. the committee will come to order. before we begin, i would like to ask unanimous consent that congressman sublon will be able to sit and participate in today's hearings. hearing no objection, so ordered. welcome. and thank you all for joining us today for the joint hearing of the house and senate committees on veterans affairs. this afternoon, we will discuss implementation of the john s. mccain, daniel kay akoka and the samuel r. johnson department of veterans affairs maintaining internal systems and strengthening integrated outside

networks act of 2018, better known as the v.a. mission act. the mission act is a truly transformative piece of legislation that will impact virtually every aspect of scare that the v.a. provides. developing it took many months of intense negotiation, and close collaboration between our committees, the trump administration, the department, and numerous veterans service organization, stake hoermds and advocates. we should all be proud of our work on the v.a. mission act and of the benefits our veteran, our nation's veterans will derive from it in years ahead. however in many ways the real work has just begun. almost six months ago, the mission act was signed into law. almost six months from now, one of the act's most noteworthy requirements, the creation of a consolidated community care program, will go into effect. today, at the midpoint between enactment and execution, we are here on a bicam ral and bipartisan basis to evaluate both the progress the v.a. has made thus far with regard to the implementation of the mission

act, and the barriers that may exist to full ontime and onbudget implementation in the coming months. seeing the mission act signed into law took the collective effort of all of us working closely together, with one another. and with v.a. senior leaders, with the white house, and with our veterans service organization partners. seeing the mission act implemented appropriately would require no less than the same amount of team work. in 2014, we passed the choice act, in response to what can rightfully be categorized as a price sis in access. a recent news article has criticized execution of that program, namely the high cost of administrative fees. while i do not dispute that the cost of this community care expansion were higher than typical government insurance coverage, the choice program represented a transformational first step in how v.a. provides care, where and when it is needed. these contracts were stood up in record time and changes that were made both legislatively and

contractually over the past three years as a program matured, and i will say this, as a physician, we asked that the v.a. at that point in time to do something no one could do, which is to stand up, stand up a nationwide network, in 90 days. no one could have accomplished that on time. the choice program is not perfect. but it did allow for an undeniable expansion of access and care both internal to the v.a. and in the community for veterans. this is why it is so vitally important that the mission act, i will guide v.a.'s future coordination of care, be executed fishtdly and thoughtfully. mr. secretary, thank you for being here today. to provide concrete answers to our many questions about the work that the aegts agency has been doing these last six months and the work that lies before you in the next six months and beyond. the importance and the enormity of the task ahead cannot be overstated but i have faith in you and your team and i know

that considerable support from this administration and this congress is behind you. we want you to succeed. i am for you to be as upfront as possible today and every day about the challenges you're facing and the help that you need from us to ensure success for our veterans. i look forward to working together to overcome any barrier that may be in your way. i will now yield to chairman isaacson for any opening statement that he may have. >> chairman, thank you very much fort introduction and thank you for spearheading calling this meeting today to look at the first six months under the mission act. i'm glad we're doing it. and before i make my comments on the mission act, i want to say this. your service, when working you with, as been a privilege. you have done a phenomenal job as chairman in the house. have helped us in the senate immensely. your goal setting and what you focused on has been unbelievable. and with the exception of a few minor things, mainly where we may have dropped the ball, we have carried the ball and made significant changes in the

veterans administration that are known for a lasting and long period of time. so i wanted to publicly thank you for your cooperative spirit, your desire to work, it is so great to have a physician at the top of the leadership, in the house, or the senate for that matter, because we make better decisions when people has done this, it is easy for me, i'm a professional patient, you're a professional doctor and you've done a great job and i appreciate your friendship and what you've done and the leadership of the committee and john tower deserves a lot of credit. he has done a great job. let me say this. we are prepared in the next two years to do everything we can do to continue the cooperate ive spirit between republicans and democrats that we've had on the senate side, and to work on fine tuning the action we passed and implementing things that need to be done to help you and the v.a., those who are here for the v.a., get your jobs done. we understand that what is ahead of us is tough. but we have no choice but to see to it that the v.a. is functioning at the highest possible level. so those that have risked their life for our nation and pledged

their service to us as soldiers, have the same treatment back to them when theer' ensuring their health care and those benefits they're promised under the laws of the united states of america. so i look forward to serving you with and working with you and i want to tell you how much i appreciate the great job that you've done. i want to tell my senate membership, and our committee members that are here, democrat and republican, we have had the greatest cooperate ive spirit. we had the mission act passed in committee with only one negative vote. sailed through the floor. you all did a great job on your end. we realized that we dropped the ball with you on one thing. you all got the blue water navy through on a voice vote on the floor or a suspension vote i think on the floor. we failed in the senate in two, one today and one last week and i still have difficulty with one or two objections but we will come right back and hit the ground running. the secretary wilkie has done a great job of indicating he wants to work with us and help us where he can. and i'm not going to let that bone, take that bone out of my mouth. this is one bull dog from

georgia that will keep that bone in my mouth until we get it done. a lot of us in the house committee have worked on the blue water navy issue and we want the same team work as possible. and primarily i want to thank you and thank senator wilkie to bring a breath of fresh air in the v.a. he has done a great job. he took over after a problematic and tumultuous time, but he has a good bedside manner which most physicians have. we welcome you and your v.a. membership here today. so thank you very much, chairman, and merry christmas to everyone and the awesome audience today. >> thank you, mr. chairman. and i wish that bull dog of georgia could have done something to those folks in alabama. i wish that can have happened. >> i can't tell what we want to do with the alabama people in public. but i apologize, i have to slip in on a minute but i have one more thing to do on our side. thank you, mr. chairman. >> thank you, mr. chairman. it has been a privilege to work with the senate this year, too.

this term, i should say. the last two years. and i was going to reserve my remarks until the end for you, and i realize you had to leave but what an incredible year, to work with you and senator tester, and we could have never passed 80 bills in the house and heard so many in the senate and our staff worked hand in hand behind us to make this possible. it wouldn't have happened. and i think that 29 or 30 pieces of legislation. and just very briefly, a small thing, like a contract, a cable contract, you might have signed, or a contract on an apartment, and then your spouse loses their life, in service to the country, you ought to be able to get out of that contract for a year, and now hopefully you will be able to do that. little things like that, that don't seem like big things but if you're o-the person on the end of, that they are big things and i have seen it and witnessed

it with my friends who have had to deal with this and these are ideas that came from both sides of the aisle and i want to thank all of my colleagues in the senate and the house for those ideas. i will now yield for any opening remarks. >> thank you, chairman. i look forward to working with you in the next congress to serve our nation's veterans. thank you ranking member tester for also being here. good afternoon, mr. secretary. thank you for taking the time to testify before us today. we will always welcome the opportunity to speak with you about the progress you have made regarding the implementation of the mission act. it has been a little over six months since the mission act was passed. and seven months since you were confirmed as secretary of veterans affairs. i commend you on your hard work so far and assure you that as we move into the next congress, you will continue to find a willing

partner on this committee, meaning me, and as most, as the most bipartisan committee in this congress, i intend to work with my colleagues on both sides of the aisle, with you, mr. secretary, and with our vso partner, to ensure veterans get the benefits that they have earned. transparency and open communication between the department and congress is key to our oversight efforts and to ensure that our work here is effective. now, we've asked for, and need information from the department, so that we have an understanding of the steps the v.a. must take to achieve the objectives mandated under the mission act, over the next six months. we also need to know more about the reported outsized influence, a group of advisers may have had, on your decisions, as v.a. should not be subject to outside influence, or the whims of

individuals or interests who cannot be held accountable, and who did not have veterans' interests, veterans' best interests in mind. however, the v.a. should ensure that the voices of veterans expressed through our veterans service organizations are adequately considered when important decisions such as the adoption of the designated access standards are made. the term designated access standard seems a bit wonky. so what i would like to hear from you today is a simple explanation of what those different scenarios wook like in practice. and i think to unpack designated access data, for the public, we can simply understand them as the criteria by which the v.a. refers veterans out to private sector doctors, outside the

v.a., non-v provide a, provider, what are those criteria? we began with an arbitrary criteria of 40 miles, living 40 miles outside of a v.a. radius, the radius of a v.a., of a health center, and somebody who has been waiting for more than 30 days, without those arbitrary standards initially, we would have spent large sums of money, diverted large sums of money of the v.a. health care dollars. so it is important that we get these standards right. the truth, we've always, always, at the v.a., the v.a. has always embraced outside non-ava medical providers as part of the solution. this is nothing new in terms how

we take vare care of our veterans but we can't do that at the expense of maintaining and adequately growing the internal capacity of the v.a. so these access standards, will outline when and where and how veterans will be referred to providers under the act and how much of your budget will be needed to pay fort private sector care which we know is often more expensive than v.a.'s internal services. so, and we know, based off of multiple studies by the likes of the rand corporation and dartmouth university, vha care is often, is frequently of higher quality than the private sector. so standards that are too liberal for access to private care could easily jeopardize that high quality v.a. care that our most vulnerable veterans rely on as the dollars that support this care will be diverted into private sector care.

so we need that right balance. so we need answers to these question, and i remain concerned with the department's lack of transparency. for instance, yesterday, we discovered via the media, not the v.a., that yet another veteran has taken his life at the bay pines v.a. medical center. this is the fifth suicide since 2013. we should not be first learning about this in the press. we should be notified immediately with facts that will help us act so that we can prevent other veterans from taking their lives. the gao report requested by ranking member walls demonstrates a lack of leadership and commitment by the department to prevent veteran suicide. this is the department's top clinical priority. when veterans between the ages of 18 and 34 are committing suicide at the highest rate, the department's failure to communicate services, and attempt to reach veterans in this age group, via social media, is shameful.

the v.a. offers mental health service, but the quote, disabled american veterans, they are useless and actually preventing suicide, if veterans and family members don't know they exist, or are unable to access them. now, it is simply wrong, simply wrong that only 50,000, 57,000 dollars in funds congress prioritized to address preventing veteran suicide has been spent, and $6.2 million has been left on the table. now, i'm committed to achieving progress over the next two years, and i hope that you will in fact, make suicide prevention a priority that the department claims it to be, so that we, as congress, can support, not criticize, your efforts. the same offer applies to the implementation of the mission act. now, the implementation of the mission act thus far has been rocky. and all too often member, their staff and veterans feel misled,

or misinformed. in the next congress, let's work towards having a productive relationship, an open dialogue, so that we can work together on behalf of the veterans we serve. and i look forward to our discussion today. and hope that it is the beginning of a strong partnership between the department and congress. i yield back, mr. chairman. >> thank you for yielding. now yield to ranking member tester for any opening comments. >> thank you, chairman. and if tim walsh were here, i would be thanking him too, and congressman tacono, thank you very much very, very much. before i get into my written statement, i want to say it has been a pleasure this last congress working with all the other three corners, and i think what's made the relationship work is communication. we have tried not to surprise one another. we've tried to keep one another informed on where we want to go and i just want to give you a prime example of it, when i was walking over here to this hearing just now, one of my

staff members that dr. rowe wants to say something about confirmations. and he is concerned it might embarrass you. that's damn nice of you. i just want to tell you. that and by the way, give them hell in the confirmations because it is ridiculous that the folks are not confirmed for the office. and the other thing i want to say in a statement is blue water. it was objected to in the senate. i know we have been providing information after information after information on this issue. i'm going to tell you, if we're not willing to take care of our veterans, we shouldn't be putting, or making them, and the bottom line is, we've got to get this done. the science is clear. and i would say that i think that maybe the folks in the legislative branch don't realize it, but we're different than the executive branch. and we need to make the call. and if they want to veto the damn bill, then let the executive branch ve stow. it in the meantime, we need to take care of our veterans.

secretary wilkie, thank you for being here. implementation of the mission act is going to fundamentally transform the delivery of the health system to our nation's veterans. for more than a year, we all worked carefully with the white house and the v.a. to negotiate the text of that bill. we were in regular communications with the v.a. on how it would interpret and implement the bill. passing it back and forth. for technical assistance. ensuring that we were all on the same page. since that time, i have grown increasingly concerned with the department's planned implementation of the new veterans community care program created in the bill. mr. secretary, the v.a. is moving away from the direction it was headed just six months ago. make no mistake about that. the most dramatic example has to do with the v.a. designating certain types of care as merely automatic eligibility for community care. six months ago, we agreed that if veterans faced excessive wait times or driving times or distance, to access certain services at a v.a.'s facility,

they should be offered referrals to the community. specifically we discussed access standards for services like routine lab work and x-rays. we agreed to give the v.a. the authority to the extent, to decide exactly what services or categories of care should make veterans automatically eligible to receive care within the community. now that we've passed the v.a. mission act, the v.a. has decided to head in what i believe is a completely different direction. the v.a. now indicates the plans to designate access standards that apply to each and every type of care a veteran might need. this would essentially outsource all segments of v.a. health care to the community based on arbitrary wait times or geographic standards, which were supposed to be moving away from by any of the choice programs. and that's despite the fact that several studies, one as recently as last week, have indicated that the quality of care at the v.a. is good or better than the private sector. let me say that one more time. because it is not said enough.

as recently as last week, we received yet another study that indicated that v.a. care is as good or better than the private sector. to make matters worse, v.a. officials have offered only vague verbal descriptions of the various sets of potential access standards under consideration by you, mr. wilkie. it also concerns me that each time we discussed this issue in the last two months, v.a. officials have given us wildly different estimate estimates of budgetary resources needed to implement these sets of access standards that you're considering. for example, if the department chooses to go with the same access standard used by tri-care prime, we have been told it could cost anywhere from $1 billion for the first year, to more than $20 billion over five years. some of the v.a. estimates indicate that the costs will be less than what we spent on choice. but would make a greater percentage of veterans eligible for community care referrals. that doesn't make sense. so we need to know what you're doing, mr. secretary, and how

much it is going to cost. no conflicting or vague answers. >> no fuzzy math. no game, because the stakes are simply too high. mr. secretary, not just six months ago you came before the senate veterans affairs committee and you said you would oppose attempts to prive adverti advertise privatize tv health care system. and i believe you. and if you don't, you will bring down the whole vote and spend more time and money sending veterans in care that is less tikely and not as high quality. it is a bat deal tore the taxpayers and a bad deal for the veterans who would ultimately bear the brunt of the services or the benefits of the increased cost of community care. and that will lead it a bad deal for veterans. bought at some point, you will burn through the funds quicker than expected and come us to because vha is running out of money again. veterans will be in limbo when

seeking community care as congress sorts out the v.a.'s fiscal issues. i am frustrated because this hear woog have a great opportunity to talk about the great work being done by the v.a. employees across this country every single day and indeed they are. and about how their critical work will be bolstered by additional health care officials. and about how streamlining the various v.a. community care programs in the new community care network will make care more efficient, more timely, and more seamless for veterans. instead, we're here left trying to figure out why the v.a. decided to take things in a different direction, in what i believe congress is intended, and certainly what veterans have advocated for. my suspicion is that it is politics. i hope i'm wrong. because at the end. day, i really hope that meaningful consultation will take place before final decisions are made. we've got this far, by working together, and by taking our cues from veterans. and it would be a shame to undermine those efforts and relationships, because of a

political agenda. i said it before. and i will say it again. i have tremendous faith in you, secretary wilkie, to make sure that the v.a. is run in a way that our veterans deserve. we need to really step up, and do it. thank you for being here. >> thank you, gentleman, for yielding. we're joined on our first and only panel by the honorable robert wilkie secretary of the department of veterans affair. welcome. senator wilkie thanks for being here. the secretary is accompanied by dr. melissa glenn, the assistant secretary of the office of enterprise. and the executive in charge of the veterans health administration. thank you for being here. senator wilkie, you are now recognized. >> thank you, mr. chairman. and thank you, chairman isaacson, chairman elect tacano and senator tester and distinguished members of both committee, i want to thank you to address the opportunities to implement the v.a. act and share

you with the governance and management approach instituted over the last 130 days. as you have said, we are on the cusp of the greatest transformative period in the history of v.a., and your leadership led to the passage of that historic legislation. as i testified in front of the senate veterans affairs committee earlier in the year, i am happy to report that the state of the department of affairs is better and it is better because of the work that these committees, and the attention paid to our department by the president. as secretary, i visited 17 states in 130 days, 23 hospitals from anchorage to orlando, four claims processing centers, and the veterans treatment court in maryland, and as senator tester said, am astounded by the commitment of the v.a. work force. it is dedicated. and it is in my opinion the finest work force in the federal government. today, i'm honored to have with me two senior v.a. leaders. dr. steven lieberman, the current executive in charge of

the veterans health administration, and dr. melissa glenn, the assistant secretary for enterprise integration. we are committed to implement can the mission act by june, 2019. and describe how that kmichlt is being fulfilled. we have established a task force representing key offices across the v.a., and guided by experienced program leaders. we now have a battle group of progress reviews to align resource, identify and mitigate risks and deliver on the promise to transform v.a. health care, that puts veterans at the center of everything that we do. this effort is emblematic of a new govern and management structure we have established throughout the department. that is how we were able to identify the technology supported, the gi bill implementation, it was untenable. i made the decision to define a new approach to deliver education and housing benefits to our veterans and their family

members. i want to emphasize that we will execute the law as written, and every post-9/11 gi bill beneficiary will be made whole of their housing benefits based on both sections 107 and 501 of the forever gi bill. i made the decisions not only to stabilize the delivery of services, but to improve the current choice programs. the expansion and extension of the tri-west contract ensures access to community care for our veterans. the decision allows the smoother transition to the community care network contracts when awarded. after multiple delays prior to my arrival at v.a., the acquisition process and subsequent awards are back on track. community care regions one through three will be awarded before the end of february, 2019, and region four is expected to be awarded in march. once active, these contracts will support a key pillar of the mission act, by giving veterans expanded choice in their health

care. as parts of our new community care program, we are addressing the timeliness and accuracy of payments to providers. we are moving away from paper claims and requiring providers to submit electronic claims through our new electronic claim administration and management system that will be deployed next year. through the mission act, it established a center for innovation, care, and payment, to develop new approaches to testing payment and service delivery methods. the center has developed a charter and is developing criteria for pilot projects to drive health care quality and efficiency. another pillar of the mission act is ground-breaking support for care givers. there are 5.5 million veteran care givers across the country. i had the privilege several weeks ago to address the third annual national convening of military and veteran care givers jointly sponsored, by the elizabeth dole foundation and veterans affairs. the work of senator dole to

invest in care givers and their experiences, to strengthen our ability to successfully execute an expanded program of comprehensive assistance to family caregivers under the mission act. i would be remiss if i did not thank the foundation of vsos for their efforts to make sure that this effort was incorporated into the legislation. and i will take the opportunity also to thank in person someone who is familiar to all of you, and who was instrumental, not only in the development of the mission act, in the caregiver program, but someone who has been on point for veterans for many years, and he is retiring, and that's gary augustine of disabled american veterans and i thank him for being here as well. the other most meaningful aspect of this legislation is the series of related projects, products, that ultimately support the work of the asset infrastructure review commission.

these include outputs of national market assessment, and our strategic plan. and a data-driven asset and infrastructure assessment and recommendation, with input from our veterans, employees, vsos, local communities, and other key stake holders. the v.a. is embracing the opportunity to assess our footprint and develop recommendations for modernization and realignment of the facilities. mr. chairman, i would like to beg your indulgence for a minute, and i'm going to go offscript, and it is partially in response to a series of stories that i read this morning, stories that have particular meaning to so many members of these committees than is on the issue of suicide prevention. when i was acting secretary of the department, for eight weeks, i declared that suicide prevention is the number one clinical priority of the

department. in addition to that, i named a permanent head of our office of suicide prevention, dr. keta franklin, who was the head of our efforts at the department of defense when i was the under-secretary. in addition to that, we have developed, with the department of defense, a stream-lined and comprehensive program to begin addressing the issues that impact our veterans and the issue of suicide, beginning from the time that they enlist. our transition assistance program is done in conjunction with secretary mattis, and now, thanks to the work of this committee, we are including other than honorable dischargees, in our education and outreach efforts when it comes to suicide. the tragic aspect of this is that for the 20 american warriors who take their lives on a daily basis, 14 of those

warriors are outside of the department of veterans affairs. when i have gone across the country, i have asked governors, i have asked mayors, i have asked vsos, to help us find those veterans. when i was in laevg recent, alaska recently, i spoke to the alaska federation of navy, 50% of the veterans in the state of alaska, are outside of the v.a. system, and i've asked them to help us find those who might be in danger. suicide prevention is the number one priority of this department when it comes to our clinical efforts to keep our veterans healthy and well. in addition to that, i do want to say that i echo what senator tester said. last week, dartmouth and the annals of internal medicine indicated that the department of veterans affairs health care, medical care, is as good or better as any in the private sector. that is the story i wish to

tell. the other part of that story is, and it will come as a confounding statement for some in the press, that a conservative republican is here saying that. i am incredibly proud to be part of the work force that i consider to be the finest in the federal government. in my travels, i have seen the dedication of our men and women. 370,000 strong. and it is my pledge to tell the good news stories that they have created on the behalf of our veterans. in addition to that, another story that i am proud of is that the partnership for public service, for the first time in memory, has now included the department of veterans affairs, in the top third of all federal departments when it comes to workplace satisfaction, and the pride that our workers have in being part of the v.a. that is a great step forward. without that pride, we will not

be able to deliver the kind of customer service that our veterans expect. in addition to that, i'm also happy to say that the department of veterans affairs, when time issued its list of the 50 most influential health care minds and providers in this country, the department of veterans affairs had researchers on that list. it is a good news story to tell. it is one that i am proud to tell. and i am very happy and humbled to be part of that outstanding work force that on a daily basis helps veterans remind all of us why we sleep soundly at night. mr. chairman, i thank you for the indulgence and look forward to your questions. >> thank you very much. and just very quickly, since we have a large number of people here, i will be dropping the gavel at five minutes, including myself, appreciate you being here, but i would like to focus

today on the, on this hearing, on the implementation of the v.a. mission act specifically the community care part. because that is, that is coming up in six months. and really, it's literally, if we can do three things, i think mr. secretary, and if you can lay out and give me some ease about how i feel about this, one, will we have networks in place. number two, can you schedule an appointment to the doctor and those networks? and number three, will you pay the bills once the veterans have seen them, so they don't get the bills. nd i think if we can do those three things and my concern, we have four regions of the country, the various regions have a year, according to the law, to put these networks together. and i know you're sign can the contracts for three, you said hopefully by february, and then region four by march.

that's less than 90 days from the time this thing goes live, that last contract, because i remember very well in 2014, the fiasco that occurred there. so of those three things, when we go live, are you going to need more time? and quite frankly, if you say it isn't happening, i would rather keep doing exactly what we're doing, and implement it a month later ann than i have this thing fall on its face and we fold up all of the community care proms that we have into one and it not work. >> yes, sir. the, obviously the goal is to fulfill those time commitments. i'm going to take a step back, and answer the third part of your question first. and that is the timely payment to our community care givers and particularly our small town doctors across the country. without that, the entire choice system contained in the mission act fails. we have learned valuable lessons

from the experience of choice. i do believe that we have the beginnings of a comprehensive set of standards, where by we will, we will take to the country, to bring those community care providers into the network. those contracts are ready to go. we do have the lessons learned from, as i said, the problems that we had with choice. right now, and i will go ahead and address an issue that was raised in the media this morning, tri-west is the bridge to the expansion of our program through the community care networks. and i am confident that given the governance structure that we have in place that we will be able to reach, reach those goals. i will also say that if at any time i don't think we can, i will be up here post-haste, to make sure that we inform the

congress of that, that contingency. and dr. lieberman wants to say anything about where we are, in terms of the contracts. >> so we're really pleased with how our contracting has been going. we've been meeting weekly on this. and as the secretary said, we expect it to be completed on schedule, as he told you. and then we are ready to go with all of the topics that you have brought up. we certainly are implementing a number of things to help with timeliness, including the timeliness of the payments. we are going to be requiring, except in rare circumstances that the payments be electronic which speeds up the claims process. we are also going to have an off the shelf product that will auto adjudicate the claims and pay them timely. >> and i would note, that's key. the department of veterans affairs, as this committee, these committees has noted on more than one occasion has an

i.t. problem. when it comes to claims processing, hands have to touch each claim. what we have done is look to the market for off the shelf technology that will allow us to automate the claims process. so that individuals are not having to touch each claim, and this will put the department of veterans affairs in line with the most modern health care administrations in the country. >> well, my time is about expired but this is what i want to have happen. if i'm a patient and i come to see the doctor, and i need to go see a neurologist or whomever, i'm seeing the v.a. doctor that day, i walk out front, the v.a. doesn't have that specialist in the hospital, i get my appointment schedule, i get it made, i go see the doctor, that information is transmitted back, and the doctor gets paid. that's how the system works. i had surgery two, well, 18 months ago, two weeks after surgery, the bills had been paid by the third party administrator. and that's the kind of, i know it is not going to be that

great, but that is the kind of efficiency we want. and i hope that we have. and i'm 'not expecting it on june 7, but i am expecting it sometime fairly soon. you're recognized. >> thank you, mr. chairman. mr. secretary, over the last few month, the committee staff has heard from various stake holder, including the v.a., conflicting information regarding the v.a.'s development and/or adoption of what i talked about in my openings statement, designated access standards. we also heard from v.a. staff the president is likely to announce the adoption of a designated access standard model during his state of the union address. however, congress has not yet been made aware of which models are being considered, and the reasoning behind any imminent decisions. would you commit to us today that you are willing to offer each of the four corner, and i would say members of the committee, but i mean it should be made available to all of us,

a briefing by millman, who is the actuary, prior to the state of the union? and a reasonably before the state of the union. >> mr. tacano, what i will promise is that as soon as the president is briefed, i owe him that courtesy, and certainly, he is responsible for the final decision, and once he makes that decision, i will be up here with our team to brief this committee, these committees, for any comments and advice you have, and any corrective actions that you might have. it is absolutely vital. i think i mentioned in my confirmation hearing, i grew up in this institution, i know why article i is the first article, and i will commit to coming up here and when the president does make his decision, and it is still not clear if he is going to announce anything at the state of the union, but i hope to have him brief and have those

decisions made. >> mr. secretary, i'm a little concerned that this decision could be made, you know, the night before he delivers his speech. and makes a grand speech about how every veteran is going to be able to see any doctor they want to see. i mean that's one model. the veteran can see any doctor they want to see. of course, that sounds good, but there is a lot of down sides to that kind of a model. all the more reason why, the vso's, many of them, are complaining that there's a lack of participation, as per what we said in the mission act, that they should be participating in the development of these access standards. and so i'm not really satisfied with the answer. i wish we were able to get better insight as to what models you're considering. what the costs are associated with each of those models. because that has a lot to do with how much money might be diverted from, you know, regular central v.a. care.

>> let me answer the second part of the question first. in terms of engagement with the vsos. i can say that they are a vital part of what we do at the department. in my time as secretary, we have doubled the number of vso engagements that the department had prior to my arrival. the majority of our vso engagements are handled at the undersecretary level, or above. over the last nine weeks, our vsos have experienced briefings from senior leadership in the department, that lasts well over four hours a week. i will also tell you that in my travels across the country, i have made it a point to reach out to veterans organizations, in the rest of the united states, in alaska, i spoke to the largest vfw post i think west of the mississippi. i was just in your area of

california, spent two hours with veterans leadership in southern california. did the same thing with the indian nations, the native nations in oklahoma. and also in senator hirono's state on island, on the big ide and also in oahu. . so that is important to me. if the veteran is not at the center of the decisions, it won't work. but i will say when it comes to access standards, i have in mind, not only senator tester's state of montana, when it comes to the ability of our veterans to get to services, but also have in mind some of most heavily congested metropolitan areas this country. we have to make it easier for our veterans to get the care that they need. but i will also say, and i will repeat what i said when i testified in the senate in september, my observation, my

experience, and senator tester said it earlier today, veterans are happy with the service they get at the department of veterans affairs. i have not seen any indication that the majority of our veterans are chomping at the bit to find alternative ways to take care of themselves. the most important part of this is the one that is not quantifiable, and that is the communal nature of veterans care. veterans want to go places where people speak the language and understand the culture. that is what i have experienced in my lifetime around the military, and that has certainly been validated in the travels that i have undertaken in the very short time that i've been the secretary. veterans will always be at the center of any decision that i make. >> appreciate the gentleman yielding. >> i want to thank mr.

secretary, and i am sure mr. secretary you are aware of an article published yesterday, outlining the program, that was reported that 1.9 billion, nearly a quarter of the funds spent on choice, were for admin fees, i've got a huge problem with that. do you have a problem with that? >> absolutely. >> okay, so moving forward, what are you going to do, or what are you doing, when it comes to admin costs from the private providers? >> well, in order to move forward, senator, may i please take a step back? >> quick step. >> this committee addressed the problems with choice with the mission act. the article in question addressed the problems with the system before mission was passed, before i became the secretary. i am cognizant of what went on with choice.

you mentioned it, hastily put together, in response to a tragedy in arizona, so it is my direction, and i believe because of negotiations that we've been having with potential community care providers, that those administrative costs you will not see at the level that we experienced through choice, because the department, i will admit, was taken advantage of. because of the hasty nature that took place when the program was put in place. >> i will kind of accept that. but a lot of the folks who are delivering the care now under your thumb are close to one quarter in admin costs. close to one quarter. now, i asked my staff to find out where the v.a. was before choice, for admin, but as i recall, it was one of the, not if the cheapest delivery care system in the nation, when it comes to an admin cost. so i would say that. the other thing i would say is this. and congressman tacona talked

about this, if access standard models are expanded to the point, and i don't think it was congressional independent for, this in fact, i know it wasn't, for unfettered choice, we've got a big problem, because it is going to cost more money. the care isn't going to be good. i talked about my only statement about blue water veteran, you know why we can't get blue water folks covered? money. extrapolate this a little bit. if it costs more to be in the private sector, if admin costs are higher, benefits are going to be cut. and so while you say it is the president's decision, and it is, he's the boss, there better be some good, good information coming from you and the people that know belter that this access standard needs to have some controls around. it would you agree? >> i agree with you. i just want to mention that the administrative costs are not as high as was quoted in that article. the number is less and it has actually been over years, so it is a much lower percentage.

we have learned, since choice was first implemented, in a hurry, what we now move towards is itemization of the administrative charges, so there is now a range of what the charges are, and to close to the amount that was in the article per individual, but then with the care network, what we're actually have learned more and we are going to go to a new model which will further decrease the administrative costs. >> so are you planning on putting overhead caps on those contracts? >> we are moving towards a standard that is similar to what the community does. >> that's a no? you're not going to put caps on them? >> we certainly can -- >> i'm not advocating for it but what i'm saying somebody has to have the finger on these costs because i tell you, we're talking about billions of dollars. and after the fact, we can't get it back. and those are dollars that should be spent taking care of veterans. is that, so do we have a plan?

do we, have because the truth, with the mission act, we passed it with the best of intentions, but it could be a train wreck too, and i hate to tell you, but it is kind of in your lap, it is in your lap, so when we're talking about too high admission costs and we're talking about access standard models that were basically unfettered choice, we could end up with a problem where we're actually cutting benefits where veterans moving forward, and my guess is if you ask any of the vso's, that would not be a good thing. so i want to make sure that's on your radar screen. i got to have one more and i got to get it in and i only have 25 seconds left. you talked about giving information to the vso's. you talked about briefings. are you gathering information back from them? this isn't an information dump on the vso's. you're actually listening to them, and finding out what their concerns are. because i'm telling you, it is critical. it is critical for us. it is critical for you. did you want to answer that, dr. glenn? >> i can do it. >> go ahead. >> absolutely. in fact, many of the people in

the audience will be with me tomorrow morning, in my office, discussing what was discussed here, and they will be telling me their input. >> so i'm not throwing anybody under va. it's not where it needs to be. >> senator, let me add one thing to that. >> add that very quickly. >> i'll do it real fast. something has happened in the makeup of our veterans' population. since the fall of saigon half of our veterans are under the age of 65 which means they have different cares and they have different interests. what i have done in my short time is actually opened the apperture at department of veteran affairs to bring in veterans that aren't traditionally part of the system, purple heart, blinded veterans, student veterans. in fact, we have more veterans at the table discussing their issues with us than we have ever

had and that mirrors the change in the active duty and reserve population that we've seen. so you have my commitment that every veteran who wants to talk will be heard and input be given. >> thank you, gentlemen, for yielding. senator moran, you're recognized. >> thank you very much. mr. secretary, thank you for you and your team's presence today. i asked my staff to give you the statutory requirements and it turned out to be pages. in the mission act you are asked to develop regulations and the goal of that language was to make certain that congress was informed before the regulations were determined, not a consultation that says this is what the regulations will be. my understanding is that those consultations that have occurred have progressively gotten better. we still want more specificity and you seem to be headed in

that direction, but i would encourage you and your team as we get those briefings to give us the details so that we can encourage, comment, suggest in advance of decisions made in the department of veterans affairs and that is an intentional aspect of the language included in the bill. let me see if i can get a couple of things in the four minutes i now have left that are specific. first of all, how you define how the department of veteran affairs defines episodic care is a hugely important issue in regard to how the mission act will be implemented and what kind of care our veterans will receive. can you, mr. secretary, in a specific way, tell me how you will define episodic care? >> i will let the doctor describe that. >> doctor, thank you. >> so -- thank you. so it will depend on what the issue is. certainly, we have the six

different criteria that go into it. if it is something where you require orthopedic surgery and require physical therapy, we will bundle the care for that whereas if we can't provide it we will provide it outside. >> obviously, in four minutes there's not a way to be terribly specific, but it will be something that we will continue to ask you. i will tell you that my interest in these topics is generated by our casework and what veterans bring to our office and what problems they have under choice. the idea that you have to go back to the va every time to get the laboratory work and the x-ray and that is not an efficient system and one not designed to fail and not be beneficial to the veteran. would you commit that we'll be able to review your definition, mr. secretary of episodic care before the regulatory process. >> let me turn to access standard which is have been a

topic of conversation by most of my colleagues who have spoken already this morning. here is what i would look for in today's setting. i'd like to have assurance that might be applied to where the veteran links to his or her post office box as has been the case in the past. >> absolutely, and i've said on many occasions and most of my focus have been on the western united states. that is absolutely necessary if we're going to make choice work. it is striking to me that in 2018 we don't understand the scale of the american west and what you've said is absolutely essential if we're going to make excess standards work. >> another piece of work that has become a challenge for us is the definition of in the va and that is that in circumstances in which our veterans are trying to access care, the va's response

is the care is available within the v abroadly. in my view, the question is is the care in the va available at the facility, the hospital where the veteran lives and our veterans are being asked to travel long distances because the care is available in the va, but not geographically. that is one of the things that we'll fix as a result of the mission act and we will get a system in place that allows the veteran the opportunity to get that care that is most convenient to him and to his family. senator tester is gone and what i use is the 700-mile round trip in montana, kansas, and the distances are almost as great. >> absolutely. thank you, mr. chairman. >> senator murray, you're

recognized. >> thank you very much, mr. chairman. >> before we get in the main focus of this hearing and my concerns about the caregiver bill, i do want to remember the chaos with the current gi bill. it is unacceptable to leave veterans without a stipend or an incorrect stipend especially when they rely on that to pay for rent or food and it is unacceptable to put veterans' enrollment at risk by tuition payments and these are basic tests that the va cannot get wrong. you've had more than a year now to implement the changes in the forever gi bill. i've written you two letters and one more than a month ago and one more than three weeks ago looking for how the va will fix these payment problems and how they'll address the short comings with the gi bill comparison tool and especially in light of the recent collapse of eca to explain why the department of education has

stopped sharing accreditation information with the va. i don't want you to take the time to answer rid now. i would like a written response to that and i want you to know we're all very concerned about it, but do i want to ask about the program, according to briefings from the va the department has ruled out trying to narrow out the eligibility criteria for the caregiver program, but i am still very concerned that there are a number of issues that the va is looking at that i am concerned about including changes to the stipend, restricting veterans based on their type of injury or requiring a minimum disability rating. this seems to be va's still focused on keeping people out of the program instead of making it work better for our veterans and yesterday npr reported on several cases where veterans including a double and triple amputee are downgraded or kicked out of the program completely inappropriately and these are,

by the way, not one off va cases and we're hearing it's a continuing problem in the va's management of this program and when the va previously downgraded and terminated care give e the va assured me that they led to those type of actions and it is very clear it is not true and i would like you to immediately reinstate a ban on downgrades and terminations until the va can demonstrate to us that the serious management problems have been corrected and these types of outrageous errors will not occur again. >> i will say that caregivers is especially important to me. i'm the son of a gravely wounded vietnam warrior. >> i appreciate that, and i've seen my mother and family take care of my father prior to his passing last week. >> i appreciate that. will you reinstate the ban?

>> i don't know the rule, but i will tell you the national public radio story that problem was corrected within 24 to 48 hours. >> those are not isolated cases. we're hearing many of them. >> and those cases, it is my understanding, have been corrected because people were not record the veg lagregulatio properly. so my promise to you is i will do everything i can to make sure everybody stays in the program. it is that important to me personally. >> can i have your assurance that no one else will be downgraded or kicked out of the program until you look and make sure that the regulations are being implemented at every level correctly? >> absolutely. i will make that commitment and we'll brief these committees. >> okay. and also -- i won't have enough time, but i would like you to get me what your guidance to the program office is and your guidance to the field on how this is being implemented so that we can see how you're telling your staff. >> okay.

and i am also very concerned about the implementation of the changes to the caregiver program that is part of the mission act. before the expansion can begin. you have to certify that a new i.t. system is in place and the law requires you to have that system in place by october 1st, that was a month and a half ago and this is not a new requirement and gao's initial recommendation to fix the i.t. system was made in september 2014 and the va has assured me that it is working on that issue and i want to know when you will have that i.t. system in place and have the certification as the law requires. >> the goal is october 1st. >> i would -- i would not be telling you the truth if i told you that i was absolutely certain that given the state of va's i.t. system that that day will be met. >> that was a month and a half

ago. >> yeah. the dates passed. >> no. it's october 2019. >> to certify that the i.t. works. >> are we confusing two dates? >> that's your goal and not the goal given by congress. >> the time to certify that the new goal is ready is october 19. we did miss the october 18 date to put forth -- >> you gave yourself another year. >> well, there were two dates. there are two dates the senator associated with the requirement. the first date which was october of this year was for validating and deploying a new system. we have not deployed the new system, but the certification of that system was prior to expansion. >> cdid you define the requirements for that system? >> we have defined requirements

and we are on user acceptance testing of the system and we are working through that and we do not want to deploy a system until it has been thoroughly tested and we feel is capable of serving caregivers and veterans' needs. >> i will say that has been the problem that i identified and talked, discussed with the members of this committee. the gi bill was a classic case of a program imposed on a system that was incapable of handling it. that's why i had to make the decision to go back to the old system on the gi bill. the same applies here. the system was not capable of addressing it. i give you my commitment. i am doing everything i can and so is the department to bring the i.t. system up to modern standards. the g.i. bill, weir talking about a 50-year-old i.t. system, and it's not acceptable, but you

have my commitment that we're working with the best minds we can find to make va a modern health care administration and benefits. >> i know my time is up. i've been on this committee for more than 20 years and i always hear we're not going to get an i.t. system because there's a problem. every time it change e every time there's problems. we've got to get this right. people are counting on us. >> i appreciate the gentle lady for yielding back and i've heard that for ten years. general bergman, i yield to you for five minutes. >> i can yield back right now, but i won't. folk folks, we'll get to the heart of the matter very quickly. you are developing a system that will benefit the outcome for the veterans. in my district, the first district of michigan, if any

system will work in that system it will work anywhere because you have a largely rural district with some small cities so i am hoping or at least optimistic that you have factored that in that whatever system you're designing to get the veterans, caregivers, in this case, into a functional status that you consider the tyranny of distance and the tyranny of weather and all of that. now in setting up your network, i'm guessing, although there aren't slide, there are certain assumptions you have made and certain risk assessments that you would like in those assumptions and we don't need to talk about it here, but if you would give us that list of assumptions and the risks that you have put together that would be greatly helpful and i notice

in the slides here that i would guess in these meetings, whether th they be weekly or bi-monthly if there is a course correction in a meeting or an update that needs to be made, what do you do? >> i'm a pilot. you see a need to change your heading. change your heading, don't wait. >> thank you, congressman. right now our team is engaged in 180-day reviews back at the va in the provisions of the mission act and we are, as you say, identifying risks and identifying as senator murray highlighted things like i.t., how do we take different parallel paths towards getting to that october date. so we are bringing that through our executive committee and issuing guidance to the teams and working through resource

requirements and working through changes in project plans and understanding what our needs are and bringing forward the stake holder engagement protocol so we can continue to uplift this program and make sure we can hit it. >> do you feel it seems like there's a chairman on the subcommittee oversight investigation and is there aness is of urgency? within your folks that are trying to implement. you have good people trying to do the right things. is the is there a sense of -- and this may sound like an oxymoron, bureaucratic urgency? >> yes, sir, and that's one of the reasons why a battle rhythm was implemented. i have a military background and not as extensive as yours and the department has never had anything this complicated and we do now and we have just as we would on the flight line in my

air force flight, so, yes. and i'll point back to what i said earlier to the attitude of those in the department and it's been my experience that we've had incredible support of those in the career leadership because they understand that va can't fail on this one and i'm very happy with that attitude. >> well, number one. thank you for your service and all honorable service is -- it should be respected by all and personally the proudest moment i've had is to lead marines and be mentored by lance corporals who have a 20-year-old view of the world any that's what drives us, but that and the interest of time i will yield back 50 seconds. >> i thank the gentleman for yielding and one thing we can do is to confirm his assistant secretary for i.t. that would be helpful. i now yield to ms. brownlee for

five minutes. >> thank you, mr. chairman and mr. secretary for being with us today. i wanted to follow up with senator murray's questioning with regard to the caregiver program, and if i could, i heard you make a commitment, but i want to be abundantly clear that you are committing to us today to not modify any of the current eligibility requirements within the caregiver program as it expands. >> i am committing to review every case involving a caregiver who is in distress. i am also committed to making sure that before any decision is made on the future of the program that this committee is involved in it, and as i told senator murray, i will be reporting to her on the path

forward. it is important to me personally because of my own experiences and we will get this right for the 5.5 million caregivers out there. ? you mentioned earlier in response to some other questions with regards to the importance of the input of vsos and veterans in general. you respond, i think, by saying that you've e paxpanded that audience of veterans to younger veterans in trying to get a broader representation which i think is good. on the other hand, the leadership of the vsos really lead by consensus within their organization and representing that broad sense, and i, too, have heard from many of the vsos that don't feel in particular of the caregiver expansion that

they are or have not been involved to the degree of that i believe that they should be in terms of prospect early making right decisions as you move through this process. well, you have my commitment and they will be involved. they are involved in making sure that we make the right decisions, but i will fall back in what i said earlier. it's important for us as you pointed out, to make sure that we hear from the entire cross section of the nation's veterans. i said in my statement that on the caregiver effort, that would not have been able to come to the finish line without the work of what i call the foundational bsos and that is my recognition that they are central to the entire issue of caregivers because the majority of veterans

who were in that category and who need that family care at home come from vietnam and some left in the era and the foundational vsos are the ones who represent the community most impacted by the caregiver. >> can you commit to providing our committee progress reports in terms of the i.t. system for the caregiver so that we can feel as confident as you do in terms of meeting the october 2019 deadline? >> absolutely. >> that would be great. just in terms of broadly, the governance structure that you've set up for assistance in the implementation of the mission program. i think one of my frustrations on the committee, i've served on the committee now for six years is that we have va

representatives come to testify. they're updating in this case and we'll want obviously, frequent updates on the progress with the implementation of the mission program, but many times they come, they avoid answering the tough questions, the responses usually, we'll take it for the record and we'll get back to you. i have found that i don't get -- i don't get responses. if i do it's months and months later so i just would like, again, to get your commitment that if it's you or others representing you that you will provide us with the best information possible to be informed and prepared for our questions and at the end of the day given -- you've set up a governance structure that i want

to hear from you that at the end of the day the buck stops with you and that you alone are responsible for the completion of the mission act. >> congresswoman, that is right. i'm accountable to you. i'm accountable to vsos and i will say, having grown up in this institution that i will note that in the time that i have been the secretary and the acting secretary we have seen a 20% increase in terms of the number of round table briefings that we've given to the committee and staff and we have seen a 50% increase in terms of the number of actual individual congressional engagements with offices around the congress and that is part of the commitment i've made, in my confirmation

hearing i will make that better and again having grown up in the institution i am aware of article 1. >> thank you. i yield back. >> thank the gentle lady for yielding. >> mr. secretary, in my mind the mission act is in making sure that the committee -- it actually makes it and reaches the veteran. our committee has a spirited debate every year about the funding levels, but the reality is, and you can pick your analogy here and it seems like we've been leaking money, the veteran does not receive the necessary care in a timely fashion. when the providers do not get paid they eventually drop out of the network and the veteran far too often winds up in collections. so by consolidating all of the legal authorities and programs for community care, the va

actually gives the va the first chance in year to make the system works. do you agree that the mission act merely maches it possible and that it's only the beginning of a lot of hard work with stronger audits and connected i.t. service ask clear communications in so enema other areas? >> absolutely. absolutely it is. it is the greatest first step, but it can't stop. >> i appreciate that sentiment, but i do want to explore one aspect of that hard work. achieving interoperability with the ehrs is one of my top priorities and i know from speaking to you personally it is one of your top priority, as well. the va representing cerner will advance interoperability

providers that already run cerner, but what about the other medical practices that have other ehrs? what is the linkage between the office of community care and the office of electronic health record modernization to start specifically attacking that problem? >> right now, i will -- i will confess i'm not an i.t. -- those standards in the operations in the pacific northwest and alaska so that these systems talk to each other. our first goal that it dod and va talked to each other. i think we are far along the road on that, but the next is to make sure that we communicate with doctors in the private sector, community care hospitals as well as private pharmacies and to talk to those systems not part of the cerner network. it's done in other areas of the

country. i am confident that it will be done here. i will say quickly, you are right about the interoperability and i will say to the issue of privatization. i have argued that the success of the electronic health records systems ensures that va will stay at the center of the veterans' health care, that va will be the central node no matter what that veteran decides to do and that that is one of the answers when it comes to the issue of privatization. i see that as a veteran myself. i see that when i look at the experiences of people and my family, as well. >> appreciate that. >> one of the other areas it is consolidating the community care contractors and whoever wins the contracts to bring to the table a new and improved claims

processing system. >> the va will still have to pay the companies somehow. the idea is to outsource the i.t. system along most of the claim -- along most of the claims playing function. can you comment on the thinking here and how that will improve the situation? >> overall, we are making as you have mentioned specifically, there are changes and it's not just the consolidation of the regulations that govern the choice program now and thigh are implementing payment system so we can adjudicate claims and we also are changing the way we will pay the third-party administrator, as well so that they have the funding available to pate providers. so all of that has to happen in tandem and as part of the implementation to get to june

6th. as you mentioned there are other aspects and it's not just the consolidation of programs and it is building up the technical infrastructure associated with the community care program and there will be changes in how the tpas are paid, as well, and we have committed significantly to looking at the potential for fraud, waste and abuse in the system. >> thank you. my time has expired. >> thank you for yielding and we recognize mr. lamb for five minutes. >> thank you for joining us today. >> are you aware that the congressional budget office estimated that the mission act would cost around 46.5 billion over the 40 years from 2019 to 2023? >> yes, sir. >> that number is familiar to you? >> yes. as far as i'm aware there is no pay for that $46.5 million, right? >> correct.

>> those would be discretionary funds? >> yes. so they would count against the budget gap? >> yes, sir. >> and if -- if we went over that budget cap because of this 46.5 billion or any other spending that would trigger sequestration, right? >> correct. >> so, in other words, for that 46.5 billion in order to avoid the sequestration we'll have to find the money within va's current budget, right? >> correct. all right. now are you aware that the president has asked that each of his agencies cut their total budget by 5%? >> yes, i have. >> did you receive that request yourself? >> i did. okay. >> do you have a plan to do that? i have discussed the plan with omb. >> what is the plan? >> i have discussed the plan with omb and the president has aren't approved it.

so i will wait for his decision. >> will the money for community care be cut by 5%? >> i am -- well, first of all, i'll say for the choice program we're fully funded into next year. i have no -- and i will say that in the submission that i made there were no cuts in community care. so the 5% would come from the rest of the va's budget that does not involve community care? >> absolutely. and as a steward of the taxpayers' money, i'm going to do my best to make sure that we are as efficient and lean as possible. >> so actually the non-community care part of the va's budget will be cut twice, right? it will be cut by the 5% and it will be cut by whatever needs to be spent by community care? >> well, we don't know where it's going to be cut. i've made proposals --

>> you have made a proposal? >> i have made a proposal. >> you're not sharing any of the details of that proposal? >> because i've not had the conversation with the president. >> does it involve cuts to personnel? >> it makes efficiencies in the system. i will say that. >> does that involve fewer personnel two or three years from now than there are today? >> i can't say that. i can say that in the last fiscal year we've hired 11,000 more employees at va. so we have been hiring at a very steady rate. . will you commit to providing us by the end of this year an itemization of the things that you propose to be cut with that 5% requirement? >> i commit to discussing with the committee at the earliest possible date the decisions that are made by the people who are responsible for those decisions.

again, i owe the president the courtesy of having him make the decision and then come to the congress and you are the ultimate arbiter of what that budget will be. i can tell you from my experience what usually happens in democrat and republican administrations when a budget comes to congress. i can't think of the last time one was passed as it came over from the white house and that's just a practical nature of the business. >> do you know when you'll find out from omb or from the president. i certainly hope in the next few books, once you receive worried on them to brief us. >> once the president has given the all clear with the budget process usually anything to the

finish line as january and i'll be as i can as they existed in 1974. >> we would like to see an itemized proposal that you have give tonight white house as to what should be cut, and we would like to see that at the earliest possible date. >> absolutely. >> thank you. mr. chairman, i yield back. >> thank you for yielding. just to clarify all of this, it does get wonky, but the fact that you would cut 5% doesn't necessarily mean that it would come out of the va's budget and i would refer to this grab right here. you can take a look at it. these are the number of employees right here, mr. lamb, that have been hired and i've been here ten years and looked at this and the va and they're retiring 31,000 during that time, and on the budget caps, if we go back to the sequester

levels, that was away for two years. we've gone from 97 billion when i showed up here in 2009 to this last budget was 206 billion so it's over doubled in the last ten years and we found that money elsewhere and it didn't necessarily come from the cap. the va benefited under the caps. >> mr. chairman, may i make one more comment to mr. lamb's line of questioning, and i may be out ahead of my skis and i come from the department of defense. i am now at the other department in the federal government whose needs, its mission is unique. you served in one of the two departments, and as the chairman has said, our budget has been going up. it is at record levels. i do expect the president is to continue his robust support for

this department as he has for the department of defense. they are different and as the chairman has said that has been reflected in the increase of our budget and the priority which this administration has placed on both department of veteran affairs and the department of defense. >> thank you, gentlemen, for yielding. thank you. >> ms. wright, you are recognized. >> i want to thank chairman isakson and chairman roe and the ranking member who is not here for holding this joint hearing and greeting chairman-elect o'connell and i want to thank secretary wilkins and the panel for their testimony. i also want to thank the va for working directly with my staff in keeping me informed on the status of the community care network contract in the u.s. territories. the specific territories including american samoa are

facing challenges due to their isolation economically for the united states. one size fits all measures simply do not work for the territories and special care must be taken to ensure that the unique health care needs of pacific veterans are considered. to that end, i am glad that va is considering the uniqueness of the territories in handling their ccn contracts separately. secretary wilke, i would like to take this opportunity to touch on the topic once again. could you go over how the unique challenges faced by the pacific territories will affect the time line for the ccn contracts and your ability to comply with mission act requirements and could i also get your commitment to work with congress so that implementation of the mission

act, the contracts and any future related legislation is in line with the needs of the territories. to put it another way, will you help us help you provide for our pacific veterans? timeliness is also a factor, but we also want to make sure we get this right. >> thank you. i just returned from hawaii, and i made a commitment to one of your counterpart, the governor of the northern marianas that i will be visiting american samoa, guam and the northern marianas. it is important to me. i have made a commitment in the continental united states to reach out to the native peoples of this country. the same applies to the american citizens in the pacific opinion no group serves in the pacific at a greater rate than the men

and women of the pacific islands or the native peoples of the continental united states. the unique nature of the challenge is 4.5 million square miles that we have to take care of in the pacific, and the categorization of the network for the islands in the pacific will address the unique needs and we will make sure that the implementation of the telehealth services and more robust visits of the major medical center in hawaii to the pacific islands that we always take care that the islands are recognized for the special needs that they have.

>> and i wanted to add and you were probably briefed and we want to succeed how tricare is in these areas and yes, we have to get this right and we'll continue to walk until we get this right. >> thank you, mr. chairman. i yield back. >> thank the gentle lady for yielding and i ask to yield for five minutes. >> thank you, mr. chairman. i want to thank chairman roe and isakson with tester and waltz in particular with the efforts of the blue water navy veterans. this is an incredibly important issue and these are folks who served decades ago and we owe it to them and it's relevant to today's hearing and we are not managing these budget appropriately and they will not be able to get the care they deserved. they say if you brought it, they broke it, and we owe it to them to find the means and not just the will, and to do right by them and we thank our leagues in the senate for their enduring efforts to get this passed.

i wanted to quickly say something on the care for all caregivers as senator murray did. several of us have worked on these issues and this is an area where we have made commitments and we know it as a preference of our veterans and we need to find a way to honor those commitments and that brings me to today's hearing. the utter importance of managing these budgets appropriately. we've made promises to people that we'll get them care, where they want it, how they want it and in order to do that we have to manage those budgets. i have not lost all my time here, but we will continue on. i have negative 12 seconds already. will you have sufficient funds in the 802 account given what we know right now? do you have sufficient funds in the community care networks in the 802 account given closeout costs and given authorizations and contested claims that you still need to finish? so just wanting to make sure

that we make that transition to mission, but we can't let go of what we currently have. >> may i assure you that we are monitoring on a very close basis the expenditure of the current choice and the pc3 programs and we do believe in forecasts that we will have funding available through the end of this fiscal year and have taken account all closeout dofts and what we believe are perspectives in those projections. >> thank you, dr. glenn and if it turns out not to be correct, please do let us know because it is very important and we should not leave it hanging in that transition. i would add to that, you are correct. this is the wave of the future for medicine and va care, particularly for the majority from the vietnam era for the new

veteran. they demand service at home and they expect service at home and the trend in medical care in this country as you rightly pointed to will let people get better when they're at home and you have my commitment to do everything i can to make sure that this is fully funded and it reaches every veteran that we can touch. thank you again, secretary, for being with us here today. i wanted to just review again from the very beginning what time line we are to expect rid now with the awarding of the contracts for renalness on, o contracts for regions of the contract with one, two, three and four and i want to make sure we're all on the same page, please. >> from one to three is by the end of february and four is by the end of march. all right. we will want to be looking at that timeframe again, and i'd

like to return for a moment on the discussion we had on the number one clinical priority and that is on military suicide prevention and it is secretary wilke in part from the handoff of dod from the va and that is something we need to do a much better job of, and i would suggest us working on the committee really do believe a check back in six months after returning would be a very helpful time to make sure people are in the system. that's number one, but number two, i do have to push back as my colleagues have, if we know for younger veterans that they are using social media and they are not already involved in the system with the va, why in the world have we barely touched the money that this congress has allocated for you to do that outreach? it's just astounding to me that this is in the system and we are baffled with the epidemic of

military suicide how we've done so little to use the funds that we've allocated. >> we have used 1.5 million of that and as the year went on we used 1.5 million, but overall we've used 12.2 in outreach and we've done a number of different efforts. we were in the nielsen top ten for the public service announcements and last year our suicide coordinators reached 2.2 million individuals. we also had to be there campaign and i don't know if you saw the advertisement with tom hanks and we set up a website with information and actually had over 100,000 hits to that site and they've been very active and this year, i'm making sure that we are spending the funding 100% and so i'm reviewing the budget monthly and making sure that this moves forward and we sure

have obligated all of the dollars to reach out including social media and we have to get it right. >> i will also say those are responsible for personal and readiness for instituting the training and the awareness on the part of the pentagon commands on the challenges and the threats to our servicemen and women regarding suicide. we instituted the transition assistance program to include those markers indicating a potential for a tragic event. i am committed to being part of that. we also -- thanks to these committees are treating those who would have other than honorable discharges in making sure that they have the transition assistance and that

we join with the department to try to catch this before it becomes tragic. >> thank you, and i yield back. >> senator bozman, you're recognized. >> thank you, mr. chairman. secretary wilke, thank you for being with us and we appreciate your service very, very much. i've had the opportunity to serve on the house or senate va committee since i came to congress over the years and i've seen the va go repeatedly through pains of implementing new programs. and the congress we passed significant legislation with fundamental transformation to the va and as you know, when the va fails to properly implement programs these committees become the resources to mitigate the impact to the greatest degree possible and the staff briefing

about how the va is going to fix its implementation of the forever g.i. bill, and the payments was unprepared to answer basic oversight questions about how much funding has been spent on failed attempts and how much funding is spent on efforts to react to the problem and what lessons the va has learned from the situation that it can take forward to other implementation efforts in the future and under way at the current time. these aren't hard-hitting questions. these are just the basics. more to the topic of this hearing, the staff had a meeting with your staff to get an update on where the department is when determining access standards, a key factor that will have an impact are va funding levels when i hear one set of information is provided to appropriating staff is provided

and briefing to all committee staffers and that's a problem. and i agree with you totally that the va is filled with wonderful people and when the staff comes over without their act together with no semblance of transparency that reflects on the va leadership which you have direct control over. you know that it just works better when we work together and trust each other and 5.2 million with the fund and can you tell us what the current right is with the choice programs. >> and it's -- i don't remember the exact number and we can get it for you and we've gotten two different ones and 460 or 340. >> my understanding is it's

around the 460. but we'll get back to you with the exact number. >> and you're saying in current estimates, funding is sufficient. i guess the next question is if it's not and at times it's come up in the past when it wasn't and how does va intend to address any possible shortfall. i would come to the congress with that, but let me talk about the burn rate for a second. one of the things that we saw with the choice act is that many fewer veterans decided to take advantage of it that was originally ject originally projected for what happened in phoenix and the 100% care outside of the va less than 1% took advantage of that. that number of veterans is in

the three or 4,000s and we are well positioned to take care of choice funding for the rest of this year. as the va develops regulations that will have rates and access standards for the mission act and implementation and many decisions will have significant budget implications and certainly those do. we understand that va has choice and medicare advantage, and what is the estimated budgetary impact of the range of options and when will you be prepared to let the committee know that the mission care to cost annually and senator, i expect to be up here -- and the president approves the recommendations that i give him. in terms of the excess standards and i perceive them to be a hybrid of several of those

programs that you just discussed cms, tricare and we will come to a conclusion based on the combination of those standards and what is best for veterans and i will be up here as soon as the president approves of the access standards. >> thank you and thank you, mr. chairman. >> thank you for yielding and the senator is recognized for five minutes. thank you, mr. chairman. let me get unanimous consent to place into the record the recent article in propublica. >> without objection. >> in regard about the fact that several private companies have been paid nearly $2 billion for

overhead including profit to provide health care to veterans and that's about 24% of the company's total program expenses so we have enormous administrative costs in private care for veterans at a time when i hope we could agree that the function of the va gets to provide the highest quality care to all veterans in a cost-effective way and mr. chairman, my john going concern in this article that demonstrates that is that we are in the process of dismembering the va and taking resources away from the va and putting it into the private sector and the results will be that many of our veterans will not get the quality care that they deserve. mr. secretary, it is no secret, and by the way, thank you very much for being here. it is no secret that i oppose

the mission act and there are parts of the law that i obviously support like expanding the caregiver support program and increasing loan repayment through the debt reduction program. however, i remain concerned that as written and without needed funding, this law puts us into a situation where we're forcing the va to pay for private sector care at the expense of investing in its own facility budget staff and i remain very concerned about the level of understaffing at the va that continues to exist. i fear this is nothing short of a steady march of the va and sometimes when people talk about the privatization of the va they think that one day the secretary is going come forward and he'll announce that the va is now privatized and that is not the way it's going to happen. it is going to happen piece by piece by piece until over a period of time there's not much in the va to provide the quality

care that our veterans deserve. no one disagrees and we've been through this discussion a million times that veterans should be able to seek private care in places where the va cannot provide, the specialized care they require or when wait times are too long or when veterans would have to travel long distances and there's no disagreement. the va has done that for decades, but to my mind, the way to reduce weight times is not to direct resources outside the va as the mission act does, but to strengthen the va. va should be focused on recruiting and retaining the best health care professionals in our country, to care for those who have put the lives on the line to defend us. va should be focused on investing in its aging infrastructure so that veterans can have the best health care facility and va should be

focused on figuring out the budget it needs to provide the demands of our veterans and our veteran patients. mr. secretary, let me start off by asking you a simple question and that is the veterans organizations in my mind do a very good job in understanding where the veterans are at and the problems that the veterans of our country see when they interface with the va. upon to my mind, what the law says that you are to consult with the vfos and that's what we have in law, but that does not simply mean a one-way discussion. it does not mean simply you telling them what's going on. it means you are listening to them. so let me ask you this, mr.

secretary, can you tell me in precisely a way that you can, how you have solicited feedback from the vsos and how you have that in the regulations currently being written on quality and access standards. senator in the little less than four months that i have doubled the number of vso engagements and i've also opened the aperture on vso engagements by including groups that represent the new breed of veterans. even some that represent vietnam and the purple heart veterans and meeting tomorrow with many of the people who are in the audience today and it is absolutely essential? i have served and i have a long line of family service without talking to the veterans and when i say talking to the veterans,

when i am out in the country, in the great nations of the plains, when i was out in -- >> i'm sorry to interrupt you. >> i do meet with them. >> here's the point, here's the point and i appreciate that, and i know you're trying to do that, but meeting with them and talking to them is different than listening to them. can i have your dmcommitment th you will incorporate their ideas and their concerns into the work that you do? >> absolutely. >> my time has expired. >> mr. chairman, may i answer a -- mach a comment about what s senator sanders said? i agree with him about privatization, and i do need to make it clear that we do not exist in a vacuum and the united states, as you have pointed out

in many floor debates that i heard in this institution and suffering from a shortage of mental health professionals and is suffering from a shortage of women-held professionals and suffering from a shortage of primary care. >> we are competing for those. what has happened with the mission act and one of the benefits that i have now is that i have the opportunity to offer more impressive packages to bring the health care providers into the va and we're doing our level best because we are absolutely right and we are short on those, and i will also say that when it comes to privatization, you and i discussed this in your office several months ago prior to my confirmation. i believe this strongly. i've said it all across the country. i don't believe that veterans will allow va to be privatized

and i'll tell you why. it is not anecdotal, but it is emotional. veterans want to be where people understand their culture and speak their language. i'mmotional. veterans -- emotional. veterans want to be where people understand their culture and speak their language. i'm from that world. i understand it. and i agree with you that my job right now is to ensure that those veterans who need that care outside of the v.a. and we don't have it get it. >> thank you. let's continue the discussion. >> yes, thank you. >> i think, gentlemen, i would also encourage support from the v.a. and from the senate and house on a bill that i have on an immigration bill to help allow doctors who are trained here in this country to stay here. we are sending them out of the country. it is ridiculous that we are doing that when we have such a need here. mr. herring ton i recognize you for five minutes.

>> thank you. if a veteran doesn't get good care at the vha, do the doctors still get paid over there? >> they get paid because they are on a federal scale. however -- >> so the federal government will pay them whether they serve the veterans or not. will the administrators get a paycheck whether the veterans are receiving good quality care and service? >> i can give you an example of how i acted on that. >> just historically. just historically is the answer that they get paid regardless of the outcome for the patient? >> historically before the accountability act was passed before the mission act was passed the secretary of the department of veterans affairs was under the same strict tours that every cabinet member was under. there was a laborious process involved in removing federal workers who did not perform. that does not exist anymore. in the one year that -- well, the one year that i have been in

and out of v.a. we have removed 5,000 employees including -- including the director of one of our largest have. a. medical centers. i did that because the work was not getting done, veterans were not getting treated, and i felt that the powers that the congress had given us needed to be exercised. and i intend to exercise those powers whenever i see a problem. because the veterans are first and the institution is not first. >> i hope you continue to do that. that's the only way you will stay relevant and the only way you will prevent the veterans from voting with their feet where this is all going to go. let's not be arrogant that think we can build a mouse trap from the federal government from washington that is going to satisfy the customer. either you deliver good service and they are satisfied or they are not. if they aren't, they will make the decision whether this is

privatized or not, or some high trid brid. i hope you continue to do it. because in the private sector, if they don't like the providers, they don't go to them and they don't have a business. that's the incentive you are competing with. that's why i am for choice, for giving the veterans the freedom to choose to opt out a system that may not be working for them. maybe a union controlled money on listic bureaucracy isn't the best way to provide service the our heroes. i don't know. where it is working, good, great, continue the do good. where it's not, i get why it is not, because it is a very different animal altogether. so. okay, it was good to meet you the other night by the way. >> good to meet you too, sir. >> and your wife. i am really not an angry guy. i get fired up when i talk about this. i know you are passionate about it, too. let me ask you this, are people choosing to go to community care at a greater rate today than

they did a year ago? >> they are not choosing to go to community care at a greater rate than they did when omar bradley ran the v.a. in 1945 to 1947. it's been about the same level, which is 30 to 35% historically. i think we are even seeing dr. lieberman a slight dip in the use of community care. >> so fewer veterans are choosing to go outside of the v.a. today than they did a year ago, two years ago, five years ago? >> a little bit. it is a small, small number. >> let me ask you -- i take your word for it. did -- i assume you guys measure the quality and the i don't have all service that veterans get at the vha. do you all measure the quality care and overall service at your various facilities in the vha? yes or no, doctor? >> within vha. >> yes, sir. >> yes, sir. >> and do y'all compare the

quality metrics and the service metrics in community care with the quality of care and service at the vha. >> absolutely. but we also compare it to -- >> how do they compare, mr. secretary? are they comparable? are they better at the va? >> i will tell you, the dartmouth released its most recent study a week or so ago in the annals of internal medicine. and their conclusion was that care at the department of veterans affairs is as good or better than any care in the rest of the country. of course that includes community care. so we are being judged by comparison to -- >> good. that's good to hear. >> the biggest health care networks in the country. >> that's good to hear. last question. i represent a big swath of rural west texas. how are the access standards going to affect their access to

v.a. care? >> i have talked a lot -- >> i yield back. >> -- congressman, about the scale of the american west. i sometimes joke that the loneliest sign in america is on interstate in 10 in houston that says el paso, 910 miles. what we see access doing is offering our veterans, particularly in rural america, the opportunity to alleviate a burden on themselves and their families by giving them the option to seek care that is closer to home. if they have to embark on a 300, 400, 500 mile round-trip journey to get to a v.a. center. as i have said many times, it is incredible that in 2018 -- i saw this in hawaii last week -- we do not understand the scale of the west, and we certainly don't

understand the scale of the pacific. >> thank the gentleman for yielding. mr. harrington, i was in greg waldon's district in oregon a year ago. his kong district has more square miles than the state of tennessee does. our challenge in this committee was to devise a problem that was good for rural america and urban america. that's hard to do. if you are on the 405 in los angeles you may be quicker to somewhere else if you are stuck on there to get to an appointment if you don't live ten miles from somewhere. so it is a real challenge to do this and to get it right, where you provide the care at the point of service for those veterans. i think the v.a. is moving in the right direction with the cboc model, taking care of the veterans. i absolutely believe that. mr. roark, you are recognized. >> thank you mr. chairman. mr. secretary, in answer to

senator tester's question about administrative costs totaling around 24%, and then that number was disputed. but in response you said, we were taken advantage of. could you clarify by whom the v.a. was taken advantage of? >> i meant in a generic way that the choice act -- and i think there is agreement from the leadership of both committees -- that the choice act was rushed and we were given such unreal, unnatural timelines to implement a program in a 370,000 person department. >> so there was no actor or third party administrator or outside contractor who took -- >> we were forced to take what we could get to implement a law based on the time line that was created by that act, which has now been rectified by the

mission act. when i said taken advantage of, we -- and i wasn't there. i was happily in the department of defense. i understand -- my understanding was v.a. had to move as rapidly as possible, and there was not time for reflection that you would usually have in an issue like this. >> the articles about the recently released j.o. report about unspent suicide prevention outreach dollars, $6.2 million allocated as of september, $57,000 spent. doctor, you suggested there was another $1 million, $1.5 million on top of that spent on top of the 6.2. you say you will exhaust that throughout the end of the year. you got hits on the website. another thing that the j.o. says that is perhaps more alarming than the unsent money is you

have not established targets for the efficacy of the website. hi -- of the program. hits on the website, you really tonight know what they are doing. i am grateful suicide prevention is a priority. how do you know what you are doing against that priority? what are your goals? >> let me talk about the national situation that we face. first of all, i was responsible for the department of defense end of this before i came to the v.a. >> i have limited time and i don't want to hear anecdote. i want to hear goals and numbers. >> i am not going to give you an anecdote. 14 of the 20 veterans who die of their own hand every day are outside of v.a. >> correct. >> we have spent $2 million on that outreach just in the time i believe that i have been in charge, which is just a few months. but i have to go beyond what

that gao report says. talk with governor brown, talk with other governors. i am busy when it comes -- >> if it is a priority, what is your goal? and how are you doing against your goal. >> i am not blaming you for where we are. i want to know what the goal is and how we are doing against it. >> the goal is to do our best to make sure we have done everything possible. >> we will never be able the judge you on that. do our best, what does that mean. >> the majority of those warriors who take their own lives come from my father's warrior generation. that means these are problems that are 50 years in the making. i am not going to tell you that i can wave a magic wand and correct problems that began when linden ginson was president. i am doing my best through the outreach that we have and the resources that start with the department of defense.

we never had a transition program or an aware beside program on suicide until the last year or so at the department of defense. that's where it has to start, so we make sure that the mistakes that began in 1968 and 1969 and 1970 are not replicated now. that's not anecdote. that's just historical fact. >> i hear but if you don't measure it you will never be able to achieve it. what are you doing to correct the finding? >> we concur we didn't have robust enough metrics at the time of the g a, o revelation. we are in the process of developing robust ones. >> when will you have them. later this year. >> this fiscal year or the next one? >> 2019. >> i put in place, that is the

number one clinical priority. and i can promise you that we will expend everything that we can to try to correct this and address this great national tragedy. >> thank the gentleman for yielding. i think mr. o'roark's question is if the you don't know where you are going you might end up someplace else, if you don't have goals set you don't meet those goals. i think that's what you were asking. mr. kaufman, you are recognized. >> thank you. mr. secretary, i think the v.a. has always had the authority to reach out to community providers prior to the choice act, i think in specific relationships. i am trying to remember the name of the -- is it the p 3 program? p 3 program. one of the complaints i have heard about that program that still exists today is that every

separate agreement is negotiated independently. and what i think -- and so in colorado we have had some potential providers under the p 3 problem drop out because of the length of the negotiations and the complexity of the negotiations. where i think one question that they always raised to me was why don't we simply use medicare rates as reimbursement on the p 3 program so we are not renegotiating every new agreement from scratch? >> we actually are moving away right now with the triwest and in the future with the agreements, the community care agreements with the mission act. and right now we have -- try west has stood up, and actual low at colorado, in denver. and in the first week -- they are getting medicare rates. in the first week they actually have entered 2700 consults and already scheduled 500 patients. and so they have been able to

create the network that the facilities have been struggling to do on their own. so they are creating it. that's what's going to be part of the community care networks as we roll them out. >> okay. how are we doing in terms of efficiency on telemedicine? i think it was raised about rule of america -- rural, he ma. certainly rural colorado it is a struggle. people in grand junk, colorado, there is a cboc there, but oftentimes for care they have to go to the v.a. medical center, regional medical center, which is down in aurora. that's a four-hour drive. i know they are reimbursed for the mileage for that, but are we doing better in terms of telemedicine? >> so we are investing through support of the congress. we are investing in increasing bandwidth at many of our cboc

locations, which is areally important. we were doing anywhere to anywhere access to provide telehealth into the home. we are also entering into partnerships with different private entities. they will give us a private room in a rural area and the veteran can go there and have their appointment that's closer to their home. we are really working a lot in this area. >> okay. there was legislation passed that i authored. i think it was included in a larger bill that requires a independent study as to those veterans who died -- who committed suicide, who were under v.a. care. and i think up with -- the objective of it is to go, to look into what prescriptions that they had at the time of their death because i do have a concern that we are overprescribing some of our veterans in mental health.

>> yeah. let me talk about the opioid issue, which does -- is part of that continuum. v.a. -- and also to congressman o'roark's well founded observations about the suicide program, i do want to say that we are not divorced from national problems. we are one part of that, which is why in the answer to your question i will say in this case the v.a. has taken the lead in creating alternative therapies, alternative prescriptions for those with great pain. the one factor about v.a. care that is not shared in the private sector is that we help people who come from a dangerous profession. people like my father, after 30 years of jumping out of airplanes, needed two new knees,

two new hips, and had lead in his body from vita. in a. what we have been able to reduce opioid prescriptions by 41% just in the last two years. in addition, we are on the cutting edge of alternative therapies. occupational therapies, tai chi, acupuncture, thing that would have been unimaginable ten, 15, 20 years ago. and that is part of the answer to those veterans who are suffering from pain and subsequent issues like mental health. >> mr. chairman, i yield back. >> thank the gentleman for yielding, ms. kuster, you are recognized. >> thank you very much. just to pick up right there, i very much appreciate the progress that is being made by the v.a. on the opioid epidemic. and i hope that we can spread those new alternative pain

management strategies not only within the v.a., but, frankly, within the private sector as well. i just want to revisit briefly this issue because i think certainly my constituents, but i think constituents across this country were so shocked and concerned to read today about this issue that your department had only spent 1% of the $6 million on suicide prevention. we have had a little bit more testimony on that today. you say that you are doing your best. but what i'm concerned about is that -- that can't be true when we have so many leadership vacancies at key posts in the v.a. related to these programs. what are you going to do about getting the right people in the right place? and i just with a on the to give you one chance to revisit mr.

o'roark's question, because we can't really respond here in our oversight function to the concept of doing your best if we don't know what your goals are. and you talk about the majority of the suicides are committed by people outside the system. that's true. that's our frustration. how do we bring them into the system? >> as dr. lieberman said, we began to move when i became acti active. the vacancy that you talked about at the head of the suicide prevention office was immediately filled by me, by making permanent the position -- >> does that person have the staff that they need. >> yes >> on board? >> and also the expertise as having been the leader at the department of defense in the suicide prevention office. >> so is that -- >> we are in the process of hiring more staff for them. just for the record. >> here in the process -- >> i am sorry. there are other vacancies and

you are in the process of hiring for that program? >> we are building a larger office underneath this program and we are hiring more people to support her. >> and does that program have functional capacity at all the -- around the country as well? >> they certainly work with all the vizens. the vizens have their own responsibility to roll in and work with her what ideas are coming out. i want to let you know we are focusing in a new way on the high risk veteran populations both within v.a. and the ones outside. number one there is an executive order to work with transitioning veterans. we have been working with d.o.d. on that. the honorable, we have been working on that since 2017. this week and the rest of the month we are i will maing out letters to 500,000 other than honorable encouraging this. to come to us to seek whether they are eligible for care here

in mental health. we are also looking at the reserve and the guard that have never served. they have been identified recently. as our data gets mature we can identify more at risk populations. they are at risk. we do mobile vet center outreaches to them on the weekends when they are doing their drills. and reaching to out to leadership in those areas. finally, another risk that we identified recently was that if a veteran came to the emergency room in the prior three months and had just a little bit of suicidal ideation, not enough to have to admit them or -- that if we -- we did research and we found that if we made a suicide safety plan with them where if they are having suicidal thoughts, what are they going to do? are they going to call a loved one? are they going to call their therapist? are they going to listen to music? what are they going to do? it has been shown to reduce suicide rates by 50%.

we have implemented this all across the country. we are trying new novel things as they come along. >> research is important. my time is running short. i had another question about the whole issue under the v.a. mission act and the designated access standards. but i guess i will leave it at this. new hampshire is one of the rare states without a full service v.a. hospital. and i think we are all trying to find this balance of care at the v.a. and if that's not possible, then care within the community. but i would just use new hampshire as a cautionary tale and the problems that we had recently at manchester when the level of care drops below what is necessary for a robust v.a. going forward. and i think that was the point that senator sanders was making. and i think it is instructive as we move forward. with in a i will yield back.

>> i would add, i agree with you completely about suicide. i mentioned that i have been -- i was in and out of the v.a. as acting and then had to go back to d.o.d. and await confirmation. in my first week, i laid down the first path on the suicide issue. i will tell you, there is nothing more important. and there is nothing more tragic. and you have my commitment that as long as i'm privileged to be part of the v.a. team, that will continue to be the case. >> if i could, one quick second, i have been in congress for six years. you are our fifth v.a. secretary in those six years. so i appreciate your personal commitment. i have literally heard that five times. and veterans are dying every single day. so we will hold you to the commitment. we will want to know the metrics. i appreciate the innovative

solutions. and we'll look forward to continued discussion. thank you. >> senator, you are recognized for five minutes. >> [ inaudible ]. okay, this one is working. can you add to my time? okay. are you listening? >> we froze the clock. >> okay. thank you very much. i'm glad you were in hawaii. obviously, you spoke with the governor. but did you let the congressional delegation know that you were going to be in hawaii? >> yeah, i think i mentioned it to you the last time we spoke,

that i would be in hawaii in december. >> i don't think we got the date. >> but not to beat you over the head with it, but i think it would be good for you, your team to alert the congressional delegation when you come to our state. >> i do. >> so we can maximize your ability and support and work with you. >> i will go back on what you and i discussed last time. i made two commitments, one to go to hawaii, and one to go, if you are not there, i have got to go back, because i am going to go to samoa and guam, go there when you are there. >> thank you very much. >> the v.a., over the years of course not only have we had so many secretaries over the last five years as mentioned, there are ongoing challenges, whether i.t., homelessness, suicided, construction delays, of course access to care. you have been asked whether there is a sense of urgency at the v.a. but i ask you whether you have a

sense of urgency? >> absolutely. >> so if you have a sense of urgency, what are your top priorities for the v.a.? >> my top priorities for the v.a., and i mentioned the first clinical priority, which is suicide prevention. >> that's one. >> my top priority is to create, with the assistance of these committees, a modern 21st century health care administration that keeps veterans at the center of their health care. this committee has already laid down the template for that. it is my duty to carry that out. >> i am looking for something more measurable. for example, you were asked how can we verify whether you are reaching your goal regarding suicide prevention. a former v.a. secretary said that his goal would be to end homelessness. so those are the kind of specific kinds of priorities that i am asking you to articulate, if you have them.

>> well, i will tell you, i am not going to come to this committee and tell you that i will end homelessness. i am not going to come to this committee and tell you that i can eliminate suicide amongst -- >> that is not what i am asking you. what i am asking you is what are your -- out of a sense of urgency what are your top priorities for the v.a.? whether it be decreasing suicides, decreasing homelessness, do you have those independence could of priorities? >> i just mentioned modern, 21st century health care administration for the v.a., which means modern i.t., meaning the best medical care possible. >> when you say something best medical care possible, you know, how do you have -- how do you come up with a verifiable matrix? >> well, i can tell you that our health care is -- we have the standards. we have the metrics, which we share with this committee. we compare what we provide with

health care across the country. i have referenced the latest comparison that dartmouth, ivy league has done that was in the annals of internal medicine last week that says. >> i am running out of time. >> that says our care is as good or better than any in the country. i want to make sure -- >> if you have those priorities for you, i think it will be good for us to hold people accountability and there be transparent issy and accountability. i want to apply that to you. if you have those priorities and how they are listed and whether you have verifiable metric to enable us to realize whether you have attain those priorities, that would be great. i have a question about the family caregiver comprehensive assistance for family caregivers. that is a very important program for a lot of veterans. and i am glad that we expanded

it. so i have received for example, a note from a caregiver in hawaii just this week. and she wrote, quote, i just received the devastating news that we were no longer eligible for the caregiver program. i did not even receive a phone call, follow-up from my coordinator, or even an explanation other than the fact that her husband is simply no longer eligible. so how are you communicating with the 5,500 family caregivers as to what is happening with this program, what the requirements are, et cetera? >> first of all, if your office could share with us that individual so we can follow up. >> certainly. >> the mission act is giving us the tools to do this right moving forward and making sure that we have objective ways so that we make sure that we are implementing the same thing no matter what state you are in across the country. part of what we are proposing is to move away from these

reassessment and more towards wellness checks to make sure that the caregiver has what they need to succeed and the veteran is receiving the services that they need. we have regular ways that we communicate with the caregivers. we have phone calls with them around the country. we have a phone line where they can call in. but we have not yet made our decision on how we are rolling out. we are still getting input. right now it is in the federal register, some of the ideas of how to improve upon the services available in the program. >> and you are absolutely right. it is 5.5 million family caregivers out there. >> that's a lot of people to stay in touch with. >> absolutely. but it is the wave of the future. >> thank you mr. chairman. >> that's right. senator blumenthal you are recognized.

>> thanks mr. chairman. thank you for having this hearing. thank you to the secretary and your colleagues for being here today. i want to thank my house colleagues for passing the blue water navy bill unanimously. i want to say how disappointed, in fact, ashamed, i am that the senate failed to do the safe. even though as recently as a couple of hours ago i was on the floor of the senate asking for unanimous consent from my colleagues to move ahead so that that bill would become law. if the v.a. were doing its job and supporting this bill, it would have overcome the opposition of a small number, a handful of my completions who are blocking it now. i am going to ask you to commit, as i have before in hearing, that you will help us pass that

blue water navy bill. >> i committed to the chairman and to senator tester that i would do everything i could to help that -- your committee. >> well, you have done that before. >> yes. >> but, unfortunately, that support has to the been translated into active advocacy with my colleagues. and i hope you will be -- you will do better during the next session. i want to follow up on a number of questions asked by congressman o'roarks about met rigs. you can't do better unless you measure what you are doing. so far as i can see one of the chief criticisms of the gao report has been the lack of metrics and measurements. and i would suggest to you respectfully that two good ones would be whether the rate of suicide is coming down. which it is not. and whether the gao is using all the resources at its disposal to

bring it down. which it is not. would you agree? >> well, i agreed with the state of affairs at v.a. that g a,ao d out. >> you agree with the report. >> which is why -- >> so you would agree that the reason that you failed at the v.a. to spend more than a fraction of the money given to you by the united states congress is i'm quoting, the reason they did not spend the remaining funds on suicide prevention, paid media in fiscal year 2018 was that the approval of this paid media plan was delayed, due to changes in leadership and organizational realignment of the suicide prevention program. and they go on, more specifically to say, on pages 15 and 17, in a it wasthat it was

leadership available to make decisions about the suicide prevention campaign. and then on page 17, by not assigning key leadership responsibilities in clear lines of reporting. the v.h.a.'s ability to oversee the suicide prevention media outreach activities was hindered and these outreach activities decreased. that's a failure of leadership? >> senator, i am grog to agree with you. you and i i think discussed in your office when i was the acting secretary, that the first thing i did when i became acting, which is sort of being in limbo, but i did it anyway, was to start moving on the suicide prevention issue. i identified leadership. and i made this the number one clinical priority. i agree that the department had not done what this congress and what veterans demand of it. >> let me ask you, because my time is limited and i apologize

for interrupting. >> yeah. >> can you commit that the v.a. will spend every dime devoted by the congress, allocated by us, to suicide prevention during the come fiscal year? >> absolutely. and i will probably ask for more or allocate more, because of this national tragedy. >> how much more do you think is necessary? >> i don't know. i don't know. that is why -- and i mentioned it, and you were not here -- in the last few weeks, i have been on the phone or in person with jerry brown, with the governor from hawaii, with governor inslee, discussing the way ahead. we have not had a comprehensive nationwide response to vettance' suicide. i need the cooperation of our governors. and that's why i put in train the development of the metrics that senator hirono talks about, that you talk about, so that we have in place a program to go and attack this problem.

that's the best answer i can give you, that i have moved on it. as soon as i moved into v.a. >> well, i know that you have moved on it. but you have to forgive me and maybe us that we've seen this movie before. as one of my colleagues remarked, we have seen a slew of secretaries who have made commitments and programs, and i think we are at least discussion the impatience that is well founded because of the turnover in leadership from the top through the middle ranks. and with all due respect, dr. lieberman is an example. he follows others who have been in that position for small lengths of time. we can't demand accountability if there is this constant kmurn and turnover in leadership -- churn and turnover in

leadership, which then becomes a failure to spend the money that's allocated to suicide prevention and maybe other programs. >> i agree with your observation about suicide. the program -- at best, it was incoate in 2017. and that is why i permanently appointed the d.o.d. leader in suicide prevention, the person with the most expertise in this matter available to the government, and that we are increasing the size of that operation. i agree with your criticism. >> my time is expired. i apologize, mr. chairman. >> thank you senator blumenthal. first of all, thank you all for being here. i would like to yield to my colleague, mr. at that cano, next year's chairman, to see if he has closing comments. >> thank you, mr. chairman. mr. secretary, i do look forward to hearing as soon as possible your -- more about the designated access standards.

i know you told me in your response to me that you still need to await the president's choices. but i hope that you will consider speaking to us before that time because i see no reason why the vsos and congress cannot participate with you i think as the spirit of the mission act does stipulate, that these access standards were not to be developed alone between you, mr. secretary, and the president. and i certainly don't want to see expectations unnecessarily raised at the state of the union speech and congress be in the position to have to fry and pull those expectations back. so i would -- i would like to, in the time between now and the third week of january, like to

see your department work more closely with the vsos and congress in developing these access standards because so much is at stake. and we need to do some trust building among the stakeholders, congress, and your department. with regard to -- i want to reiterate what senator blumenthal has said, that the frustration of congress being able to hold, you know, the v.a. accountable when we have seen such changeover or acting secretaries -- and some of it is on -- i said to say, the senate not confirming people in a timely manner. but nevertheless, it is been very disappointing the see in the last two years an administration that has not been able to put in place stable leadership at the v.a. and i see the i.t. failure with regard to the v.a.h. payments.

the issue with the social media and adequate marketing being done to inform veterans about homicide prevention hotlines, all leading back to the same fundamental problem, which is the unstable leadership at the very top. and this has got to change. and so mr. secretary, i would like nothing more than to see you succeed and for you to serve out a tenure which allows you to implement changes. i certainly -- i certainly do appreciate the sentiment you express when you quote the dartmouth study recently. and further back, the rand study, and that you have an understanding about how well our v.a. does deliver health care. and you recall that the rand

corporation study indicated that the main problem is access. and we have still 41,000 vacancies. i want to work with you, mr. secretary on not slow walking those vacancies but doing all that we can to improve the personal function of the v.o. so that applications are acknowledged, people are quickly made offers, and that we also need to take a look at what we need to do to develop the health care work force of this country. i think that's part of the problem. it is not just doctors. it is the technicians. it is the allied health professions that we need to pay attention to. not everything is resolved by medical degrees or four-year agrees. some of it could be putting a lot of americans to work this the service of our country. mr. secretary, i hope in that spirit i intend to work with you and i hope that we change and turn around the situation. >> thank you sir. and i intend to work closely with both committees. i mentioned earlier, this is

where i was trained, my respect for this institution knows no bounds. and the beauty, as you said at the beginning, is that this is a bipartisan effort. i like to think of the department as being non-partisan. like the department of defense. and you have my commitment to do everything that we can to make sure that the lives of our veterans are better. >> thank the gentleman for yielding. i will first of all thank you you mr. secretary and your team for being here. want to thank our staffs. we passed a major piece of legislation, the v.a. mission act. it would not have happened without the staffs. and onand ray, thank you for your leadership of thisset. >>. we worked very closely with our senate colleagues on both sides of the aisle. thank you for the work you all did. you were very, very helpful. i permanently point of privilege through my life is serving as

chairman of this committee. i will serve as ranking member just as passionately as i served before. and i looked at the veterans organizations. they were instrumental. i remember sitting around that table in my office for hours on end hammering out the details on this. you had tremendous input and it would not be the bill it is today without your input. thank you for that. the v.a. mission act, the idea was to take a bill, a piece of legislation, and make it applicable to rural america and urban america and make sure the number one thing that happened was that the veteran got the absolute very best care this nation has to offer. whether it was at the v.a. or whether it was outside the v.a. i was one of those physicians who provided carous the v.a. i have some medical training -- i was a doctor in the army.

i think i understand the system fairly well. three things before i leave. number one, on june th we are ready to go. if we are not, would you be willing to come back mr. second say at the end of march and give us one more -- it can be a combined meeting, however we want to do it. to let the members know we are ready to go live on the 6th of june or thereabouts. number 2 that we can make appointments at the v.a. for the veterans in a timely fashion. number three, can we pay our providers so they will stay in the irk no. i have friends who want to serve veterans who won't because they can't get paid. these are good doctors who want to serve. i would like to see those three things happen. there will be other hearings on the caregiver bill and asset reveal. i would encourage my senate colleagues. we have an i.t. position and accountability and whistle blower protections. the young woman who is a staff

memberan our committee right now, tammy bond zano, an incredible woman, immigrant to this country, who came here without education, served in the arme auto. has gotten an rn, and a doctorate. she could be in that position right now doing her job. i don't go to a speech that the president gives that he doesn't talk about. we need to get that bill done and she needs to be confirmed sooner than later. it is a point of frustration for me to hold her up. on the mental health side we held a hearing. and i looked at this 20 number. that's veterans and active duty military, that number is. i said, if we are doing spending, 8, $9 billion a year and we haven't moved the needle at all, why don't we thoroughly

evaluate that and change what we are doing? and there are plans out there. one in my state, guard your buddy. the commander of the guard, he took over in 2011 had four suicides the first 40 days he was commander of the tennessee state guard. he instituted a plan called the guard your buddy. i won't go into the details of it. but he lowered the suicide rate among our guardsmen in tennessee by 70%. that's scaleable. and it is inexpensive. we should do that across the country. evaluate what works and what absolutely we are doing. mr. o'roark made a great point. we had a call center. there is one in atlanta and others standing up. but i said are we changing anything? we are spending all this money and talking to people, but if the number is still the same we need to do something different. that's where the metrics are so important. so i think working with mr. at that canha -- mr. tacana is

important. i spent hours in the operating room operating on a cancer and treated the patient overwards and saved one life. if you have lowered the rate by as much as 5% by doing a simple thing in the emergency room why aren't we doing that in every emergency room in the united states whether you are a veteran or not? that should be done. to senator hirono, your question about -- it is fairly simple. in medicine now, we -- if you are looking at quality metrics, they are fairly standard. if you just look at it, you look at what medicare uses, basically v.a. does the same thing. if you come in, you are a certain age you get screened for home globin a 1c, you have had a mammogram if you are email, blood pressure checked. if you exercise. it always irritates when when my doctor asks me can i stand up? but they ask you those questions. those are scaleable. vision screening, hearing

screening. all of those things are measurable. and i think the v.a. does an outstanding job. i want to finish by saying this of what i hear about my v.a. at home. this is mountain home v.a. in johnson city, tennessee. i have traveled from long island to los angeles and puerto rico in the last two years is that not 100% but a vast majority of people like the care that they get at the v.a. almost never hear anything negative. i do occasionallies as you would in a big organization like that. it is very customer friendly. the rhett advance and i believe that they are getting great care. i want to see every veteran get that kind of care. and i am committed to that. and the other people, the men and women in this room, and mr. secretary i absolutely know in my heart that you are committed for that. i thank you all for being here today. i thank you for the point of personal privilege. if there are no further questions, i ask unanimous consent that all members -- mr.

takano? >> mr. sub lime could not be with us for the questions but i will be submitting questions on his behalf. >> that is fine. i think you are going to visit -- also. members have five days to revise and include extraneous material. without objection, so ordered. hearing is adjourned.

meets this afternoon to consider legislation to extend certain expired tax break. it also includes tax relief for people hit by disasters and repeal certain health care-related taxes. the rules committee is going to decide what amendments can be offered during floor debate. live coverage begins at 5:00 p.m. eastern here on c-span 13. you can also watch on line at c-span.org or linen the c-span radio app. tonight american history tv is in primetime. we will look at programs on political history with a discussion on the concept of populism and its role in the history of american politics. the first event is called the promise and perils of populism. american history tv primetime begins at 8:p.m. eastern.

this very government under which we live was created in a spirit of compromise and mutual concession. >> thomas jefferson questioned the need for a senate. >> founders envisioned. >> the framers believed. >> let's follow the constitution. >> the framers established the senate to protect people from their rulers. and as a check on the house. >> the fate this country, and maybe even the world lies in the hands of congress and the united states senate. >> the senate, conflict and compromise, a c-span original production, exploring the history, transitions, and role of this uniquely american institution. >> please raise your right hand. >> wednesday, january 2nd, at 8:00 p.m. eastern, and pacific, on c-span. joining us is lauren camera of u.s. news and world report.

she is an education reporter here to talk about the findings that were done by the trump administration task force on school safety. good morning. >> good morning. >> walk us through what brought us even to the point of this report. what led up to it? >> there was a school safety commission formed by the white house after the mass shooting at parkland, in park lds florida at marjory stoneham douglas high school. this was essentially an effort by the white house to take a quote unyolk holistic view of all of the school safety measures and security initiatives that schools should be looking at to prevent some of these tragedies in the future. >> what was the education secretary's hope? what did she set out to do? >> she didn't make too many commitments to be honest in terms of setting guidelines and setting what she would and wouldn't look at. she specifically said she was open to taking a look at

everything. in the report, they actually did. i mean it is 177-page report. and makes nearly 100 recommendations. you know, there is often the debate about whether this report should have touched on firearms, specifically, gun laws specifically. it does not necessarily go there. but it does take more of of a holistic view on things like mental health. how schools should beef up security in terms of maybe installing bulletproof windows and providing better perimeter security. it goes into a whole host of different recommendations for cool districts. >> what was the justification for not specifically looking at gun issues? >> i mean this is a very political debate of course and they said they wanted to focus specifically on school measures. of course this got a lot of pushback and it has been getting a lot of pushback. basically, what they did was

traveled around the country for the better part of a year. they visited 47 states, held hearing and listening sessions talking to teachers and educators, superintendents, school safety experts, everyone who might have a say in providing some additional information on how schools should better secure themselves. and these were the findings. >> lets look at some of the specifics of the findings as we go with our guest. if you want to ask questions, the lines are different today. for educators out there, you have one number. if you are an administrative, you have another number. and all others, another number. here is the education secretary talking about the release of the report. >> the report address as holistic view of school safety based on the insights, experiences and expertise of many individuals. our recommendations can assist states and local communities. ultimately, governors and state

legislators should work with school leaders, teachers, parents, and students to address their own unique challenges and develop their own specific solutions. how schools and communities consider these recommendations will vary. their approach should start by fostering a positive climate and a culture of connectedness. this report highlights social and emotional learning and a number of other recommendations that policymakers should explore. but let's remember local problems need local solutions. ultimately, the recommendations do not and cannot supplant the imcomparable role that families play in the lives of children and in our culture. >> lauren, take what she said and tell us a little bit more about it. >> so it's important to remember that these 100 recommendations are just that. they're recommendations. these are not requirements that school districts need to put in

place. these are, you know, 100 different recommendations that the administration would like school districts to consider in concert with state legislators, governors. as you heard the secretary say, every decision that a school makes is going to be coming from their local, unique perspective, not every recommendation that's going to work for every school district and so that's really important to keep in mind. >> you talked about the -- what the report said about gun violence. it also spent a lot of time talking about discipline in general in school. why and what was found? >> yeah, so, this wasn't really a surprise. the report includes a recommendation to repeal an obama-era guideline. now, this guideline was issued in 2014 jointly by the department of education and the department of justice, and it's really aimed at stemming the school to prison pipeline. we can debate and people do debate the merits and the reasoning, you know, behind the

actual guideline, specifically, but what's not debatable is that there is an incredible disparity in school discipline. the department of education's own office of civil rights has found that black boys, for example, are expelled three times -- three times more likely to be expelled than white boys. black girls are six times more likely to be expelled than white girls and even just this past april, the government accountability office found that while black students make up about 15% of all public school students, they account for 39% of all students who are expelled. so, this is an issue, and the 2014 guidance that this report recommends repealing basically puts school districts on notice and said, if you have policies in place that result in disparate disciplining, meaning, your students of color are or any student subgroup is

disciplined at a higher rate than others, we're going to look into this and we will investigate you. that sort of had a windfall effect. school districts sort of turned a little bit more to this justice approach of trying to discipline students. there's been a lot of debate about whether this, you know, should have been put in place, but essentially, it has dropped suspension rates for students of color in some areas that embraced this. but it's important to note that not all school districts changed. and so, this specific guidance, secretary of education has long called for needs to be taken a look at this specific discipline disparities. >> education -- educators and administrators it's 202-748-8000. if you're a student or parent,

202-748-8001. what was it like for the teachers under that guidance before and at least what do they look forward to now? >> yeah, so, during the background call with reporters yesterday, white house officials were really quick to say that the specific recommendation to repeal the discipline guidance was made largely because of this recurring narrative that they heard traveling around the country from teachers who were saying, we feel really hamstrung by this guidance because of the fact that, you know, we're put in a position where we can't really send students to the principal's office or we're having a hard time figuring out what to do with some of our students who do present behavioral problems because we don't necessarily want to suspend them but we don't have the resources and the training to deal with them in the class. and that was, you know, specifically one of the reasons why they recommended this. >> so, guns, specifically, are at least one aspect of this and the other is discipline. what about the idea of arming

teachers or arming people on school campuses? did that come up in this report? it absolutely came up in the report. they do make a recommendation that school personnel who are highly trained in how to handle guns should be able to or that school districts should at least consider arming school personnel that is highly trained, and that could include educators. it could also include, you know, principals, school administrators, they do make a recommendation that school districts look to retired law enforcement and veterans to see if they could maybe find a position for them within schools. so, the guidance does go there. it also includes a recommendation that states, adopt what's called extreme risk protection orders, which is another gun-related specific recommendation, which essentially says an individual who is at risk, perhaps maybe in

the midst of a mental health crisis, is prohibited from buying firearms for a limited period of time. >> and specifically to that last point, what was the reaction from the education community? >> to -- well, specifically, for arming school personnel, no one really seems to want that, and everyone -- i mean, everyone from teachers, national teachers unions to school principals, associations that represent superintendents, associations that even represent school psychologists, that specific recommendation got a lot of pushback. >> so we have calls lined up. our first one is from james for our lines for students and parents from pennsylvania. james, you're on with our guest, lauren camera. go ahead. >> yes, how are you? my statement is that the constant reversal of the obama administration laws, especially

due to the student to prison pipeline, is absurd. what it's saying is that we will put you on notice and what that is, nothing but an empty threat. one of the things that the schools have been doing is unjustly suspending children as young as 3 years old, and having them have police contact, and with the police contact, either giving them a record or citation or making some type of documentation on their school record, and it doesn't make any sense. what we have to realize is that we have an administration and we have people that really don't care about african-americans or latinos at all, and they are so obsessed with everything obama

had done that they are effectively trying to erase anything, even to the detriment of average americans. >> okay, james. thanks. >> yeah, this was, you know, exactly what a lot of the civil rights groups have been pushing back against in the last 24 hours and specifically speaking to the discipline guidance. you know, you're making the same argument that all of these civil rights groups have been making, and i should also note that the former secretary of education, both arnie duncan and john king, who served under president obama, came out with a pretty scathing rebuke of this specific recommendation to repeal the discipline guidance. congressman bobby scott, the democrat from virginia, who will be the chair of the education and the workforce committee in the new congress said that this was not even a good faith effort to try and look at school

safety, really went after the recommendation to repeal the school discipline guidance and that will certainly be something that his committee looks at next congress. but this is a really big issue, and for years, including under the obama administration, politicians have been trying to figure out how to tackle this issue and the 2014 guidance that was issued under the obama administration was a way to try and prod school districts to better consider some of their school discipline disparities. the hard thing is it's difficult to do when there aren't wrap around resources to help teachers and principals bolster some of those ideas. >> and to the overall recommendations, the report, if they are recommendations indeed, do any of them come with some kind of backing of federal dollars? >> that's a really good point.

they don't. the recommendations do not include any sort of funding commitments by the federal government and this is really, really important, actually, because the previous trump administration, when they put out their budget proposal last year, actually called for eliminating a $1 billion federal grant that specifically schools could use for mental health services and school security. now, congress ultimately didn't follow through with that and they ended up beefing up funding for that program instead of eliminating it. but you know, as the saying goes, show me your budget and i'll show you what you value. going forward, this will be one to watch. >> here is lee from alexandria, virginia, calling on our lines for educators and administrators. >> good morning. i've been an educator for 12 years in the washington, d.c., area. i spent 10 years in prince georges county, maryland, and now i'm currently in virginia. i have to respectfully disagree with the previous caller who says -- who said that to a large

extent society just doesn't care about the black and brown students in the classroom. i'm -- i happen to be a caucasian teacher, and in my experience in working in very high needs areas and very high needs schools, the thing that our students most especially need -- the things that our students especially black and brown students who are coming from oftentimes poor families and situations -- more difficult situations, what they most need is structure and discipline. i currently work in a school where the administrators actually support the teachers, which is such a novel idea, isn't it? and i have to tell you that with the same demographics as my previous school, our school is run so much better and the students know that they can't play adults off other adults. students can be very shrewd when they want to be, and if we are

going to go down that road of sending students the message that they can get away with just about anything, our students are off the chain. if we send that message to students, that their actions will not have consequences, we're setting them up for failure. >> okay. lee, thank you. >> yeah, i think it's important to note here the actual impact that the guidance had, the 2014 obama era discipline guidance actually had on schools. the school administrators association -- excuse me, school superintendents association, they actually did a poll and talked to nearly 1,000 school districts across the country and found that actually only 16% of schools changed their policies in reaction to that 2014 guidance, and of that 16%, actually only 1% had a negative

experience with it. so, again, the 2014 guidance was just that. it was not binding. it was guidance. its purpose was to try and prod schools and school districts to figure this out. and again, with the recommendation that came out from the white house yesterday, those are recommendations, and so school districts are going to have to sit down with their states and teachers, parents, students, and figure out what works right for them. >> mary's in fort worth, texas. hi there. >> yes. i'm a retired educator, and first of all, i would say this. it is utterly insane to think that a teachers in classroom should be armed. i don't care if that teacher's annie oakley. you are not going to be able to combat a shooter that burst on the scene like the sandy hook, parkland, santa fe and schools who were already combat ready with ar-15s or ak-47s or whatever they had. they're ready to shoot.

even the policeman or somebody like that cannot combat that. we've got to do something about that kind of weapon and that kind of person having -- not going through background checks and being able to acquire the weapons and there seems to be no effort to do this at all because we don't want to combat the gun industry. it seems to be more important than our children's lives. >> yeah, i'll note that in wyoming, actually, there are already policies in place that allow school personnel to carry firearms. one thing the recommendation in the white house school safety report specifies is that the recommendation may be specifically useful for rural school districts. the fbi has estimated that it takes about five minutes for a mass shooting event to occur and in some of these more rural areas, it can take anywhere from 8 to 15 minutes for law enforcement to show up.

so, that, they say, is one of the reasons why they're making that recommendation. >> how does the report address the school building itself as far as the design or at least changing it to make it harder for someone to get in with a gun? >> it recommends that schools take a top to bottom look at their structures, reinforce things like windows, make sure they're bullet and blast proof, reinforce doors, try to set up stronger perimeter surroundings, whether that be a fence or more security cameras and entry points and things like that. >> how does the report also address students that might be or at least troubled emotionally or otherwise who could end up, you know, handling a gun. does it make any recommendations on what you do with identifying and helping these students. >> it calls for a big increase in funding for mental health, and that includes increasing the number of therapists that are available to students in schools. of course, schools are very cash strapped, so making that funding available would be a big part of

that. it also actually prods congress to update ferpa, the federal law that regulates what student information can be given out and one of the things the white house official said was that there's often this disconnect and questioning among school personnel about what information they can provide to law enforcement. and that is one of the biggest issues, especially for students with mental health disorder behaviors and things like that. >> lauren camera from u.s. news and world report joining us. she is their education reporter talking about these recommendations from the task force that was tasked by president trump on these issues. you can find their report online, by the way, if you go to the education website at www.ed.gov if you want to see the report recommendations for yourself. from north carolina, tina is next. hi. >> good morning.

ms. camera, betsy devos' brother, eric pearson, i think he's with black water and an nra surrogate, have you thought about the conflict of interest there that relative to the report as it relates to guns? and at risk students to the caucasian gentleman and from maryland, and i've worked with at risk students for over 25 years. they need stability, less poverty, love, guidance, and more -- and they need it in an environment where teaching and learning occur safely, and because all teachers and students are flawed, that's the best reasons to keep guns out of the school system. so, i'd like for you to address the issue regarding conflict of interest first and then the report. how long did it take them to do it? how many schools were involved? and i know we can see the

results on the web, as they just said, but a report that determines what is being proposed, it seems to be too short. >> okay, thanks. >> yeah, so, actually, senator patty murray, a democrat from washington who is the ranking member on the senate education committee, she raised some of these same concerns regarding the nra and actually sent a letter to betsy devos, the secretary of education, asking what the nra's influence would be on the committee. to the best of my knowledge, that letter was not answered, but the commission, the safety commission, the white house safety commission, they did four different listening sessions in d.c., alabama, kentucky, and wyoming. they also traveled across the country to, i believe, 47 states and held dozens of round tables, many of which were sealed, so we don't really know what was said

in them. but you know, they did make what seems to be a good faith effort to travel across the country and get the input of parents, teachers, school administrators, lawmakers, anyone who might have some school security expertise in any way. >> this is freddie from maryland. hello. >> hello. three quick ones. i want to make sure everyone understands that this administration is doing a very, very good job when it comes to schools. if we start with the discipline of children, children go to school to learn, and teachers need to have tools to discipline children when they are not behaving well, and it is our job as parents to help our children to be able to behave well. when it comes to food, children are not even eating this food in school anymore. and i will gladly -- understand

that this administration -- even if you go to the campus, the sexual assault accusations, these have changed. in the past, if a charge is accused, he would just be kicked out of school. now the child is able to defend himself, and as an african-american, i'm just shocked that each time something comes out of this administration, we just think we are being targeted. we are not. this administration is just doing a good job. >> okay, freddie, thank you. >> yeah, i mean, i always like to say that i love covering education because it's not just covering education. you really get a look at all of the issues that are happening across the country because a lot of times, they appear in schools first, whether it's hunger, as the caller mentioned, issues around sexual assault, homelessness, all of these things percolate in schools first, and politicians are under a lot of pressure to try to deal with all of these things, and that's actually one of the reasons why the 2014 discipline

guidance came up in the first place as one of a way to tackle the school to prison pipeline. as we -- as i mentioned before, a lot of schools are very strapped for resources, so in order to implement those types of disciplinary policies, you really need to make sure you have the wrap around services available, things like mental health services, extra therapists, you know, any number of things. and so, this really is a very thorny debate with lots of different angles for people to come at with. >> this is william. he's in michigan. hello. >> yeah. hi, guys. i'm a retired teacher, and a couple things i'd like to comment on. i started teaching in roughly 1964, and i retired in '06. my basic job was french teacher, but what i'm seeing is there is

no discipline in schools, because the politicians and so forth have practically eliminated -- you can't even raise your voice and say, john, i see you or whatever the case may be. and it just -- it's horrendous and how are teachers to teach, because i believe, and, you know, i'm not -- i'm a very liberal person. i believe parents are not -- are not teaching their children discipline. they are giving -- i don't think the politicians, boards of education in particular,

administrators who usually are a result of politics are really run the schools. >> okay. thanks. >> yeah, and secretary of education betsy devos actually made this point quite a number of times yesterday, that education really starts in the home, and one of the recommendations that the report makes or i guess it's not a recommendation, but just lays out the fact that, you know, children really need to have good, stable home situations. parents who love them, people who -- >> retirement plans to their workers and helps families start saving a little bit earlier and allows business to write off more of their initial investment start-up costs. the bill includes core provisions in the family savings act, which passed the house in september as part of tax reform two. this legislation builds upon the critical reforms as seen in hr