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Legislative Hearing on H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538, H.R. 542, et al

Legislative Hearing on H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538, H.R. 542, H.R. 1426, H.R. 1470, H.R. 1471, H.R. 1527, 1944 and Discussion Draft Rural Health Care Bill








LEGISLATIVE HEARING ON H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538, H.R. 542, H.R. 1426, H.R. 1470, H.R. 1471, H.R. 1527, 1944, AND DISCUSSION DRAFT OF THE "RURAL VETERANS HEALTH CARE ACT OF 2007"









APRIL 26, 2007

SERIAL No. 110-17

Printed for the use of the Committee on Veterans' Affairs





For sale by the Superintendent of Documents,  U.S. Government Printing Office
Internet:  Phone: toll free (866) 512-1800; DC area (202) 512-1800
Fax: (202) 512-2250  Mail: Stop IDCC, Washington, DC 20402-0001


BOB FILNER, California, Chairman


VIC SNYDER, Arkansas
JOHN J. HALL, New York
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
TIMOTHY J. WALZ, Minnesota

STEVE BUYER,  Indiana, Ranking
HENRY E. BROWN, JR., South Carolina
BRIAN P. BILBRAY, California




Malcom A. Shorter, Staff Director

MICHAEL H. MICHAUD, Maine, Chairman

VIC SNYDER, Arkansas
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
JEFF MILLER, Florida, Ranking
HENRY E. BROWN, JR., South Carolina

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined.



April 26, 2007

Legislative Hearing on H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538, H.R. 542, H.R. 1426, H.R. 1470, H.R. 1471, H.R. 1527, 1944, and Discussion Draft of the "Rural Veterans Health Care Act of 2007"


Chairman Michael Michaud
    Prepared statement of Chairman Michaud
Hon. Jeff Miller, Ranking Republican Member
    Prepared statement of Congressman Miller


U.S. Department of Veterans Affairs, Gerald M. Cross, M.D., FAAFP, Acting Principal
    Deputy Under Secretary for Health, Veterans Health Administration
        Prepared statement of Dr. Cross

Altmire, Hon. Jason, a Representative in Congress from the State of Pennsylvania
        Prepared statement of Congressman Altmire
American Legion, Shannon Middleton, Deputy Director for Health, Veterans Affairs
    and Rehabilitation Commission
        Prepared statement of Ms. Middleton
American Veterans (AMVETS), Kimo S. Hollingsworth, National Legislative Director
        Prepared statement of Mr. Hollingsworth
Brown-Waite, Hon. Ginny, a Representative in Congress from the State of Florida
        Prepared statement of Congresswoman Brown-Waite
Disabled American Veterans, Adrian M. Atizado, Assistant National Legislative Director
        Prepared statement of Mr. Atizado
Filner, Hon. Bob, Chairman, Full Committee on Veterans' Affairs, and a Representative
    in Congress from the State of California
        Prepared statement of Congressman Filner
Lantham, Hon. Tom, a Representative in Congress from the State of  Iowa
        Prepared statement of Congressman Lantham
Moran, Hon. Jerry, a Representative in Congress from the State of Kansas
Ortiz, Hon. Solomon P., a Representative in Congress from the State of Texas
        Prepared statement of Congressman Ortiz
Paralyzed Veterans of America, Carl Blake, National Legislative Director
        Prepared statement of Mr. Blake
Pearce, Hon. Steve, a Representative in Congress from the State of New Mexico
        Prepared statement of Congressman Pearce
Rothman, Hon. Steven R., a Representative in Congress from the State of New Jersey
        Prepared statement of Congressman Rothman
Solis, Hon. Hilda L., a Representative in Congress from the State of California
Veterans of Foreign Wars of the United States, Dennis M. Cullinan, Director, National Legislative Service
        Prepared statement of Mr. Cullinan
Vietnam Veterans of America, Richard F. Weidman, Executive Director for Policy and Government
        Prepared statement of Mr. Weidman


American Academy of Neurology, statement
Brown, Hon. Corrine, a Representative in Congress from the State of Florida, statement
Hinojosa, Hon. Rubén, a Representative in Congress from the State of Texas, statement


LEGISLATIVE HEARING ON H.R. 92, H.R. 315, H.R. 339, H.R. 463, H.R. 538, H.R. 542, H.R. 1426, H.R. 1470, H.R. 1471, H.R. 1527, 1944, AND DISCUSSION DRAFT OF THE "RURAL VETERANS HEALTH CARE ACT OF 2007"



Thursday, April 26, 2007
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.

The Subcommittee met, pursuant to notice, at 10:02 a.m., in Room 334, Cannon House Office Building, Hon. Michael Michaud [Chairman of the Subcommittee] presiding.

Present:  Representatives Michaud, Snyder, Hare, Miller, Stearns, Moran.


Mr. MICHAUD.  I would like to thank everyone for coming here today and I would ask unanimous consent that all written statements be made part of the record.  Without objection, so ordered.

I also ask unanimous consent that all members be allowed five legislative days to revise and extend their remarks.  Without objection, so ordered.

Today's legislative hearing will be the first of many this Subcommittee plans on holding to provide members of Congress, veterans, the VA, and other interested parties with the opportunity to discuss legislation within the Subcommittee's jurisdiction in a clear and orderly process.

I do not necessarily agree or disagree with the bills before us today, but I believe that this is an important process that will encourage frank discussions and new ideas.  We have eleven bills before us and one discussion draft. 

The discussion draft represents some of my ideas to improve the quality of care available to our rural veterans and the ability to access care, such as establishing mobile vet centers, improving information technology and technology sharing between the VA and non-VA providers, establishing a Rural Veterans Advisory Committee, creating Centers of Excellence to encourage research in innovative healthcare to address the needs of rural veterans, and encourage more healthcare professionals to work in rural areas.

I look forward to hearing the views of our witnesses and to a discussion on this and the other bills before us.

I also look forward to working with everyone here to improve the quality of care available to our veterans.

[The statement of Chairman Michaud appears in the Appendix.]

Mr. MICHAUD.  At this time, I would recognize Ranking Member Miller.


Mr. MILLER.  Thank you, Mr. Chairman, for holding this legislative hearing. 

I also want to say thank you to the members who brought these bills before us this morning and to all the witnesses that are going to be appearing here today. 

I look forward to engaging in a productive discussion about the legislation that will help us provide the best care for our veterans, whether it is through contract care or requiring more VA medical centers to provide chiropractic services, and I yield back.

[The statement of Congressman Miller appears in the Appendix.]

Mr. MICHAUD.  Thank you, Mr. Ranking Member.

Mr. Hare, do you have an opening statement?

Mr. HARE.  No, Mr. Chairman.  I will have some questions later though.  Thanks.

Mr. MICHAUD.  Okay.  Thank you.

At this time, I would like to welcome two of our members who are here today to present testimony.  I know, Mr. Pearce, you have another hearing you need to go to.  So why don't we start with you?


Mr. PEARCE.  Thank you, Mr. Chairman.

I would like to thank Chairman Filner, Ranking Member Buyer, Subcommittee on Health Chairman Michaud, and Ranking Member Miller for the opportunity to discuss this issue that is critical to the veterans of the State of New Mexico.

Today I am asking for you and the members of the Veterans' Affairs Committee to consider my legislation, House Resolution 315, the "Help Establish Access To Local Timely Healthcare For Your Healthy Vets Act."

In New Mexico's rural communities, many of our veterans are deprived of accessible medical facilities and face the high cost of gasoline to travel and to obtain care.  My legislation would require the Secretary of Veterans' Affairs to contract with local doctors and hospitals on a case-by-case basis to provide medical services including primary care for those veterans who live far away from the Veterans Affairs medical facilities.

This would expand the capability of our local health providers in southern New Mexico to provide more convenient, efficient medical services for veterans who live in areas that are far away from established VA facilities.

Currently veterans residing in southeast New Mexico must drive between four and six hundred miles round trip to receive care at New Mexico's only VA hospital located in Albuquerque, New Mexico.

Just for example, it is 305 miles from my front door to Albuquerque.  Now, you might think I live at the end of the earth, but it is actually 40 miles further south to Jal, New Mexico.  So those people have an even longer drive.

I consistently hear stories from my constituents about the detrimental impact this long-distant drive has on their ability to access timely care and overall health. 

One Marine veteran amputee began having uncontrollable drainage from his good foot and was making two to three trips a week to the Albuquerque VA hospital.  This equates to 18 hours of drive time a week.  After four months, he finally lost his foot.

Several local civilian healthcare experts feel the unfortunate travel marathon contributed to the failure to save his foot. 

Another 87-year-old Bataan veteran developed a serious bladder infection and was directed to make the six-hour, round-trip drive along with his 85-year-old wife.  Halfway through his treatments, prostate cancer was found and additional trips had to be made for chemotherapy.  After seven months of trips, he died and his wife's health was seriously damaged after the strain of such long-distance care.

My father is in his eighties.  He is a veteran and I will guarantee you he is not able to make a five-hour drive one way.

Today I know that you will hear from several National Veteran Service Organizations who may not support my bill and others under consideration today.  That is because many of these groups have committed themselves to the goal of keeping VA dollars inside the VA.  I understand this concept and believe at first glance it sounds like a common-sense approach to VA budgeting.

But following this logic, the only way to get more localized access to care for veterans in my district would be to build new facilities in areas closer to their homes.  I believe there is a need for a full-service veterans' health center in south New Mexico and would love to see that come to fruition.

However, I am realistic as are the veterans living in rural New Mexico.  With the tight budgetary constraints that our Nation faces and the smaller population in States like New Mexico, that idea is much easier said than done.

This is a reality veterans living in rural areas have been forced to accept.  Since that solution is not realistic at this time, we must work to find other solutions to this problem that is hurting our veterans with every six- to eight-hour, round-trip journey to the hospital.

Unfortunately, the idea of expanded contracting authority raises flags with certain Veteran Service Organizations that see it as a step toward privatization.  Yet, if they understand what is going on, we are spending dollars for gasoline and mileage and we are not paying it for the healthcare for our veterans.

I will tell you that the Federal Government and the VA are not adequately living up to their commitment in serving my constituents in the rural parts of New Mexico.

John Taylor, life member of the Military Order of the Purple Heart and life member of Disabled American Veterans, lives in Roswell, New Mexico, which is approximately 200 miles away from Albuquerque.  In a letter John wrote to me, rural veterans in New Mexico are dying and losing body parts because of a six-hour, round-trip drive to the nearest VA hospital in this State.

Our VSO legislative representatives from the DAV have no experience or do not live in contact with this issue as they are from large urban areas with massive facilities and infrastructure for support.  The classic response to invitations requesting visits to our rural areas has historically been we will try.  But it takes time to get there and we have a very busy schedule.

I submit the same time that is an inconvenience to executives is the same time that is killing my fellow veterans or at least causing serious exacerbation of their medical problems.

U.S. Army retired Lieutenant Colonel Charlie Revie, a member of the Uniformed Services Disabled Retirees, noted that the drive from Las Cruces to our only major VA facilities is a 250-mile, one-way trip. 

The notion that providing contracted care to veterans through local doctors at non-VA hospitals is somehow a way to finagle them out of caring for them is absurd.  Under my legislation, the VA will clearly still pay for the care of veterans obtained at non-VA hospitals.

Veterans in my district and across rural America have been hearing politicians talk about increasing access for years.  It is simply imperative that Congress take these issues seriously.

Mr. Chairman, I will submit the rest of my statement, but I do appreciate the opportunity to come and testify before you today and yield back the balance of my time.

[The statement of Congressman Pearce appears in the Appendix.]

Mr. MICHAUD.  Thank you, Mr. Pearce.  Rural healthcare for our veterans is very important to me, coming from the great State of Maine.  I appreciate your testimony.

Mr. Miller?

Mr. MILLER.  I may have missed it in your comments, and it may be in the text of the legislation, but do you define geographically inaccessible?

Mr. PEARCE.  Would you state the question again, Mr. Miller?

Mr. MILLER.  Do you define geographically inaccessible?  How do you define that in your legislation?

Mr. PEARCE.  The definition, I think, is over 120 or 150 miles.  I will have to check on that.  But, yes, we do have a definition.

Mr. MILLER.  Okay.  Very good. 

Thank you, Mr. Chairman.

Mr. MICHAUD.  Mr. Hare, any questions?

Mr. HARE.  Congressman Pearce, just a quick question.  In terms of the total number of veterans that are having a difficult time getting to—you mentioned the long drives and things of that nature.  Is there an estimate of how many folks, how many veterans in your district, in your State are having this problem?

Mr. PEARCE.  Oh, Mr. Hare, I would guess that it is probably in the 20,000 range.  In other words, most of the veterans in the southern district are a long way from a hospital.  And the VA hospital in Albuquerque serves also Texas, so it reaches to the extremity.

Some of the places in the second district are within an hour or two, but most are at least three hours one way.  The rest are four to five hours one way.  Again, my home is five hours one way from the time I leave the front door.    So it is probably in the 20,000 range.  And we are just simply requesting that the Secretary consider on a case-by-case basis that people be allowed to get some care.  We have had veterans talk about driving to Albuquerque five hours away one way, five hours back to take a blood test.  And when they got there, they were told I am sorry, that has been rescheduled.  These are the sorts of problems that the people who come from large metropolitan areas just are not familiar with. 

I will tell you that we have had a significant improvement in the relationship with the veterans hospital administrator.  He has actually not this past Saturday, but about two Saturdays ago came and met with me and local veterans in Roswell.  That is still 120 miles north of my hometown and still 40 miles from the southern edge of our district.

And keep in mind, I am on one side and there is another side.  He was about seven hours from the sites that are equivalent to us on the other side, New Mexico Square.  Albuquerque is about two-thirds through the middle.  So when he was over here with us, he is seven hours from those people over here.

But at least he is coming down.  We could never get the former administrator of the hospital to do that.  So we are having some discussion, but he needs the flexibility to allow these people to go to local providers to do common-sense things.

Mr. HARE.  Well, my district is very rural too.  And one of the things we have done, and I was just wondering if you have any of these, we have three veterans' outpatient clinics because, for example, we have people who have to go from Quincy, Illinois, to St. Louis or drive to Iowa City which was, you know, a tremendous hardship on them and people getting in vans and taking them to get prescriptions or a blood test or something.

Are there any VA outpatient clinics in your district?

Mr. PEARCE.  We do have clinics.  And I will tell you that the clinic in Artesia, New Mexico, has a big sign that says we are not an emergency facility, meaning if you have an emergency go somewhere else.  That is extraordinarily disruptive. 

So sometimes they do those things like the blood tests.  Sometimes they do immunizations.  Sometimes they say, no, we are too busy, you have got to go to Albuquerque.

Mr. HARE.  So you had a veteran drive five hours—

Mr. PEARCE.  Yes.

Mr. HARE.  —for a scheduled blood test only to find out that—

Mr. PEARCE.  Absolutely.

Mr. HARE.  —they cancelled it and you had to drive— so ten hours for absolutely nothing?

Mr. PEARCE.  Yes.  And that is one of the things, that we had the VA hospital administrator, he said he would commit that if they are going to start cancelling people's appointments, they would at least do it the day before or two days before. 

Some of these people have to go on their own money.  There is no hotel compensation allowed and they have to go on their own money.  And they may leave a day and a half early because the drive is so hard.

I will tell you that I suffer from varicose veins and they have recently gone in because I had this pooling of blood problem.  And the worst thing you can do is drive with that situation.  And to be describing this Marine veteran that was having to drive five hours with a foot that is leaking is to me the worst thing that you could do.  And, sure enough, he ends up losing his foot.

They tell me sitting on the airplane, though it is nine hours for me to commute home from here to Washington, they tell me the worst thing I can do is sit in the airplane and, yet, that was the prescription for him.

Mr. HARE.  Thank you, Congressman.

Mr. MICHAUD.  Mr. Stearns, any questions?


Mr. MICHAUD.  Dr. Snyder?

Mr. SNYDER.  No.

Mr. MICHAUD.  Now I am pleased to recognize an honorable member of this Committee, Mrs. Ginny Brown-Waite.

Once again, Mr. Pearce, thank you very much.

Mr. PEARCE.  Thank you, Mr. Chairman.  You have been very gracious.

Mr. MICHAUD.  Thank you.


Ms. BROWN-WAITE.  Thank you, Mr. Chairman, and thank you, Ranking Member and the members who care enough to attend.  I know that many people have simultaneous hearings going on that they also have to be to as I do, so I will be leaving after the testimony.

I appreciate the opportunity to testify on House Resolution 92, the "Veterans Timely Access To Healthcare Act."  When I first came to Congress in 2003, I introduced this measure after hearing of the long wait times facing some veterans in need of healthcare.

We recently checked with the VA and the VA is saying that 96 percent of the patients seeking primary care can get an appointment within 30 days.  I think that every member of Congress, if they were polled, knows that they are hearing otherwise.  I do not know where the VA is getting their figures from, but we hear otherwise.

The stories that many of us have heard about these delays are unacceptable.  The holdups can worsen the veteran's health and pose a greater financial hardship on everyone involved.  In some situations, these waits can be the difference between life and death.

Events in Iraq and Afghanistan also remind us of the urgent matter at hand.  With thousands of soldiers returning from the front lines, many will require immediate healthcare.  VA medical facilities face a difficult task. Unless Congress takes action, wait times will only grow.

My legislation would help ensure that our Nation's veterans receive timely healthcare.  For veterans seeking primary care from the VA, the bill would establish a 30-day time frame as the standard for access to medical services.  This standard would cover from the time the individual schedules a visit until they actually see a medical provider.  In the event this standard is unachievable, the VA would have authorization to contract for care from a private provider.

At the same time, my bill also grants the VA some flexibility in meeting the standard.  For those facilities in geographic areas that have a 90-percent or greater rate of complying with this requirement, the contracting provisions would not be necessary.

Finally, Mr. Chairman, this legislation would establish comprehensive reporting requirements on wait times for individuals seeking care at VA medical facilities.

As members of Congress, we have an extraordinary responsibility to veterans.  These brave men and women answered the call in our time of need and it is only fitting that we take care of them at their time of need.

I look forward to working with my colleagues on the critical issue of wait times, and I would be happy to take any questions regarding the legislation.

When I first got elected, I contacted all of the clinics in my area and asked what the wait times were.  It did not jive with what I was being told by veterans.  I then said I want you to tell me the real wait times that they have.

Mr. Chairman, I am embarrassed to tell you that there was a big difference between their quick and dirty analysis and the true wait times that the veterans had to wait for the primary care.

This is unacceptable, and because we have stayed on top of it, those numbers are somewhat within the acceptable range, but still not where they should be.  Everybody in Congress wants to make sure that our veterans are taken care of and timely access to healthcare is very important.

And with that, I yield back the balance of my time.

[The statement of Congresswoman Brown-Waite appears in the Appendix.]

Mr. MICHAUD.  Thank you very much, Ms. Brown-Waite.

Mr. Miller?

Mr. MILLER.  To my colleague from Florida, I think you have already answered the question, do you have any confidence  in VA's numbers in regards to wait times?

Ms. BROWN-WAITE.  No, sir, I do not.  I honestly do not.  I question it and every member of Congress who hears from their veterans has to also question it.  I know you have a large number of veterans and that you are very much on top of their needs as we all are.  That is not what we hear. 

I am known as the nag in the 5th District.  And I am fine with that because unless you nag the VA and let them know that you track those numbers, they do get out of control.  And also they play games.  They will schedule an appointment within "30 days" and on the 25th day perhaps cancel it.  So it is not really an appointment within 30 days.  So we need to constantly question their numbers.

Mr. MILLER.  You also talk in your legislation about requiring that veterans be referred to private physicians.  What about the instance of the veteran that says he is willing to wait and go ahead and go through the system as normal?  It does not preclude them from continuing on through VA?

Ms. BROWN-WAITE.  If they are willing to wait, they certainly would have that flexibility.

Mr. MILLER.  That is all, Mr. Chairman.

Mr. MICHAUD.  Mr. Hare?

Mr. HARE.  I was just interested in where the VSOs are coming down on the legislation and if you could tell me why, from your perspective, there is opposition to the bill.

Ms. BROWN-WAITE.  Most of the VSOs that represent the veterans up here want to make sure that all the healthcare resides within the VA.  And that certainly is their job.  However, I think each of us when we go back home hear different from the veterans who want a much more timely access.

Historically the VSOs have always wanted to contain the healthcare only within the VA system.  And in a perfect world, that would be the ideal because of continuity of care.  But we also do not want the veteran waiting inordinate amounts of time and the VA playing games with the wait times.

Mr. HARE.  Could you give me an example or two of what you have seen in terms of wait times.  I know you mentioned a little bit about it, but maybe from in your district because, as you said, when we go back and we hear from the veterans, I just wondered if you had an instance or two that you could—

Ms. BROWN-WAITE.  Certainly.  Mr. Chairman, if I may respond.  I have had veterans tell me exactly this situation that I just described of, yes, they had an appointment within 30 days, but on the 21st or the 25th day, VA called to reschedule it 30 days later.  That is not timely access and that is not serving the veterans.

Certainly the VA clinics, and we are fortunate we have many in Florida, the VA clinics do all that they can, but they are also having trouble hiring for positions that are open.  They do not have enough doctors.  They do not have enough of the nurses and the medical technicians there.

We are expanding clinics regularly, but people are still having trouble with the primary care access.

Mr. HARE.  Thank you very much.

Mr. MICHAUD.  Mr. Stearns?

Mr. STEARNS.  Yeah.  Thank you, Mr. Chairman.

My colleague from Florida has been a leader on this ever since she came to Congress and I commend her for it and for particularly in an informal basis to try and understand the facts.

Ginny, you had indicated that it takes 30 days, that that is the question.  But have you looked at once a person gets the appointment and then has to come back sometimes and it is not just the first appointment that takes a long time, it is coming back for the second and third?  And I heard complaints that they can get within the 30 days, but then when they come to get the referral sometimes takes longer.  And I just wonder if you had any experience on that.

Ms. BROWN-WAITE.  Mr. Stearns, it depends whether or not the second appointment is for specialty care.  I know that there is a much longer wait for specialty care.  I recently heard from a veteran seeking dermatology care and that was an inordinate amount of time that he had to wait. 

As you all know in Florida, dermatologists are, even in the private sector, there is a long wait for the dermatology appointment.  But very often they will get that first appointment and then there is a delay in the follow-up appointment.  So, yes, I am hearing that as are other members of Congress.

Mr. STEARNS.  Yes.  That is what I hear that some complain, well, okay, I can get into the front door, but I cannot get any response beyond that. 

I do not know.  I heard you talk about your informal investigation.  What did you find was the real time when you talked to these veterans themselves?  What have they been telling you?  Like some of my veterans have told me well beyond 45, 50 days.

Ms. BROWN-WAITE.  Oh, absolutely.  I hear well beyond that, as much as two months and longer that they are waiting.  And that is just not acceptable and, yet, the VA tell us that overall 96 percent are being seen within that 30-day period.  I guess it is in, you know, dog years that they are counting it because it is not 30 days in human days.

Mr. STEARNS.  Just your option you talked about, about the referral of veterans to private physicians if a network fails to meet the standards of access.  I guess the question is, is your intention not to give an individual veteran the option of waiting to receive it or just, in other words, the veteran could decide, okay, I will wait 45, 50 days or is it a mandate that he has to go to a private physician?

Ms. BROWN-WAITE.  No, sir.  Obviously the veteran could wait for the VA care if that is their choice.

Mr. STEARNS.  Yeah.  Mr. Chairman, I think it is important to point out that the legislation is not a mandate to go private, but giving the veteran the choice which is what I think ultimately the veteran wants to have.

And I thank you.

Mr. MICHAUD.  Thank you.

Dr. Snyder, any questions?

Mr. SNYDER.  Thank you, Mr. Chairman.

I did not realize we had such Florida domination of the Veterans Committee until this very moment.

Ms. Brown-Waite, I guess just two comments or questions, and I like what you said about nagging.  I think that is what we all do sometimes on different issues.  And I think it is really important that we all do that.

The concern I have about this bill and some of the other bills is there is no new source of funds in this bill and if we pass any kind of language that requires the VA to hit this mark or we have to pull money out of our system, that money is going to be pulled from some place.  And if you magnify that all over the country or at some point, then they say, well, we need to lay off a primary care doctor because we got to pay these bills down the road. 

And it seems like we dealt with this a few years ago and I think there was a decision made that trying to find healthcare in the private sector because we do not like what is going on in the VA system that we love so much, at some point, it leads into a spiral of funding problems for the underlying system.

How do you respond to that?  I mean, I applaud you.  I mean, this is kind of a sophisticated form of nagging you are doing here this morning.  I think it sends a message that we, I agree with you a hundred percent, we need to be working on these problems.  But how do you respond to that criticism that we have heard through the years and which I have agreed with, by the way?

Ms. BROWN-WAITE.  Dr. Snyder, as you know, we have increased funding.  This is my fifth year here and we have increased veterans' funding for healthcare substantially during that time.  It has been over 40 percent in those five years that the funding has been increased.

We need to continue to increase that funding.  No, this bill itself does not have a price tag attached to it.  That would be certainly part of the appropriations process.

Mr. SNYDER.  Yeah, which I think has some problems.

Then the other, there is this other issue, too, which I think the VA system, as we all know, gets accolades for things that it does better than the private sector, but I was nagging one of my employees not long ago about I thought he had a dermatological thing he needed to have checked out and he finally succumbed to my verbal pressures.  And it was like it was going to be almost, I think, like two months before he could get in.  I said that is not acceptable.  So then he was calling around and he finally did find somebody. 

But the standard at a private community on some of these specialty things is not all that great either for getting in.  But thank you. 

Thank you, Mr. Chairman.

Mr. MICHAUD.  Thank you, Dr. Snyder. 

And, once again, thank you, Ms. Brown-Waite for your testimony.

Ms. BROWN-WAITE.  Thank you, Mr. Chairman.

Mr. MICHAUD.  Next on is Mr. Ortiz.  I want to thank you for coming here today as well and to present your legislation.


Mr. ORTIZ.  Thank you, Mr. Chairman, Ranking Member, and members of the Committee, for this opportunity to speak to you on behalf of south Texas veterans and help this Subcommittee understand the urgent need for a veterans' hospital for the men and women who fought for us.

We have this map before you because I will be addressing the Rio Grande Valley.  The valley is way at the bottom with a population of close to 600,000 people, but the nearest hospital is about six hours away.

I would like to echo what my good friend, Mr. Pearce, testified to about the distance.  Here with me today are the Veterans Alliance of the Rio Grande Valley so you can see the faces of the south Texans affected by the lack of a hospital.

The Rio Grande Valley is the southern-most tip of my district.  And these young men fought bravely for us in different wars, from the Korean War to the Vietnam War, and some of them still fighting the Iraqi and Afghanistan War.

Here with me today is Jose Maria Vasquez, Ruben Cordova, Max Belmarez, Polo Uresti, Frank Albiar, and Mr. Felix Rodriguez.  They wanted to be here today to put a face to the problem that we face in south Texas.

My legislation gives the government flexibility in establishing a way to deal with hospital services in south Texas, but the only real solution, my friends, and I know you understand this problem, is a hospital.

Most of the clinics that we have do not have any inpatient care.  All they do is have outpatient care.  We did try to contract out, but ten beds is not sufficient.  The bottom line is veterans' inpatient healthcare must be available where the veterans reside, not several hours away.

Part of the healing process is for the family to be able to be close to their loved ones who are recuperating from wounds.  Now we are beginning to see wounds that we did not see before because our young men and women are surviving this war because they have body armor and better equipment.

These guys have fought, bled, sacrificed for this Nation.  They need something that belongs to them, a hospital that gives them the care that they need where they reside.

And we know that the VA plays the numbers game, but the numbers do not reflect the need, particularly in the Rio Grande Valley.

When the VA commissioned the CARES study, they recognized the far south area of south Texas was in need of acute, inpatient care.  They decided to meet this demand through contracting and leasing beds with the local hospitals, an approach that we tried but simply did not work.

Veterans are still traveling in large numbers to San Antonio for care.  And for many who are treated for emergencies at area hospitals, the bills go unpaid.

Before, you can imagine this, these young men went and fought a war thinking that we as a government were going to take care of their problems.  Now they have a five and a half hour drive, and do not even have vans.  They do not have an ambulance.  They have to get volunteers, my friends, to drive them for five and a half hours to the nearest VA hospital which is in San Antonio.

Some of the Second World War veterans are bedridden and no ambulance to drive them and are dependent on volunteers to drive them.  They have a van.  How in the world can you see the Second World War veteran on a van when he is bedridden?  Some of them just simply do not go to the hospital anymore or to the clinics that we have.

Many of the veterans are so disgusted by the level of VA healthcare that they just simply do not sign up anymore.  They have given up.

You have heard me describe the conditions of south Texas veterans today, but they want to show you experience of veterans themselves, veterans who shed blood for our Nation.

What I have done and what they wanted to do was give you testimonies, and it is a stack this high, of some of the sacrifices that they have gone through to go five and a half hours to get a 15-minute checkup because the locals do not have the equipment, because the locals just cannot do it.  They go up there for 15-minutes.  They drive five and a half hours.  Then they come back another five and a half hours' drive.

Some of them, the older people are having prostate problems, in the eighties.  They go there just to see that their appointment was cancelled.  Then they have to drive back again, and they say come back in six months.

This is just something that I cannot understand.  You know, we can find money to go fight a war, into the billions of dollars, but for some reason we cannot find enough money to take care of the promises that we made.

I am a veteran.  I served.  We must give them what they fought for.  And Vic and I, you know, we served, Congressman Snyder and Jeff Miller.  This is something that we do every day.  We talk about readiness, about military, about personnel, and about funding into the billions of dollars.

I am afraid that what we are doing today is going to have a huge impact if we do not try to resolve some of these problems on retention and recruitment.

I was at a fair that we had for veterans and I see this older man in crutches with his young two grandsons.  And as I was talking to him, he says do you think I am going to recommend for my grandsons to go join the military when you look at my condition and they have not been able to take care of me? 

This is why we need something to address the needs of our soldiers, people who have fought, people who have bled, many have died, have never come back.

We just had a recent young man come back from Iraq.  He was shot in the back.  His spinal cord is gone.  He cannot walk anymore.  He says I remember when I was in Iraq and I saw those young men lose their legs and I felt sorry for them, you know, and I still do.  But you know what?  Those young men who lost their legs can walk because of prostheses.  There are a lot of us coming back with spinal injuries with our legs, but we cannot walk.

When he was coming out of anesthesia, my friends, he was fighting.  They thought they were taking him prisoner.  We need competent people, trauma care, who understand what they are faced with.  And this is something that we do not have.

I have a large testimony, but I know that time is limited.  Look at my legislation.  I will leave with you some letters that you can read about the sacrifices that they go through.

Thank you so much for listening to us.  Hopefully you will take a look at my bill, and I will give you the testimony that the veterans and some petitions because this is something.  I have been in Congress 25 years.  I have been fighting for a hospital for the last 24 years. 

What they have done in the past is to consolidate some of the clinics, shut down some hospitals, and now we are getting more and more soldiers coming back with different wounds from Iraq and we need to take care of that.

Thank you so much. 

[The statement of Congressman Ortiz appears in the Appendix.  The petition submitted by Congressman Ortiz is being retained in the Committee files.]

Mr. MICHAUD.  Thank you, Mr. Ortiz.  And do you have a copy of that map, so we can have it for the record?

Mr. ORTIZ.  We do.  We are going to pass you a copy of the map with the testimonials of several of the veterans.

Mr. MICHAUD.  Okay.  Great.  I appreciate it. 

And it is my understanding that under the Capital Asset Realignment for Enhanced Services (CARES) process there is no hospital, but we will check with VA to make sure.

Mr. Miller?

Mr. MILLER.  Solomon, I assume that the closest DoD facility to south Texas is Corpus Christi.  Is there a Navy hospital there at the Naval Air Station?

Mr. ORTIZ.  We had a Naval hospital.  It was shut down.  And sometime back, I testified before the VA Appropriations Subcommittee.  They came down and they looked at the hospital.  Again, the lack of funding.  And then they came down and they said this hospital is obsolete, you know, does not conform to the American Association Guidelines.  So we do not have a facility.

Another problem that we have is the influx, you know, we have a lot of winter tourists, veterans that live in the area for four to six months they are vets who need treatment, about 20,000.  We have about 140,000 people, soldiers who have served in the military.  We do not have a facility.  We tried contracting out with the local hospitals.

One young man was having a cardiac arrest and he called his people at the VA, say go to the hospital, go to the nearest hospital.  He did.  Then he got a bill for $10,000 that he still has not been able to pay.

These are the problems that we face on an every-day basis.  There is not a hospital.  It is all outpatient care.

Mr. MILLER.  You said that the contracting side was not working.  Is it not working in regards to them being able to get the care?  Is the breakdown just in paying for the bills?  Where is the breakdown?

Mr. ORTIZ.  It is both, because when you have 140,000 eligible people and you only have about ten beds, you know, either they are full, they cannot take anybody, or if they take somebody else, they do not have room, then they charge the patient coming in.

So this is why the system, we tried it before, it is not working.  And when I meet with a veteran, they say, you know, when I enlisted, they told me that they were going to take care of my health and now I am back and I have to wait six months for an appointment.  I cannot get inpatient care.  It is all outpatient care.

Mr. MICHAUD.  Mr. Hare?

Mr. HARE.  Congressman, let me just say thank you for two things.  One, first and foremost, for introducing this legislation.  You know, you were absolutely right.  I was listening to your testimony and the amounts of money that we spend, you know, $11 million an hour on this war and, yet, I sat at this Committee and I keep hearing people say how are we going to afford this.  And my answer has always been the question is not can we afford, the question is how can we afford not to do this.

So, Congressman, I would be honored to be a co-sponsor of this bill.  I think it is something that your veterans need and you have been a champion for veterans.  And so I just want you to know that.

And we will find the money.  We have got it.  You know, and I said before maybe we ought to take it out of Paris Hilton's tax break.  I do not know.  But we will get it.

But let me just suggest this to you, too, or thank you for this too.  I thank you for taking the time to come in.  Lane Evans is my predecessor as you know.  And I want to thank you for coming in helping us complete the Hero Street Memorial with your help. 

And for those of you who do not know what that is, that is a Hispanic area in my district, one street where five young men gave their lives in World War II. 

And thanks to you, Congressman, that memorial is now finished.  And I want to, on behalf of the people of Hero Street, I have not had a chance to thank you yet, but I want to thank you for doing that.

And, again, thank you for introducing the legislation and I will do everything I can on my end to help you with it.  And, you know, you are right.  When you bring veterans in and you put a face on it, you know, I think it is a wonderful thing to do because sometimes we look at charts and numbers, but we are talking about people here. 

And from my perspective, I cannot think of anything more important to do than to support this bill.  So thank you for taking the time.

Mr. ORTIZ.  Thank you so much for your comments.  Thank you, sir.

Mr. MICHAUD.  Dr. Snyder?

Mr. SNYDER.  I have no questions.

Mr. MICHAUD.  Well, once again, thank you very much, Mr. Ortiz, for bringing the legislation forward.

Mr. ORTIZ.  Thank you so much.

Mr. MICHAUD.  The last panelist for this panel is Mr. Rothman.


Mr. ROTHMAN.  Thank you, Mr. Chairman.

Ranking Member, members of the Committee, thank you for having me here today.

I am here to testify today about the moral responsibility and national security obligation of the Federal Government to honor its commitment to all veterans, namely the commitment to provide them with quality, affordable healthcare.

It is a moral responsibility because the American government makes a promise to every veteran.  We say that you volunteer to put your life on the line for freedom, because you are willing to sacrifice yourself for the good of all Americans, because of this courage, we will take care of you when you leave the service.

We do not make that promise with our fingers crossed.  We do not tack on fine print or attach a bunch of strings to the promise.  We make that promise freely because our veterans gave freely of themselves in the service.

It is a national security obligation because without question, the morale of a young soldier, I believe, is seriously hurt when he meets a 35-, 45-, 55-year-old veteran, combat veteran who is battling cancer or who had a heart attack but had no health insurance and was banned by his government from getting healthcare through the VA.  It is outrageous.

As a representative for more than 156,000 veterans, I have heard story after story from veterans in Bergen, Hudson, and Pasig counties of New Jersey who tell me that their government has broken its promise to them.  That is because in January of 2003, the Bush Administration decided to cut costs by telling veterans designated as Priority 8 that they are banned from enrolling in the VA health system and will no longer have access to VA hospitals, clinics, or medications.

The Administration defended its decision by saying that Priority 8 veterans make too much money to be worth the added expense to the system.  Just so you know, the amount of money they said was too much was anything over $26,902.  I say that Priority 8 is wrong and that the Bush Administration has the wrong priorities.

We made a promise to those men and women to take care of them and there is absolutely no justification for breaking our word.  Those veterans often live in areas where the cost of living more than eats up the $26,902 of income that the Bush Administration seems to think is so great.

In Bergen County, New Jersey, we have the second highest concentration of veterans in the State of New Jersey and the largest number of Priority 8 veterans.  There are 73,000 Priority 8 veterans in New Jersey alone, 273,000 Priority 8 veterans throughout the country, 273,000 veterans who have been told they make too much money making $26,902.

So an example, if you served in combat in Iraq or Afghanistan for a number of years, three, four deployments, five deployments and thank God you come home without any physical injuries, five years later you get cancer, you cannot use the VA if you make more than 26,000 bucks.  In my district, the number is a little bit higher, but it is certainly not enough to cover the costs of healthcare.

Turned away, 273,000 veterans turned away from the VA.  What is the message we are sending to our soldiers?  We are saying that even though the government made this promise, even though all Americans believe that this is the case that if we serve, we are going to be taken care of, that is not the case.  It is a lie.

The President may promise to love veterans and love people in the Armed Forces, but that is not what he is doing.  He had this Congress or he had his Administration come forth with a plan that has cut 273,000 veterans from healthcare through the VA.  We need to keep our promises to our veterans.

Mr. Chairman, Mr. Ranking Member, and members of the Committee, again, we did not make those promises with our fingers crossed or our hands behind our back.  They deserve this healthcare.

And one of my colleagues was asking where we get the money.  In my book, I think the way most Americans feel is this is an obligation, this is a promise we made.  It is a moral imperative that we live up to our promise to those who put their lives on the line for us.  It is a national disgrace, a national dishonor.

Where should we get the money?  Well, you know, if you have a lot of different needs, you take care of the most urgent need and the promise to those who did the most, that would fall into this category.  And if my goodness, because the health of the veterans' healthcare system cannot take care of all of its veterans because this Administration will not provide the money, then maybe we ought to rethink our healthcare system.  Oh, my goodness.

The first thing we need to do, though, is live up to our promises to our veterans and take care of them if they get sick when they come home.

Thank you, Mr. Chairman, Mr. Ranking Member, members of the Committee.

[The statement of Congressman Rothman appears in the Appendix.]

Mr. MICHAUD.  Thank you very much for your testimony.

Mr. Miller?

Mr. MILLER.  Thank you very much for your testimony, and I think we all agree that there are many things that we can work on and do better.  Certainly the VA system gets that from this Committee and Subcommittee all the time.

Are you aware, Mr. Rothman, that an Operating Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) combat veteran can, when they come home, get two years of healthcare, so they do have that.  I do not know if there is a lie being perpetrated on those veterans at all, and I do not think that is what you were trying to characterize, but—

Mr. ROTHMAN.  Thank you for the clarification.  But with regards to those veterans whose service preceded Iraq and Afghanistan, if they get a heart attack, if they get cancer and they do not qualify for Medicare because they are too young, they are under the age, they are in their thirties or forties or fifties, they are out of luck.  They do not get any healthcare.  And that is a lot of folks, 273,000 in the United States.

Mr. MILLER.  I concur. Again there is an issue, but I think a lot of times while we are at war, we use current stories about veterans as they are returning home and there is a clear distinction in regards to their ability.

Mr. ROTHMAN.  I accept that distinction and I appreciate that.

Mr. MILLER.  Thank you for your testimony, Steve.

Mr. MICHAUD.  Mr. Hare?

Mr. HARE.  I would just concur with you.  I mean, a promise made to veterans is a promise that we have to keep and for the life of me I continue to shake my head because even if we did not care about the health of the veteran, which should be first and foremost, I do not know how we are going to recruit other people to go in when they see the kind of treatment, or lack thereof, that we are giving to the current veterans.

I really applaud you for doing this because I do not care what category you are, it just seems to me if you served this country, you are honorably discharged, this country makes a promise, and, as you said Congressman, we did not make it with fingers crossed or wink and a nod.  We made the promise.  So if we are going to make it to veterans we have to keep it.  And for those two hundred and how much?  I am sorry.

Mr. ROTHMAN.  Two seventy-three.

Mr. HARE.  Two hundred and seventy-three thousand veterans, I mean, what does that say for the service that they have given to this country?

Mr. ROTHMAN.  If I may, Mr. Chairman.

Mr. MICHAUD.  Absolutely.

Mr. ROTHMAN.  There are a lot of our service men and women who are not in combat as defined under the law that my friend from Florida referred to.  Nonetheless they are in harm's way.  There are terrorists who would seek to blow up any servicemember in uniform or out of uniform.  And so there is a justified distinction in those who served in combat, but I think every veteran deserves the right to, especially after 9/11, to, and before, to get this kind of care.

And by the way, if you ask yourself is this not so sad and shocking for veterans, is it not sad and shocking for an industrialized nation, the richest in the world, if one of the people that served in the military gets a heart attack or cancer and they cannot afford health insurance, they are going to suffer in the United States of America?

Mr. HARE.  I just want to say, Congressman, you know, when people are sworn in to any branch of the service, they swear that they are going to protect this country and they do.  And once they are discharged, I think we have a moral obligation to protect them. 

And for the life of me, I do not know why the Administration decided they were going to do this unless it was a cost-saving factor and even if that was the excuse, that is about as lame as it gets.  So I think we have to restore this.  I think your bill does that. 

And, again, I think, and I know one of the members on the other side, what do you want to do, do you want to cover everybody?  The answer is, yes, I do.  And I think it is something that is terribly important.    

And, again, this Committee, and I love this Committee a great deal, we have been able to do some wonderful things.  We have a great Chairman, great Subcommittee Chairman, great members, and I think we finally decided that enough already.  We have put the brakes on this. 

And I look forward to working with you on this because I think it is a moral obligation that we have as a country.

I yield back.

Mr. ROTHMAN.  Thank you.  I hope you will consider my bill, Mr. Chairman, Mr. Ranking Member.  I appreciate your service for all of the veterans.  We need to do more and to find the money to do it.

Mr. MICHAUD.  Thank you very much, Mr. Rothman, for your testimony. 

And since there are no further questions, I would ask that the next panel come up.