Military Construction, The Department of Veteran Affairs, and Related Agencies Appropriations Act, 2016 -- Motion to Proceed

Floor Speech

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Ms. MURKOWSKI. Madam President, I am here this morning to speak about the issue that is before this body, the motion to proceed to H.R. 2029, or what we refer to as the MILCON-VA appropriations bill.

I certainly intend to support closing off debate on this and moving to take up this important appropriations measure. This is important for a host of different reasons, not the least of which is that we need to get to the substance of this issue. We need to get back to a regular order process in order to advance the appropriations bills that we on the Appropriations Committee have spent a considerable amount of time and effort drafting.

Over these past many months, we have worked to make sure that the bills were ready for floor consideration. We didn't want to find ourselves in a situation where, at the end of this year, we scramble to piece together an omnibus measure that has not had the considered debate and opportunity for amendment that I believe we all seek as lawmakers. It is important that we consider the Military Construction-VA bill in regular order and do it now--not stick it on the back end of another measure, not incorporate it into an omnibus bill or into some fashion of a CR omnibus right before Christmas.

I serve on the Appropriations Committee. I had input into this bill at the subcommittee level and again at the full committee markup, which is a lot more than can be said of many of my colleagues in this body who don't have that opportunity since they are not on the Appropriations Committee. But even after having the input that I have had, it is extraordinarily important that I have another opportunity to influence the bill, and I will illustrate why.

I am going to speak about one very specific issue today that has garnered the attention, concern, and passion of Alaskans and veterans around the State, and that is the issue surrounding the Veterans Choice Card.

In the view of many Alaskans, the Veterans Choice Card is an unmitigated disaster in our State, and there are many reasons that is the case. We don't host a stand-alone VA hospital in Alaska. So the VA has issued a Choice Card to every veteran in the State who is enrolled for health care. In order to use the Choice Card, you have to identify a provider that is willing to accept the card, qualifies under the very onerous Choice Card standards, and is also willing to put up with the bureaucratic strings that are attached to determining which care is approved by the VA over what period of time and for what price.

In Alaska, we have a demand for health care providers that far outstrips the supply, and I have been on the floor many times speaking on that subject. We have many Alaskans that have private health insurance which pays the providers better, and it is certainly more efficient than the government-sponsored programs.

Structurally, the way the Veterans Choice Card Program is currently designed, it does not provide Alaska's veterans with the choices that it promises. It is just as simple as that, and those are just the structural problems we are talking about. Many of our colleagues know that TriWest has encountered difficulties with implementing the program, and the VA has had trouble coordinating TriWest's work with the work of the local VA facilities.

Unfortunately, these problems have led to some dangerous near-misses.

We had one situation with a veteran who was scheduled for a fee-basis neurosurgery. He was going to receive this care from a community provider in the State. Then he was told by the VA that the VA had changed its mind. They were not going to sign off on paying for the care. The vet was told to call TriWest. The TriWest call center operator gave the veteran a list of behavioral health providers who had signed up to accept the Choice Card. The call center operator didn't know that neurosurgery is not the same as behavioral health. By the time the VA had reversed itself, the neurosurgery that the veteran had initially scheduled was no longer available. The vet had to wait for one to become available.

What happened in the interim? They gave the veteran pain medicine.

In another case, we had a veteran sent to Seattle for a course of radiation therapy, and in the middle of this course of radiation therapy the vet was told to return home because his authorization had expired. He was told: The authorization has expired. Go home.

It is not as if he could just get in a car and drive 20 minutes back to his house. He had been sent to Seattle from a rural community in Southeast Alaska for the care--for the radiation therapy. They said: Go home. Your authorization has expired.

So there was a whole series of exchanges with TriWest and then with the VA itself. The vet began, basically, calling family members to tell them he was coming home to die and to start making funeral preparations. This is not how we treat our veterans.

Now the Veterans Choice legislation provided that the Choice Card program does not displace any of the existing VA purchased care programs. It explicitly supplemented those programs, which for us in Alaska would be a good thing. In Alaska, the VA--and this was under Secretary Shinseki's leadership--established two purchased care programs to address gaps in VA capacity in Alaska. One of the programs provided for partnerships with our tribal health system to care for our vets in more remote areas of the State where the VA simply doesn't have a presence. It was innovative. It was innovative at the time, and these partnerships worked. They really did help to facilitate the care. The other program called ``Care Closer to Home'' enabled the VA to purchase care from community providers in the State who performed medical services that the VA didn't offer--services such as neurosurgery and specialized forms of radiation therapy.

Before this program was implemented, the VA forced veterans to fly to Seattle or other parts of the country for services that we would consider pretty routine. You have a 1,000-mile-plus flight to Seattle for an orthopedic appointment or for a neurosurgery appointment. This is what we are putting our veterans through. Imagine you are 70 years old, 80 years old, and you are told to go take a flight for 3 1/2 hours to Seattle--get yourself to the hospital just for an orthopedic appointment. By the time the veteran is at this place and needs that appointment, you are not feeling well in the first place.

I have talked and written before about a veteran on the Kenai Peninsula who died while fighting with the VA over urology care. He couldn't travel to Anchorage, which is about a 3-hour drive, much less to Seattle where the VA wanted to send him because he was in very frail condition, but the VA refused to purchase his care on the Kenai Peninsula where there are facilities that could have helped him. I think we would all agree that when our elderly veterans are in perhaps their final months of life, they have got a lot better things to do than fight with the VA and the bureaucracy.

When the VA came to the hearings before the appropriations subcommittee, I asked them pointblank whether the implementation of the Veterans Choice Card would adversely affect the existing purchased care programs in Alaska, whether it is through IHS or further specialized care, and the answer was clear. There was no nuance; there was no doubt. The answer was no, it is not going to impact negatively the purchased care program. When the Senate Appropriations Committee marked up the MILCON-VA bill on May 21, the VA hadn't changed its answer. It is not going to negatively impact, they said.

Then a week later, on May 28, I happened to be visiting the VA facility in Anchorage, and I learned there that the VA had spent all of its fiscal year 2015 purchased care money and was planning to suspend its relationships with community providers and the Alaska tribal health system.

I had gone to the VA center to get an update, to check in with the new docs who were there and to see how things were going. It was basically a checkup with the folks at VA, and they laid this bombshell. They weren't trying to be coy with me or hide the ball. They had just learned themselves. I don't know who was in greater shock, me or the folks there at the VA and their military partners.

We were also in a situation where there were a lot of rumors that the VA was going to pull out of the Joint Venture Hospital that it shares with the Air Force on the Joint Base Elmendorf-Richardson. Again, this was a bombshell of news. Now we know that the VA was not just out of purchased care money, it was out of money to operate its health care system, and without the emergency infusion of money we provided from the Choice Act fund before August recess, the VA would have run out of money before we had come back from the August recess.

It was a situation that was a mess. We fixed the mess for 2015 but did nothing for 2016.

What does the VA's failure to properly project the cost of purchased care in 2015 mean for its fiscal year 2016 appropriations? After asking the VA on several occasions, I am left with the impression that the VA once again will run out of money for purchased care and then will remedy this situation by shoving veterans who are seeking care under the Choice Card whether the care is meaningfully available or not. So we have been pushing the VA on this, and to Secretary McDonald's credit, he came to Alaska this summer. The Undersecretary for Health, Dr. Shulkin, visited Alaska. They weren't sheltered from the anger that our vets were feeling.

My colleague Senator Sullivan conducted an incredible field hearing to create a record of how the VA, TriWest, and the Choice Card Program were individually and collectively failing Alaska's veterans. But here's the problem. We don't have a fiscal year 2016 solution locked down, and we may not have an acceptable solution locked down by Veterans Day, either.

Without an opportunity to debate the fiscal year 2016 appropriations bill on the floor, I have limited opportunity to press this point, to demand that the GAO investigate what actually is going on and try to amend the bill to ensure that the VA has adequate purchased care money available so that it doesn't drop these veterans through the cracks when it can't serve their critical care issues, and neither can the Choice Card program. Without the opportunity to debate in regular order, I can't do what the people of Alaska have asked me to do in representing them the way I know that we need to in order to deal with this.

I hear what the Democratic leader is saying, that the Budget Control Act needs to be addressed, but I don't agree with the tradeoff that we cannot consider appropriations bills in regular order while conversations are ongoing to address the bigger, broader question. Failing to consider these bills in regular order corrodes the influence of this body; it corrodes the ability of Members to fulfill the responsibilities that we have to the people that we work for. These are issues.

Again, I chose to focus my comments this morning on one area within the MILCON-VA, on that implementation of the Choice Card in Alaska, and how it has so basically failed our veterans. But there is so much more. Again, if we don't have that opportunity to bring it up, to offer our amendments, to do our best to serve the needs of our veterans, we fail them. We fail the system.

I do hope we will have the opportunity this afternoon to advance to these important measures. Remember, this is just the first of 12. It is very important work that we have in front of us.

Madam President, I know my colleague from Connecticut has arrived on the floor, but before I yield the floor to him, I want to briefly mention a meeting that I had this morning in my office.

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