Madam President, I rise today to discuss the legislation before us, known as the VA MISSION Act of 2018--a significant change for the healthcare delivery system at the Department of Veterans Affairs. The VA MISSION Act passed the House of…
Madam President, I rise today to discuss the legislation before us, known as the VA MISSION Act of 2018--a significant change for the healthcare delivery system at the Department of Veterans Affairs.
The VA MISSION Act passed the House of Representatives last week and is scheduled to be voted on in the Senate in the coming days. The bill is a result of months of negotiations and discussions between stakeholders, the administration, and the House and Senate Veterans' Affairs Committees, of which I am a member.
While I appreciate the hard work of those involved, unfortunately, the final legislation is not something that I am able to support. Before I get into my concerns about the bill and what I believe to be its fatal flaws, I want to acknowledge that there is a host of good provisions in here that I do support.
The one on the forefront of many minds is the caregivers program expansion. The caregivers program, a program that gives support and assistance to certain veterans so they can receive home healthcare by a family member, has always been limited to post-9/11 veterans. However, there are many pre-9/11 veterans' family members who do the same work as a caregiver recipient but are not compensated for that work. This program is more cost effective over the long term than an alternative long-term care accommodation. It is due time for this expansion to occur for all families.
I also support section 101, paragraph (a), which expands extended care services, such as nursing home care, through the community care program. It is similar to a bill I introduced with the senior Senator from North Dakota, the Veterans Access to Long Term Care and Health Services Act. This provision will allow long-term care services to more easily work with the VA in serving veterans.
Further, section 101, paragraph (k) of the VA MISSION Act establishes in law that a veteran shall not pay a greater amount for receiving care or services outside of the VA, compared to receiving care at a VA facility. It is similar to the Veterans Equal Cost for Care Act, which I introduced in Congress last year. This section makes certain that veterans will know that VA policy will not change in this regard and that the VA will not place additional financial barriers for veterans to access care outside of the VA at a private provider in an effort to incentivize in-house VA care.
Last, section 101, paragraph (d)(1)(D) of this bill, along with section 104, requires the VA to develop appropriate access standards when seeking healthcare. However, I remain concerned that the VA will not implement it properly.
If the VA implements access standards similar to TRICARE, which is the health program at the Department of Defense, then, these sections could be good for veterans.
Let me get into my concerns with the bill. This bill makes significant changes to the 40-mile rule under the Choice Program, and I am concerned that it puts our rural veterans in jeopardy.
The Choice Act, which Congress passed in 2014, before I took office, allowed all veterans who live 40 or more miles from a VA facility to receive care at a local, private hospital or clinic. Under the VA MISSION Act, this provision will end for all veterans except those in the top five rural States after 2 years.
When the Choice Act was first enacted, giving rural veterans the option to receive care in their communities, rather than at a VA facility, they overwhelmingly chose to stay close to home and receive private care. They voted with their feet.
Because of the law, many are getting better local, private care. I believe veterans who use this type of eligibility successfully today ought to be able to use this program in the future, no matter which State he or she is from.
In fact, these concerns were addressed when the original legislation was crafted in the Senate Veterans' Affairs Committee, and all veterans who use the Choice Program today were grandfathered into being able to use the 40-mile rule in perpetuity. Unfortunately, the proposal agreed to in committee is not the one in front of us today.
I understand that the number crunchers did the math and concluded that the bill discussed in committee was too expensive and they didn't want to pay this much for the care of our veterans. So the provision I offered was cut down significantly to be limited to the top five rural States, including my own State of South Dakota.
While South Dakota was fortunate to be a part of the top five States, this country has many rural States and many rural veterans who rely on the Choice Program's 40-mile eligibility to get their healthcare.
There are roughly 750,000 eligible 40-mile veterans across the United States. Of this portion, a little less than half, or 330,000 veterans, have used this eligibility to receive healthcare.
In just 2 years, many of these veterans will no longer be eligible to receive care outside the VA system based on the 40-mile rule alone, as they do today. Instead, more veterans will have to work through more gatekeepers and review processes to get their community care request granted, if it is granted at all.
Just as important is the way in which 40-mile-eligible veterans receive community care. Currently, when a rural, 40-mile veteran wants community care, they get community care. There are little, if any, barriers to access community care today. The VA can't decide for the veteran where he or she should get the care. The veteran is in total control of their care. There are no reviews, gatekeepers, or consultations. The veteran just goes.
Under the VA MISSION Act, as it stands today, a VA clinician acts as a gatekeeper for the veteran. Section 101, paragraph (d)(2) states that a VA employee must consider certain criteria, some of which are peculiar to a rural veteran, when consulting with a veteran on where the veteran should go for healthcare. ``Consider'' is not a very tough or obligatory word, and it leaves a lot of leeway for our Washington bureaucrats to write rules in a way that may not put the care of our veterans above all else.
My concern here is that when this bill is signed into law, rules are going to start to be written, and the number crunchers are going to influence every rule to meet the bare minimum of the required language.
Just in case anyone is interested in an example, let me briefly remind the Chamber that the original Choice Act intended to provide community care to veterans who live 40 miles or more from a VA facility. How was that rule initially written? Community care was based on 40 miles as the crow flies. That is right--as the crow flies. It took intense pressure from the veterans organizations and Congress to amend that rule to be based on driving distance, or better known as the way almost every veteran travels to a VA facility.
Why was that rule written to determine community care as the crow flies? Cost. Cost and nothing more. The VA wrote the rule in a manner that complied with the bare minimum requirements of the law but not with the spirit of the law. The VA did not write the rule in a way that was in line with the way a normal veteran would access community care. By writing the rule this way, the VA was able to restrict community care access to veterans to control cost.
With so much ambiguity in the language as it is currently written, my fear is that the same cost-first mentality will be used once this bill is signed into law. We believe veterans should be in full control of their healthcare, not a bureaucrat.
Additionally, under the Choice Act, the access standards have been clear when it comes to the 30-day rule. It states that if you wait longer than 30 days, you can use a private provider, period. Under the VA MISSION Act, the standards are fluid, and the cut-and-dry 30-day standard goes away. We know that this has been a widely used metric for veterans' eligibility to receive care outside the VA. In fact, since the Choice Act began in November of 2014, there has been roughly 1.4
million instances in which a veteran has been authorized for care outside of the VA based on the 30-day rule.
Under the VA MISSION Act, there will be a new review process for veterans who request to receive care outside the VA system, based on meeting an access standard which has yet to be written. Again, if the VA implements these access standards like TRICARE, this could be good for veterans. But whether that happens is subject to rulemaking and cost constraints.
Finally, I am concerned about title II of this bill, which is the asset and infrastructure review provision that paves the way for what is essentially a VA BRAC that could close out some of our most vulnerable VA facilities, particularly in rural areas. I know that my friend and colleague from West Virginia was just expressing some of the same concerns. Of particular concern is a provision that would seek to neutralize appropriations language that prohibits the VA from reducing services in the Veterans Integrated Services Network 23 unless a series of important criteria are made.
For years, the VA has incrementally sought to close the Hot Springs campus in my home State of South Dakota. The VA has not conducted its due diligence in deliberating over the future of the Hot Springs campus, which provides veterans from three States and Indian Country healthcare. This is a pocket of rural America where few healthcare options exist.
This VA BRAC provision puts VA facilities like the one we have in Hot Springs in jeopardy. The Hot Springs VA facility has consistently been named one of the top VA facilities in the entire United States. If we are truly putting the care of our veterans before all else, we should be propping up facilities that have a track record of delivering timely, high-quality care to our veterans.
With the asset and infrastructure review provision in this bill, I worry about the future of rural VA facilities such as Hot Springs. More importantly, I am concerned about our rural veterans' access to adequate care, including mental health services, should these vital facilities be closed in the future.
Some have been saying that even though the provision is in there, the VA has provided assurances that places like Hot Springs are not in jeopardy, despite the law allowing the agency to review and eventually close facilities across the Nation if it determines it is necessary.
While the VA has some great employees, including its leadership, I am reluctant to consent to the BRAC process because the appropriations language requirements are what I view as due diligence by the VA before any decision is made on the closing of campuses like those in Hot Springs. In this particular case, the asset and infrastructure review language intends to neutralize that appropriations language, and I will not support that path forward.
At the end of the day, all we can count on is what we have enacted through legislation, and this bill clearly allows for the VA BRAC to occur.
My decision to oppose the VA MISSION Act is not one that I have made lightly. I recognize the many good provisions in this bill that would go a long way toward improving care for our Nation's veterans. I also want to recognize the hard work that went into the final package. I particularly want to thank Chairman Isakson, our Senate Veterans' Affairs chairman, for making a truly honest effort to address the ideas and concerns of all the committee members, including my concerns, which were reflected when we passed our bill out of committee earlier this year. Unfortunately, those concerns were not included in the final package. That said, the fight is not over.
Even though we expect the VA MISSION Act to pass the Senate and be signed into law before Memorial Day, there will be plenty of work to do as the law is being implemented. I will continue working with my colleagues, the administration, veterans groups across the State, and other stakeholders to keep a close watch on the VA's implementation of the VA MISSION Act to make certain the agency is putting the proper care of our veterans above all else.
Now, this is something that you never hear in this body, but this is an instance in which I would be happy to be wrong in my assessment. In fact, I challenge the VA to prove me wrong. We were close to having a really good bill with the VA MISSION Act by expanding the caregivers program to pre-9/11 veterans, by expanding community care to include community services, and in providing payment protections to rural vets so they will not pay a greater amount for using community care than they would for care at a VA facility, just to name a few.
I would have happily voted for any of these provisions as separate measures, and I am grateful that our veterans will greatly benefit from them.
I had hoped to get a place in the final bill where my concerns would be able to be fixed, but at the end of the day, my concerns outweigh the good, and I have to vote no.
I have the privilege of serving on both the Senate Veterans' Affairs Committee and the Senate Armed Services Committee, and I cannot tell my colleagues what an honor it is to fight every day to make sure that our servicemembers and veterans receive the tools and the care they so clearly deserve. They make incredible sacrifices so that we can be free. We have a responsibility to take care of them when their service is complete. I look forward to continuing to work to fulfill that responsibility.
Thank you, Madam President.
I yield the floor.
I suggest the absence of a quorum.