide the amount of money we have in the works by the number of facilities, we have 19 to 20 projects per facility going. they have limited capacity in a lot of areas. moving clinics around, moving people around. we are now hearing from a number of facilities that they have some shovel ready products
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but cannot execute because it is too disruptive. we will end up carrying some of that money forward from 19 into 20. about $1 billion of nrm. we will also carry minor construction money. >> i will do some quick math. if you don't know this already you divide 60 by 5 and it is $12 billion a year. if that need is out there and we cannot execute the amount of money we've got so far, how do we not privatize the va? >> we don't privatize the va because we still have the largest healthcare system in the country. 170 hospitals. and our veterans are voting with their feet. let me just say, this is not a libertarian be a. if it were i would be giving myself a card
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that says veteran and i go out to the private sector and get anything i want. that is not happening. again i fall back not on anecdote but on steps. veterans are happy. they are going where people speak their language and their culture. i support that. this committee supports that. but mr. secretary i agree with you but i go back to the example of history. if we are short on manpower, if our facilities are short and substandard and we are not making the hvac additions that we need to do, eventually the veterans are going to the va and they will say, not anymore. >> this committee gave me the answer. that is the market assessments. then the asset infrastructure review committee which does exactly what you said. and i think i will come to you and ask to celebrate the beginning of the commission. so that it moves more rapidly than the timeline that this
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committee has given. >> really quick, i don't have a problem with that. give me an idea of how quick. it is said to go 20 21 or 2022. >> i would like to do that earlier because our market assessments are underway. >> i would love to visit with you. >> now we have senator rosen. >> thank you very much. we do appreciate you and senator isaacson. we can be very proud that the 2019 appropriations because of your leadership and the committee was significantly increased. i think again we will see that going into the next fiscal year. we appreciate your leadership secretary wilkie and your team. especially grappling with the forever g.i. bill and getting that under control. i know that was a hard thing to do.
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also your work with the veteran suicide. i think we are coming up with a method now that is going to have significant results. we really do appreciate that and we appreciate that in your leadership style. again with your team. one thing that i would like to understand, i was in arkansas last week. a lot of our smaller communities that will be impacted by the mission that. and i guess what i would like to understand is there is a little bit of confusion as to what will happen in june. we have rules and regulations in place. going forward. for the veteran in mountain home , arkansas told he is ineligible for choice because a nearby location even though it doesn't provide the medical service he needs. what will happen to him in
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june? if anything? will he be able to talk to the va to get authorized for care from a private hospital? what is the process? >> the process is the veteran will continue to talk to his provider or scheduler in order to get authorized care and make the best decision on behalf of the veteran. frankly june 6 should almost be a nonevent for the veteran. today, we authorize -- we will do over 300,000 visits in our direct care system. we will authorize about 50,000 visits in the community care. that is all done on a manual basis by providers and schedulers. on june 6 it is our hope to have something called a decision support tool that will
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automate the process. should we fail with the decision support tool, it will look just exactly like it does today. now there will be an enhanced number of veterans eligible to make a decision of whether they want to go out for care or not. but the system will look very similar to what it does today. as far as a veteran sitting in front of a provider or scheduler. or on the phone making a decision on whether they stay or they go out for care. >> for those that are eligible on june 6 the radically for enhanced care in a sense that they will fall into that new parameters, if they call will they be told, do this and this order will it be phrased that they call back? >> senator, this will be told what to do for care. there should be no increase in wait times. there should be no increase.
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now our problem is in most areas of america, the commercial healthcare system is not as responsive as we are. please remember of those 300,000 visits we will conduct today over 22% are same-day visits. in the commercial space it is not as responsive as the secretary said previously. in an urban area, in the southeast it was found that the wait time for the commercial space was dramatically higher than ours. >> i would like to talk and again, mine was more in context with the travel time versus the wait time. we will talk about that. the veteran suicide, the collaboration with these groups that seem to be doing a good job . the secretary and i were in a meeting earlier this morning and one of the congressmen talked about a program that had a 70% reduction of suicide as a result. can you talk about the efforts
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and collaboration so that we can get these public private partnerships going that seem to work well. we need to make sure the metrics are there and all of those things. >> yes or. the budget calls for $222 million for suicide prevention programs. i have just been named as the chair of the national task force on suicide prevention. you know the terrible statistics, 20 veterans a day take their lives. 14 of those are outside of our va. i think the most important part of the task force other than a whole health approach to suicide prevention is the opening of the window for monies to flow into the states and localities. to help us find those veterans. for example i was in alaska with senator sullivan. more than half the veterans in
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alaska are not in the system. i asked the alaska federation of natives to double the number of va travel representatives they have to go out into the hinterland of alaska and help us find those veterans not in the system. it sounds simple and sometimes simple solutions are the better solution. the states and localities know better than we do and many of these instances where veterans are and where they are in need. a couple of things, i'm not going to give you a metric saying we are going to achieve zero suicides. the majority of veterans who take their own lives are vietnam era. my father's generation. some of these americans have problems that began building when lyndon johnson was president. we are not going to be able to cure all of that. but we can and if the chair will indulge me, as the former
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undersecretary of defense for personnel general matters and i both began a system of education throughout an individual's military career. that focused on mental health wellness and taught a soldier, sailor, airman, marine to look for the signs of danger. so that for the first time in our military history we actually have people coming out of the service who at least have had some educational grounding throughout their term of service in what to look for when to ask for help, not only for themselves and for others. the deepening of the relationship between the va and dod is actually essential so we never again have those numbers that we have now they began to build in south east asia 50 years ago. >> thank you.
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>> mr. secretary thank you for recommending the decision not be appealed at this point. appealing that decision is not what we should be using resources for. these are persuasive to make sure that doesn't happen. there was an article recently. by the way i understand the chairman is going to have a hearing later on on the proposed access standards. that is good because a lot of us have expressed concern about how standards would be developed and the fact we heard from any of the as those that were not consulted during the process. that will be happening. a few weeks ago, mr. secretary the new york times published a story with the heading, treat it like a piece of mead. have you read that article? it paints a pretty dire picture of the kind of experiences and
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harassments that the women veterans and/or. what we do to make sure that women veterans are respected by staff and other patients. i realize that needs to be a cultural change but i don't know. whatever you need to do so that this is not the horrendous experience where the women veterans have described the article. i want to know whether the va is conducting research into the best practices or models of care that increase utilization and satisfaction of va services . and your testimony mentions that 91% of va community-based clinics have a women's health primary care provider. and when can we expect the number to be 100%? you are almost there. >> that is certainly the goal. in our previous relationship for my former capacity as the undersecretary of defense, you
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and i discussed that the first thing i had to do was promulgate the first year the regulations on sexual harassment. and equal opportunity which we did. that tells you my commitment. you hit on it. it is a cultural change. i don't believe that what was in the new york times story is apparent in all of our va facilities. i'm not going to be able to tell you with a straight face that i can change the attitudes of every person who works in the va. but we are changing the culture and putting in women's health centers in all of our va hospitals. one of my goals is to make sure that there is an actual privacy barrier, separate entrances that in the case of this new york times story, those things would probably less likely occur. just by changing the way we bring our women veterans into the system. i can say that we had 500,000
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appointments last year for women veterans. that is a change. i will also say the culture that you talked about is beginning to change within the dod. i think the longer that goes on, the less likely you will see the end product such as you described. but i think we are on the right path. >> when you make the cultural changes you may not need to expend resources on facilities. but obviously that is something the women veterans very clearly want at this point. we want to get to the lack of progress for various projects. for example the leeward outpatient access. the project in hawaii was scheduled for the early calendar year 2018. 2018. but was delayed a number of
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times and the lease is not awarded. the project was supposed to be completed by fiscal year 2020. and these kinds of outpatient clinics, they are helpful because they are closer to where the veterans live and in hawaii, the hospital is very crowded and you can hardly get any product parking. it is really a pain. can you commit to saying the project will be completed on time with no further additional delays? >> senator, as you know i spent a great deal of time in hawaii last year. i talked with the governor about this lease. i will get you more information. my understanding was there were contractual problems with those responsible for improving the facility. that was what i discussed back in december in honolulu.
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but i will get you more information. >> thank you. i would like to see this in others country. thank you mr. chairman. >> senator vibrant. >> thank you mr. chairman. i want to thank you all for being here. secretary wilkie, thank you for the time you spent with me prior to this. to talk about the needs of some of our veterans in tennessee have. to look at how we fulfill that promise, providing for them and their healthcare. i want to start with the e hr and your deployment of modernization that you are doing there. as we talked many of our folks, would like very much to be able to under the mission act seek that care at home. because they are a good distance away from a facility.
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as we have talked before, interoperability is an imperative in making this work. i want to know where you are, what control measures you have that have been implemented to ensure that you are going to meet your milestones as you go through this deployment. as it begins to take place. >> senator, we will go live in march of next year in the pacific northwest. to reach our initial operating sites. that is on schedule. there are issues that we need to work our way through. these are old facilities. we need to rebuild communication closets and that
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will go on the summer. we also need to work our way through all of the internet of medical devices and make sure -- >> let me ask you this. as you are doing that are you working on a plan so that when someone enlists on day one, they began a cloud-based encrypted record that will follow them the rest of their life? >> yes, that is the goal. >> i will use my father as an example. the days of somebody carrying around an 800 page april record are gone. >> right but i think it would be instructive and helpful to us if you could provide us with a timeline of when you will achieve this. now and help committee today they are doing a hearing on the e hr's. and we know that whatever you do, that you have to have a strategy so if it is going to be interoperable with commercial best practices and
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do you have that in place? >> yes we do and obviously you mentioned the goal is to begin building the record. the minute that young american walks into a military entrance processing station. then there is a hand off. i expect and i don't know when there will be new changes in leadership at the department of defense but i will continue the relationship i have with general mattis. i expect to come to this committee with the announcement of a joint program office which will be the first joint program office between two departments so we combined the resources of both departments. to build this record. it will be interoperable. i would never have approved it if we could not have interoperable with the private sector. >> okay. telehealth. i was recently in gallatin, tennessee to open a veterans clinic. it is a whole of life clinic. the day after that i was at the nashville va with the mental health center. we were walking through that
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and i think that those are important components to have. because the telehealth helps to bring those services to them. especially in behavioral health. and i want to know, what is your strategy and timeline on moving more facilities so that they are functioning with telehealth and have the whole of life approach to the clinic? we have a lot of clinics, people cannot get to healthcare with long will waiting list. >> you are exactly correct. about three quarters of 1 million veterans consumed telehealth visits last year. that is about 13% of veterans enrolled with us. this year's budget will move that to 20%. we believe in order to keep
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veterans in their homes especially at risk veterans, instead of hospitalization, expanding telehealth services is essential. we will move to 20% under this budget. >> i would say this committee has given us authority that no other healthcare system in the country has and it allows our doctors to practice across state lines. this is the front line of our tech on the problems of mental health. as you mentioned, behavioral health. it provides our veterans with the opportunity to stay at home, stay in a comforting surrounding and stay with people who look after them and their friends and families without forcing them to go into a larger facility. >> i appreciate that. i know my time has expired. i just want to say listening to you all as you talk about the budget and talk about urgent need, things should never have
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gotten into this shape. never. it comes from mismanagement. my hope is as you set these timelines for implementing technologies that are going to enable greater access, that you also are utilizing technology to make certain there is not a gross mismanagement that has taken place in times past. >> senator murray. >> thank you very much mr. chairman and thank you secretary wilkie and your team for being here. let me start with the fact, caregivers, i'm sure you are shocked i'm going there. the october 1 deadline that the system was to be certified and begin the expansion process is quickly approaching. the va still has a lot of work to do before then. we have now heard rumors in the press and briefings that the va
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might not make that deadline. i do really appreciate your understanding of the challenges that caregivers face. i know you can appreciate how much our prior error veterans needed support but for the record, will you meet the october 1 deadline to certify the i.t. and begin expanding eligibility for the caregivers program? >> if i don't i will be back up here. but let me take a step back. the reason that i made the decision not to remove anyone from the caregiver program was because of not only your work and your insistence but because this process has been been managed mismanaged in the past. so that was the right thing to do and the reason i made the decision based on your recommendation. the date is october 1. the statute says i have to certify that the system is working.
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if i do not certify that, no one will be removed. we will continue to manually process the checks. right now there are 24,000 stipends that go out and it is manually done. but as long as the checks get to our veterans, that is fine with me. we do have a new commercial office shelf technology. if you have not been briefed i will get you to someone to brief it. that we brought on board on february 22. that is the template that we will be using hopefully. to be ready on october 1. the other side of this is that we have increased the budget primarily because of your work. to about $720 million and i expected to go up in the next few years. but we are also using that money to hire a professional to staff at our caregiver program. >> okay. >> senator if i may add, this
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is a manual program today and there are over 24,000 families receiving benefits. their checks are manually written every day. as he moved to this commercial office shelf software system what we will need to do is migrate all the data over and assure that we can on an automated basis for the checks every month before we are ready to expand. although we have made a decision on the software system, the migration of that data, we have not recommended a certification date yet on the software system and expansion. >> i'm not going to do it unless it is right. >> i appreciate that. at first glance, your request for caregivers looks strong and appears comprehensive however several components of the program are in need of research and you mentioned staffing the i.t. system and planned support
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systems given to caregivers. all of those will need increased during expansion. your budget request $150 million for expansion of the caregivers program leaving 550 million for the needs of the other program. as i have made clear in previous settings i want to be sure the request is not individually under offending expansion or needs of the existing program. i wanted to ask you, how does this funding, especially for the expansion be allocated to the areas of need? >> the basic management structure of this program was done at individual medical centers. resulting in dramatically different criteria for inclusion and removal from the program. the first thing you will see is the standup of a regionalized management system to look at who is eligible and who will be removed. no one will be removed until we can assure you that we are doing this in a clear manner that is transparent to
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america's veterans and to the american people. as we stand up that regionalized process that will occur under the chief medical officer of each, we remove the individual caregiver being the gatekeeper to a regionalized board process. and institute the appeal process at the va central office. the entire management structure in order to do this to the secretary's standards and standards you expect needs to be put together. we introduced this concept to the vision leadership last week and have begun talking to the chief medical officers about the hiring and standup of the system. >> the last thing i will say senator, i've used your time, we are retraining our clinical staff across the country. with the most modern techniques and information on how to deal with families and caregivers.
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i would say i think the va is really the only healthcare system in the country that is concentrated on this as the son of a vietnam soldier, it is vital to me. >> i appreciate it and i know you personally care about it too. as you know i must stay on top of this. we want to implement it correctly and we do not want to deny people the scare they have been waiting for. the help and support and i appreciate your response today. i do have other questions and i will submit them for the record. >> thank you senator murray. >> senator tillis. >> thank you mr. chair. gentlemen, welcome. secretary wilkie it is great to see. first off i want to thank you all for in your budget request funds to expand the in jacksonville. first off are people who suggest that there is a trend in the va, or members of
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congress to privatize things like budget request for the opening of 1 million square feet in north carolina with a different model you mentioned earlier when i was here. this seems to suggest you believe the brick and mortar va present is a very important part of the future. i would like you to maybe touch on that and tell me how that cbok expansion in jacksonville in combination with the pack teams are going to help improve care there and how do you leverage the model for the rest of the veterans across the country? >> senator, let me talk about the business processes that have led us to that. is a mentioned earlier, we are in the process of doing market assessments across the country. to lead into the asset infrastructure review commission.
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the demographic changes i see for veterans, they are changes that mirror those of the rest of the country. by 2027, north carolina will have the fourth highest number of veterans in the country. it will be nipping at the heels of california. >> it will be the eighth largest state. >> yes. for those like senator brown just came in, ohio remains in the top 10. because of the large populations and georgia is also in the top 10 as far as we can see in the future. we have to be more creative. we have to not only combine the brick and mortar facilities that we have and manage them more efficiently. but we also have to create an environment where the teams can reach rural areas of our states and be more creative when it comes to things like telehealth.
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but we are moving our resources to where the veterans are and i think that dr. stone has your pack answer. >> the packs will continue to expand across the nation as we higher. montana loan we have 38 primary care providers. we have office out to 8 additional primary care providers who will come in and expand the rural area. the secretary is exactly correct that you are seeing growth in north florida, north georgia, growth in your state sir. and we will continue to expand. let me talk about brick and mortar. veterans are no different than the rest of americans. our parents generation stayed in the same house on a generational basis. we don't. and our children don't. they move. we must be able to move from place to place in order to follow where the veterans go. therefore, lease authorities are incredibly important to us
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and enhance lead authorities that allow us not to just provide but to also be able to provide ambulatory medical facilities that we can move every 5 to 10 years and follow where america's veterans are. much of the nonrecurring maintenance you hear about and cost of our infrastructure is for inpatient facilities. our inpatient facilities in many cases are aged and need substantial improvements. but ambulatory facilities, more than 1000 of them need to be able to be mobile when the veteran moves each decade. >> thank you. i want to talk a little bit about access to standards in the mission that. i could infer from some comments from some of my colleagues it is almost like we are giving some of our veterans too much choice.
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in some states i think you 100% access to choice if you wanted. there may be a variety of reasons why you need that. my colleague just came from alaska and has a very diverse population over a geography that almost bans u.s. from tip to tell. i can see why you have to have different solutions for different states. what would happen or be the negative consequence if concert succeeded in rolling back the ask for standards you're putting in place and in combination with the mission act? >> senator it would no longer be a veteran centric patient centric approach to healthcare. that was the clear mandate of the mission act. not institutional prerogative but the healthcare of a veteran. let me back the chairs indulgence to describe what this is. and i mentioned it earlier. this is not a libertarian va. this is not giving dr. stone or me a card and saying, thank you very much, go out and find whatever doctor you want to
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take care of you for the rest are you like. what this says if we cannot provide a service, then you have the option to seek that service in the private sector. to give an example, there is no rheumatologist and there probably is in fayetteville. but you meet the criteria for that service than we tell you that you have the option to go to duke or chapel hill or to cape fear valley in my hometown. to get that service. it is based on the needs of the veteran and veterans come first. if we cannot do what the veteran needs, then we will provide him the opportunity to seek that. >> i think it is very important mr. chair to close out my questions. that is why i think a broader understanding of what you are trying to accomplish with the patient care teams, it is not
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like you're giving them a card and sending them on their way. you will have to spend a lot of time making sure that the outcomes are going in the right direction. that they are getting their appointments filled when they need to and you always have the brick and mortar presence is necessary. but i for one think the axle standards we need to move forward in the work you are layering on top of it will provide a better standard of care for the veterans. thank you for your work. >> thank you. >> senator brown. >> thank you mr. chairman and secretary wilkie. thank you for your letter back to me regarding the ba history center at the va in dayton, ohio and we are excited to get the next phase up and running. we look forward to a briefing on how this project is progressing and we will be in touch about that. i will be brief. i have a number of questions. senators tester, bozeman and i have been working to push for a track and report of overpayment and veteran death. by constituents reported a
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change in status or dependency to va and the va did not take action leading to overpayment and death. we are able to get provisions through last year. last week we introduced the updated bill that clearly outlined the reporting process for veterans and families to foster better interagency coordination, reduce overpayments. i would like your commitment to work with the three of us. >> yes sir. >> thank you. over the last month this is a bit of a follow-up to comments and questions about toxic exposure. over the years, you and i have discussed the issue whether it is agent orange or burn pits that took the country far too long to come to terms with. each veteran did not have to apply individually and go through that pain. i appreciate the decision not to appeal on the blue water navy, that is really important. >> that is my recommendation. i do not know what other departments are doing. >> that is your recommendation, okay. my question is this, i would like to know when the va
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intends to make a decision regarding the national academy recommendations on agent origins, bladder cancer, hyperthyroidism, hypertension and parkinson's like syndromes? >> we are working our way through that. and it would be my hope within the next 90 days that we will have decisions made. >> okay. you make the decision quickly as ratified by secretary wilkie? >> i would not presume when the secretary -- >> he sitting right next to. you could ask him. >> thank you. >> secretary you said that congress put unreal expectations on outdated i.t. systems for the forever g.i. bill. respectfully sir, the va i.t. and programmatic offices should be able to flag these issues for leadership and leadership should respond accordingly and update congress. >> if i said that, i misspoke. i should have said the va systems were not capable of handling changes that congress mandated.
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>> that i cannot tell you based on my tenure here. my short tenure. what i can tell you is that once again, because we were not ready to implement the programs required to support our caregivers, i made a command decision based on my discussion with senator murray that to make sure that nobody was removed from the program, that the text, stipends that i went out to 24,000 caregiver families were done manually but they were done. and i do expect to come to this congress by the deadline on october 1, hopefully certifying that the commercial off-the- shelf technology that we
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purchased to support caregivers is in place. but i will say i'm not going to certify anything that doesn't work. that led to problems with the caregiver. nothing moves unless we are convinced that it helps veterans. you have my commitment. >> thank you. i want to reiterate with the chairman said about the legacy i.t. systems, getting them to work together for all of our veterans. that is so important. one more comment and one last question. the comment is -- well the question is, when can we expect nominees for deputy very secretary and secretary of health? >> hopefully soon, we have made the recommendations and i hope there will be an announcement from the white house shortly. i will thank the committee for approving the nominees for the office of whistleblower
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protection and cio. i do want to say one thing, though. there is an added layer of approval for the under secretary for health. the law, unlike for any other position in federal government, requires the convening of a commission, a commission to meet, deal with candidates, deliberate and then has a recommendation onto me. that was the reason for the delay and the 8 months i was here because the commission had to be convened . >> last comment, i heard -- thank you, mr. chairman for your forbearance. i heard you -- your junior senator for north carolina is laying out choice and privatization and i know how he stands on that. i am disappointed that you are quite as opposed to privatization as i thought. i'm not asking a question
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particularly but i just ask you to listen to the veterans service organizations and what they think about this presidents philosophical commitment to privatization that i hope the v8 does follow. >> i think i have been very clear, mr. chairman about where i stand and where i think the department is headed. i think the legislation was right on target. when it said that the veteran is at the center of everything that we do. i also said that the veterans voting with his or her feet. our customer satisfaction rates are at an all-time high. i look at that is the gauge as to how will we are doing. i also believe and i'm not one to use a lot of anecdotes but i can say as someone who has spent an entire life in and amongst the military, that our veterans, no matter what age they are, will go, primarily,
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to someplace where people speak the language and understand the culture. there is nothing like it in the united states. i stand by what i have done in the last 8 months. >> the way that congress appropriates or withholds money can have a whole lot to do with people voting with their feet and we will keep that in mind. thank you, mr. chairman. >> thank you, mr. chairman and your secretary and your team. thank you for being here. i also mentioned the nominees for undersecretary, very important. we need to get those out the door and i also want to mention to my democratic colleagues they also need not to delay the nominees once they are on the floor. there has been very, very unprecedented obstruction a very basic nominees for their confirmation. we get them out the door and we will have guys like senator brown move them quickly as opposed to delaying them because that is not helping at
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all so it wasn't a nice try, it is actually a very serious issue so they need to help. they can't just say, "give us nominees" and then delay them for 10 months. it is ridiculous and that is what has been happening. it is ridiculous. first of all, congratulations on these national awards. i think what you are talking about for your team, it's, should be commended and sometimes you guys come here and you get the wrath of the congress and we rarely recognize when there has been improvement so i'm going to recognize it and i appreciate it. keep up the good work on these things. you may have also noticed that alaska va healthcare system was also awarded with the most improved inpatient experience for the entire country, 2018. i want to thank all of you for that. >> dr. ballard is one of the best. >> dr. ballard does a great job but it is help from the top,
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you know, the va out in the matsu valley, a huge veteran population. finally, not just 1, not just 2, but 3 doctors. it only took 5 years but now we have some doctors. and mr. secretary, i want to thank you, not exact you exactly in your purview but you may have seen my alaskan native vietnam veterans equity allotment act was recently signed into law and on the president, he highlighted this very important bill for alaska that helped our vietnam veterans overcome a huge injustice. the fact that the president highlighting that in his signing sarah door ceremony, made me -- >> i will highlight that and mention that caregiver legislation closes one of the
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last moves of the vietnam era, sadly. it has been 44 years since the fall of saigon. i think the alaska allotment issue was one that, sadly, took almost as long and i think that also closes a loop, particularly for a state that has the highest per capita number of veterans in the country. >> i appreciate that, mr. secretary. and you weighing in on that, former secretaries in weighing in on that, again, previous administrations, remarkably, they were opposed to it so you guys at the cabinet level work weighing in really helped make it happen so i want to thank you for that. i want to talk about the veterans benefits administration is working on and i know it is a big issue for you, identifying off the via great veterans who have yet to make contact with the vba and its services. i know you are looking at possibly doing a case study in alaska. we have been out there, you have been out there and i will
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look forward to your visit and dr. stone's visit here soon again but can you talk a little bit about that, whether it is a pilot program in alaska? we do have enormous challenges on this issue but also how you are working it in other rural communities throughout the country? >> certainly, you may recall that a confirmation time when i visited with you you spoke about your reference to engaging with center to inspect i did not forget the conversation and i set in motion to figure out how we do that. our presence is augmented by the relationship with the county and state via tribal and communities to figure out how the network should be set up so if you can't touch as, you can touch somebody, touch us and that is what we are trying to do, and we are using alaska to engage those groups to figure out how the working of that takes place in what we can do in terms of the way we communicate and the way it
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affects the way we do that. we are trying to figure out how immobilize all of the resources that are in the veteran community, vs does include two in to figure out how we do those touches. >> how about the pilot program in alaska? >> you will have to brief me on some of the details. we are getting started on that. >> mr. secretary, i know you have been asked by senator boseman and others, on how you are feeling with regard to the mission act, launch date, alaska has been carved out its own region, region 5, there has been some concern that we are behind the power curve there a little bit relative to the rest of the country. can you give me up a quick update? >> actually, because of the uniqueness of the geography and the dispersion of the population, i worry about it a lot. we are on schedule, though, for getting out the contract and so when i say that, it should be out, it should be this fall.
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>> what can we do to ameliorate your concerns and worries i share them. >> i think just the continuing dialogue with your staff and yourself. i'm looking forward to my visit where we can dialogue and work our way through it but it is a unique area with geographical challenges and you are exactly correct in our previous conversations. it should be handled locally. >> i will add, if you do go down the list, and i have said this to folks in alaska, the federation of natives, i have set it on alaska television. if you go down the list and look what we are prototyping in the va, my philosophy on electronic health, on logistics, on vba, and here with mission is if we can make it work in alaska, it will work anywhere because of the unique challenges that alaska presents by its massive size but also because of the impact the
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veterans have on the population of the state. >> it is a unique, unique situation. >> thank you all, we look forward to you getting back up there, mr. secretary and dr. stone, your visit as well . >> i have one additional question so if you don't mind, mr. secretary and i will have one very short statement after this question. >> unfortunately, the chairman almost told the truth. i have two develop while i was waiting for one. >> we have to hurry . >> i wanted to go back to the hearing aid specialist for a moment and this really is to you, mr. secretary. i understood what dr. stone said, that the va may have reached the conclusion it does not believe that additional professionals in this arena are necessary but i want to highlight a complaint i have had with the department of veterans affairs for as long as -- which is now 23 years i have been on a committee on veterans affairs, is can we get the department to abide by the congressional law, the mandate that you have and the issue of
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whether or not the specialists are necessary to the va. that is a different issue than abiding by the law to determine what the qualifications would be for that profession at the va. i don't want to diminish this issue. it is important to many people and important to many people who are hearing specialists who want to provide the services, serve our veterans. it is important to veterans that they have the care necessary but i just, knowing you, mr. secretary, i want to highlight about the importance of just the folks who work for you, not making an independent decision whether or not they get to abide by the law, the mandate congress gave them to act in any particular way . >> yes, sir. i did know that that is current. that is my honest answer and you know my background so they will be told to abide by congressional will . >> i think it is true when you are confirmed. it is true as i recall in every confirmation hearing for secretary at the va that my
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question has been, will you make certain to people who work with you, work with congress, provide the information we need, answer our letters and of course, given is abide by the law. i want to highlight the importance of that. we raised the issue of toxic exposure and i told you about a study that was completed by the national academy of medicine in november, 2018. that law that created the study requires you, mr. secretary, to determine, based upon that report, within 90 days, if there is a trigger in that law and it requires you to make a determination about now how to proceed. and i just learned that march 22 which was just a day ago, you have sent a letter to the committee. you are now, you were not in compliance at the 90 day but you are in compliance by responding and i appreciate that. you now have a responsibility that i want to work with you to make certain that there is action taken. again, we are talking about the generational consequences.
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the national academy determine there is no medical research that determines the relationship between toxic exposure and the next generation of the veteran. there is a great opportunity and a necessary opportunity for you and the department of defense to proceed in determining that relationship but also getting the facts in place so that we can determine who those veterans are and you are a perfect person with your relationship and history with the department of defense to accomplish this goal. i will digest your remark -- march 22 letter in were timely fashion but this is something i wanted to highlight for you. thank you. >> thank you, chairman . >> senator sullivan wants to ask one more question i want to grant him that privilege . >> thank you, mr. chairman. it is just one. mr. secretary, this goes to the issue of infrastructure improvements, streamlining expansion when you see the population growing in certain areas of the country and state populations that are declining and again, in your -- i know
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that broadly, the va is repurposed or exposed of 175 of 430 vacant or mostly vacant building since june 2017. that makes a lot of sense but you also talk to me about areas that you see, if the va is looking at risk expansion with regard to leases or even facilities, i know you were struck by some of what was going on in alaska and given that you mentioned not only more vets per capita, the size but also we are one of the few states that does not have a full service va hospital, not even 1. can you just give me an update on what you are thinking as far as the beers prioritization of leases in the budget request? in fairbanks, we are looking at the possibility of a new campus and also outside of jaybird, you may have membered the big parking lot area we were talking about after our tour. >> the simplest answer is that
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we are going with the veterans, where they are. this is only the first step. the legislations requires market as dutchman's -- assessments to be done throughout the country and we are in the process of doing that that develops a knowledge base on population trends, the services available in those areas to inform and asset infrastructure review commission. i mentioned earlier that i expect to come to this committee to ask for an accelerated date for the beginning of the deliberations on the asset infrastructure of your commission because we have to go where the veterans are. i also mentioned earlier that what you said is only the beginning of many different processes. more than half of our buildings, 57% are between the age of 50 and 100 and 30 years old.
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because of that, the leasing option and co-locating and i'm not going to say that we are in the process of doing this but i saw a number of facilities in the last -- in alaska that present us with an opportunity to be more creative by co- locating with entities outside of the federal structure. >> thank you. >> thank you. >> thank you, senator sullivan. let me think the secretary and the staff and each of the department heads for their being here today and for your thorough answers. i appreciate what you are all doing. we all have the vast the vets best in mind and we want to take care of them as well as possible. i want to thank the vets by not being offended by the request not to testify but rather --
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back of the room taking copious notes and i am here to say i will keep every promise that i have made as well as they will keep every promise. i want the bso's to be sure and i have asked you to submit the questions you want answered. i will not give you a deadline because it doesn't do any good, i don't think but i want to give you the encouragement to as quickly as possible, answer those questions and copy those to the committee and staff, the answers to those questions. they are very good and very thoughtful particularly on the priorities of the budget and what some of those statements and your statements have meant as they materialize will mean. it is very important. it works well. i think we will get better responses because we will consume so much time, we have so many witnesses, we don't get the points we need to get to as demonstrated by mr. sullivan and mr. miranda who had instant thoughts at the end that would both a good and appreciated. i want to thank you for being here. i want to thank all of our
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veterans for the service that they provide to us. all of you are very nice today. i wish you a very good week. -- the secretary will respond as quickly as possible to the questions and so if you will get your questions to the committee, right? they will make sure they get to the secretary and we have a copy to trail. thank you very much and we thank you, sir. >> thank you.
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c-span's washington journal, live every day with news and policy issues that impact you. coming up wednesday morning, vermont democratic congressman, peter wells discusses william barr's summary of councilman robert mueller special report. also, grace marie turner talks about healthcare and the future of the affordable care act. also, robocalls todd ruger on how states and localities are spending $1 billion in federal safety funds to protect schools for mass shooting's. sure to watch these c-span washington journal, wednesday
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mornings, live at 7 am. drone the discussion. here are some of our live coverage once he. the house made for general speeches at 10 am and returns to legislative work at noon eastern to debate the paycheck fairness act that aims to close the salary gap for women and minorities. lawmakers are also considering a nonbinding set resolution on transgender in the armed forces. watch the house on c-span. on c-span2 the senate considers whether to begin debate on emergency disaster spending. in the morning on c-span3, members of the house armed services committee here from military commanders on national security challenges in the endo pacific region. at 12:30 pm, secretary of state, mike pompeo testifies about u.s. foreign policy strategy and the 2020 budget proposal for the state department. sunday night on q&a, supreme court reporter, john this buick talks about her latest book, "the chief" a biography of chief justice john
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roberts. >> however john roberts votes now that anthony kennedy is gone is going to determine the law of the land. so the liberals want him to come over, and over little bit but the conservatives are trying to hold him back where he always was. meanwhile, you have this chief justice declaring there is no such thing as an obama judge, no such thing as a trump judge, a bush judge, he wants to project a bench that is not political when they all have their agendas of sorts. >> sunday night at 8:00 eastern on c-span's q&a. next, a discussion of president trump's order security emergency declaration. panelists considered the constitutional and statutory implications of the presidents order and made suggestions for what they thought congress should do in response. this discussion took place

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