Veterans' Administration Medical Care

Floor Speech

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Mr. President, next month our Nation will pause to honor the millions of men and women who have fought for our freedom and worked to advance peace around the world.

Veterans Day is our annual way to say thank you and to honor those who have sacrificed so much on our behalf. While I would like to stand on the floor and say our country is doing everything we can for the people we owe the most to, that we are fulfilling the promise we made to them when we sent them off to fight for us, unfortunately that is not currently the case because our Nation is falling far short of its goal of honoring our veterans when it comes to VA care.

Despite a sweeping bill intended to tackle some of the most pressing problems and give the VA new tools and a change at the top of the VA more than a year ago, I continue to hear from veterans across my home State of Washington about care that is inconsistent, outdated, and often downright dismissive of individual needs. I have heard from a number of veterans in my home State of Washington who are waiting on surgeries, MRIs, oncology appointments, mental health screenings--you name it--and far too often they say they are told it will be months to see a doctor or a specialist.

I bring their stories today, to this ``other Washington,'' to continue to make clear this kind of outdated, inefficient care is unacceptable.

This is a pivotal time for our VA, and the demands on the system will only go up as wars continue to wind down and the Vietnam-era veterans continue to seek more care for the injuries and illnesses they suffer from. As the daughter of a World War II veteran, I refuse to let substandard care be the status quo. I won't accept long wait times, redtape, and understaffed hospitals as a reality for our veterans. I am not going to stop fighting to make sure we have a system that works no matter how long it takes, no matter how many obstacles we face, and no matter who is in charge at the VA.

The law we passed to give veterans more options for care has now had an opportunity to go into effect. We can see what is working, what is not, what we can build on, and what we need to tear apart.

Last year I supported the inclusion of an independent assessment of the VA health system in the Choice Act, and recently that assessment validated what we have been telling the VA for years: There is growing bureaucracy, and there are problems with leadership and staffing, and massive capital costs. While the independent assessment identified some bright spots in the VA system, it also found that care and patient experiences differ widely across the system and that best practices and important policies are not instituted across the country. That means we all have more work to do because we have a responsibility to our veterans.

Here is what we are up against. The VA still has multiple non-VA care programs, none of which talk to each other, none of which are coordinated. They all have different eligibility criteria, different procedures for patients and providers, and different reimbursement rates.

I hear frequently from veterans in my home State of Washington about how difficult the Choice Program has been. From VA staff who don't understand the program, to confusion about eligibility, to getting the runaround from contractors, veterans are sick and tired of having to fight just to get an appointment.

I hear how frustrating some of the bizarre rules and restrictions on Choice are. For example, an authorization for care only lasts 60 days. Well, if you are a woman veteran and you are pregnant, you are going to need more than 60 days of care.

At the VA, we are still hearing that the wait times are far too high. But with long wait times in the private sector and the burdensome process to even get into the Choice Program, veterans are finding they actually would have gotten care sooner if they had stuck with the VA. If the solution to the wait time problem takes longer than going to the VA, it is not working.

It is no wonder that veterans and providers alike turn their backs on the VA. The system is so complicated, it is impossible to get good health care.

It is time for the VA to implement one--one--non-VA care program for the future. As we now approach the end of this trial period for the 2-year Choice Program, the VA has to use this opportunity to finally get it right on non-VA care. It needs to design a new system that truly meets the needs of our veterans.

I believe that system must have five fundamental characteristics:

First of all, it has to be veteran-centered, with clear eligibility rules so veterans know what they can do and what they can expect and where they can go for what care and how that system works. It also means the experience for veterans trying to use the system has to improve. For example, veterans should never be turned away with a dismissive ``We are not taking new patients.''

Secondly, it has to be easy for our providers, with simple and consistent procedures for them to deliver care, report back to the VA, and get reimbursed quickly. The contracting system needs to be simple and clear so that private providers can step in where the VA cannot.

Third, a new system must provide high-quality care that includes effective care coordination, and that requires that electronic medical records be returned to the VA. That includes oversight of the quality of care being delivered in the private sector. We have to know our veterans are being appropriately cared for.

Fourth, the new system has to be flexible enough to compensate for local needs, types of care where VA is deficient, or locations where the VA does not have a presence. Whether working with community providers to increase certain specialty appointments or seeing where the VA needs to move resources to hire more VA staff, the system has to maintain flexibility to adjust to new trends and new needs.

Finally, it has to be cost-effective for the VA and not shift the cost of care onto our veterans. Earlier this year, the VA nearly ran out of money, and they threatened to shut down the health care system. Well, we should invest whatever we need to to make sure our veterans are getting care. The new non-VA care system must be more efficient, and the VA needs to be clear with Congress about what it needs. Without a change, I would not be surprised if next year we don't find ourselves in the same position where we have underfunded the VA and need to come in and transfer funding to keep the VA operating. I will work with anyone and stand behind no one when it comes to getting veterans the funding they need.

Perhaps most important, when implementation begins, it simply must be better than what we saw with the Choice Program. VA staff have to be trained and proficient, and third-party administrators in charge of the networks of private providers have to be efficient and responsive. Veterans deserve a system that works, not one that is torn apart and weakened over time.

So the answer isn't just to dismantle the VA and leave veterans to fend for themselves, as some proposals would do; the solution starts, finally, with a real conversation about what is going on at the VA, what the problems are, and then pursues an ``all of the above'' approach that finally strengthens the VA system, uses community providers to fill in the gaps where the VA cannot get the job done, and continues to make the best use of other Federal help programs, such as DOD and federally qualified health centers--all in an effort to truly build a veteran-centered VA health care system.

I stand ready to work with anyone to do this, and I hope my colleagues on both sides of the aisle will join me and not make this a Democratic or Republican issue. Veterans issues have never been partisan, and, in my mind, there is no place for that when we sit at the table to solve a complicated problem. I hope the administration is ready to fundamentally reshape this program. I hope bureaucrats who spend more time defending the broken system are ready to get to work implementing solutions built around the needs of our veterans. And I hope providers--those who work with the VA and DOD and TRICARE, as well as those who currently do not provide care to veterans--play a role to improve veteran care.

The wars may no longer lead the nightly news, but that doesn't mean the cost of these wars is gone too. Our veterans are still there, they still need health care and services, and we will not forget them.

I expect the VA to do better. Our veterans have already sacrificed so much. They should not have to come back and fight the VA to get the care they have earned. Let's act and let's do something that truly honors our Nation's heroes.

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