Hearings to examine proposed budget estimates and justification for fiscal year 2027 for the U.S. Forest Service

Name: Hearings to examine proposed budget estimates and justification for fiscal year 2027 for the U.S. Forest Service
Start: 2026-04-30
Location: US Senate

VA Budget and ModernizationSenate Appropriations Subcommittee on Department of the Interior, Environment, and Related Agencies · 2026-04-30 · 119th Congress

The Senate Appropriations Subcommittee (chaired by Sen. Begins at ▶ 0:19:10

Transcript

Highlights

▶ 0:19:10Chair Boozman: Good morning. The subcommittee will come to order. Mr. secretary, we are really thankful you are here today to discuss the fiscal year 2027 budget and fiscal year 2020 eight advanced appropriations request for the department of veterans affairs. I would also like to recognize the v.a. Chief financial officer, Mr.

▶ 0:19:37Chair Boozman: Richard topping, who is here to provide the technical budget support, if necessary. He is going to answer the really difficult questions. And it is not hard to understand why that might be necessary in the sense that the budget request is a total of $488.2 billion in fiscal year 2027 for the department of veterans affairs, representing a 7.7%

▶ 0:20:07Chair Boozman: Increase over fiscal year 2026-enacted levels. This includes $144.7 billion discretionary funds, $337.7 billion mandatory funds, including $56 billion for the toxic exposure fund. An advanced appropriations for fiscal year 2028. Landmark pieces of legislation like the pact act and mission act have reshaped access for veterans to health care.

▶ 0:20:37Chair Boozman: The creation of these programs has ensured more veterans are eligible to receive care and have access to the resources needed to exercise these benefits. This subcommittee has worked tirelessly to ensure the department has the resources it needs to deliver world-class health care to those who have served. The budget request also includes significant investment in systems modernization to support veterans who use v.a.

▶ 0:21:05Chair Boozman: Services and the dedicated workforce that is essential to providing a positive veterans experience. For instance, this year's budget request includes $4.2 billion, an increase to support the continued deployment and acceleration of medical record. The v.a. Faced significant challenges.

▶ 0:21:34Chair Boozman: However, the v.a.'s current leadership has adapted and earlier this month delivered what seems to be a very successful rollout. Secretary collins, we look forward to an update on this program and hope we are on track to make health records boring again. [laughter] Mr.

▶ 0:21:52Chair Boozman: Secretary, your rise proposal to consolidate administrative functions in the veterans health administration above the clinic level, this subcommittee is interested in an update on the proposal. The expected efficiencies you hope to gain, what risk the v.a. Is evaluating as he considers the final proposal. And any budget implications.

▶ 0:22:27Chair Boozman: In addition to updates on those big picture items, we also look forward to hearing details about the department's request for mental health services. Including efforts to prevent veteran suicide, veteran homelessness, resources dedicated to care for veterans, and efforts to improve care for our rural veterans.

▶ 0:22:56Chair Boozman: I would be remiss to not publicly acknowledge the retirement of long-time clerk of this subcommittee. Patrick magnuson has worked tirelessly to ensure adequate funding for the v.a. And military construction through some of the most challenging and dynamic years in our nations history. Thank you, patrick, and godspeed in your retirement. [applause] I understand you got a bunch of metals last night.

▶ 0:23:25Chair Boozman: I'm surprised you're not wearing them. [laughter] we do appreciate all of your hard work. Before we hear from the sec. I want to advise the subcommittee that secretary collins has a family matter to attend to after the meeting. He has been gracious enough to come and testify regardless of this, but we will aim to finish no later than noon.

▶ 0:23:54Chair Boozman: To allow him to catch his flight. With that, I would like to recognize my colleague and friend and ranking member, senator ossoff, for any opening comments he may have.

▶ 0:24:04Sen. Ossoff: Thank you so much, Mr. chairman. A pleasure to be back with you and I deeply appreciate how well we have worked together and our staff have worked together on a bipartisan basis to advance the interests of america's veterans. Mr. secretary, welcome back. A pleasure to welcome back a fellow georgian and please pass along best to your family. And Mr. topping, good to see was well.

▶ 0:24:31Sen. Ossoff: We are examining the fiscal year 2027 budget request. $488.2 billion for both mandatory and discretionary resources. A $34.9 billion increase over the 2026 level. The request includes increases for mandatory and discretionary funding levels and increases for health care and benefits.

▶ 0:24:54Sen. Ossoff: He also see increases in the electronic health record modernization account, to accelerate implementation in the coming years, as well as in the major and minor construction accounts. You and I, Mr. secretary, discussed those this week. Those are important investments. I look forward to hearing more about how you intend to use those funds to better serve america's veterans.

▶ 0:25:19Sen. Ossoff: Our shared priority on this subcommittee is to ensure the resources provided to the department are sufficient in their entirety, but also allocated appropriately across the v.a. System to best serve those veterans. Who deserve the best, as well as their families, caregivers, and survivors. While I am pleased to see robust overall investments in care and services for veterans reflect in this request, I do have some concerns.

▶ 0:25:49Sen. Ossoff: Among them are the requests for clinical staffing levels. For example, it appears that the fy 2027 request for physicians would employ fewer physicians than the fy 2026 physicians. Likewise, it appears the fy 2027 request for registered nurses would employ fewer disturbed nurses then the fy 2026 request.

▶ 0:26:17Sen. Ossoff: I hope we can get sums -- some clarity on the justification for those changes. We also see a very large -- 17.2 percent -- increase for outsourced privatized care in the medical community care account, while the direct care accounts increased by a combined total of just over 2%. And we see this imbalance continue in your advance appropriation request for 2028.

▶ 0:26:46Sen. Ossoff: I also want to note that this request does not appear to fund some specific programs, including child care for veterans during their health care appointments, as well as health care veterans living in the compact of free association states, which have been passed by congress. I would like to better understand how the v.a. Intends to implement those laws. Finally, v.a. Intends to implement its organizational effort we have discussed, restructure for impact and sustainability, or, rise.

▶ 0:27:18Sen. Ossoff: The subcommittee is seeking information on how this funding request reflects the new staff reporting structures and the cost of this reorganization effort. We are looking for some more transparency on that front. I want to come back to this point about the clear preference in the 2027 and 2028 advance requests for privatized care outside the v.a.

▶ 0:27:43Sen. Ossoff: The department's own data shows that outcomes for veterans are either the same or better through direct v.a. Care compared to privatized outside care can we see growing demand for v.a. Care, but we are not seeing here the request for the investments in clinical staff to reflect that, and again we have this huge imbalance in the requested funding for outsourced, privatized care, versus direct care.

▶ 0:28:14Sen. Ossoff: These are some things we are going to need to work through, and I think we all share the goal of supporting america's veterans, helping them to live healthy and fulfilling lives, honoring their service with the care and benefits they have earned through their service. I look forward to the opportunity to engage with you both today and to your testimony. Thank you, Mr. chairman.

▶ 0:28:35Chair Boozman: Thank you, senator ossoff. Mr., your recognize.

▶ 0:28:39Sec. Collins: Thank you, Mr. chairman. Go dogs. And patrick, thank you. I don't think there is a member who served for eight years on this hill, any member here, we are not here because we are the best looking and best-ordered. It is because we have great staff. Patrick, your service has been amazing and will be missed.

▶ 0:29:06Sec. Collins: Not just by this committee and your chairman and the other staff members, but also by veterans. I want to thank you for that. In light of all that has been going on this week I had an english feel about me, although I am from north georgia and more irish than I am english. When I started this job it had a dickens twist. Was a tale of two departments. A tale of two cities. A tale of a department I found and a tale that it is now. This is the story today.

▶ 0:29:37Sec. Collins: I agree with senator ossoff that there are ways we can look at him things we need to make sure we are taking care of our veterans. As we put the resources we need to be, this is why we have these hearings and dialogue to make sure we are doing it is best for those I have served alongside for many years and you have served in what you do in this committee. One of the things we had since taking office -- I have been to about 32 states. I have hit about 50 of our hospitals. More than that of our clinics and everything.

▶ 0:30:07Sec. Collins: The only way I could get a handle in managing this department was to get out of vermont and hear from people who have run our places. One of my favorite questions is, what are we doing that is stupid ? What are we doing that takes away from care and how do we apply it? One of the things that became clear was the first statement to the department. President trump has increased our budgets both years I have been in, it also said, take care of veterans.

▶ 0:30:36Sec. Collins: What we did first was, we put the veteran first. The mission is the veteran. It is not our organization. Just a reminder for all that are listening and watching, we are the only retail agency in the cabinet. If a veteran doesn't show up we don't have a job. If a veteran doesn't, I don't make policy for anyone else. If a veteran doesn't come, we don't have a job, so our first and foremost responsibility should be the veteran.

▶ 0:31:03Sec. Collins: We expect every dollar to be appropriated, to be spent wisely and built around those complete functions. I agree completely that we have had a situation in which we first came in. Unfortunately it appeared the organization was more important than the veteran. That is one of the reasons we will discuss rise today. I have to say the results are astounding.

▶ 0:31:28Sec. Collins: Even though we have had a lot of issues go on and a lot of change in the first year I have been here, just this week the joint committee said we had 100% safety throughout everyone of our facilities. No other hospital group can say that. We have that. That is coming this year. Our cms ratings are higher than any state. I would encourage you to look at your public and private hospitals. We consistently score above most every hospital.

▶ 0:31:58Sec. Collins: And those that are not we have a system set up where I can challenge them to get better. These are the kind of things we are doing. There is going to be a lot of discussion about staffing. There is one thing you need to know and we found this over the last year. We did a study and looked at it from 2019 to 2025 and had a 14% staffing increase across the board in our staffing and among our hospitals. Yet we only had a six percent increase in patient interactions.

▶ 0:32:26Sec. Collins: You had 14% hiring and a 6% interaction. You will hear today we had double-digit increases in staffing in certain facilities while we had negative patient directions -- patient interactions. Senator ossoff is right, making sure the resources go where they need to go. Other things we are going to look at today and I want to highlight is the things that are often not seen. But they are very powerful.

▶ 0:32:51Sec. Collins: In our vba, I cannot say enough about our folks over there who have lowered our backlog from over 125 days. This morning it is at 77,000, on the backlog, the average days were over 138. They are now at 70 at this point. It is the great work of the men and women of the v.a. Working in our vba side. By the way, before you say, quality has went up and higher-level reviews are keeping more off the board.

▶ 0:33:22Sec. Collins: It is a good new story all the way around. We have increased 2 million more hours than we have had before in our facilities. We needed our younger veterans to know they could come after work or on weekends. We made an emphasis on women's health, taking our women veterans so they don't have to go to their pack doctor anymore to get obstetric and chronological care. They can go straight to their ob/gyn now. These are the kind of changes we made.

▶ 0:33:48Sec. Collins: Some things that are still up there that I am really looking at. Suicide or death by suicide. Look, the numbers are way too high. I don't care which number you use. I think it is in the 20 to 30 range and I have never acknowledged that, but one is too much and we are putting that money to good use. Hrm. You talk about a good news story. It is all I heard before I was confirmed. Health records management system.

▶ 0:34:17Sec. Collins: The previous administration had basically stopped because it had become such a problem. I promised during my confirmation within the first month we would address it and I'm here to tell you today not only did we address it, we had a rollout almost three weeks ago in michigan that has been phenomenal. Even by industry standards it has been phenomenal. It is working well. I also have to say this. Wouldn't you know it, the one week we roll it out, on wednesday of that week he had a tornado hit one of our facilities.

▶ 0:34:47Sec. Collins: [laughter] senator peters, I'm glad you are here. It is a great thing. We had a facility lose power and we never lost a bid in a new system. Two days later they performed open heart surgery and it worked perfectly. The hrm, thank you to Dr. lawrence, neil evans, our team. It started badly, I will admit, but right now it is going to hit. Rise, we talked about. That I will end with this. It is not a quote for me.

▶ 0:35:18Sec. Collins: It is a quote from one of your colleagues. He is the ranking member. Senator blumenthal wrote a letter to the editor and it read like this. The editorial board asked, our veterans better off for the investments we have made? The answer is a resounding yes. He goes on to say, today the department of veteran affairs is providing more care and more benefits to more veterans than ever before.

▶ 0:35:44Sec. Collins: On many occasions I would not have to say that may be senator blumenthal and I agree on everything, but I agree with his editorial. We are providing better care to more people and veterans than ever before and I look forward to this hearing.

▶ 0:35:58Chair Boozman: Thank you, Mr. secretary. We are going to go to chairman collins. Chairwoman collins, and then go back to senator awful -- senator ossoff. You are recognized.

▶ 0:36:10Sen. Collins: Thank you, Mr. chairman, and thank you for your leadership and all of the members of the subcommittee. Mr. secretary, welcome. The atticus center in augusta, maine is the oldest v.a. Facility in the country.

▶ 0:36:31Sen. Collins: It was established by abraham lincoln in this november will mark the 160th anniversary of the first veterans admission to this historic facility. So, we are very proud of this history and of my state's willingness repeatedly to step forward and serve.

▶ 0:36:56Sen. Collins: But we are also very aware of the challenges that come with the operating an active medical center out of our nation's oldest v.a. Facility. Last year the v.a. At self identified $594 million in needed infrastructure improvements throughout the main system.

▶ 0:37:20Sen. Collins: Yet the budget requests provides only 226 million for projects in maine. I understand that the v.a. Is in the process of reevaluating its future construction projects. When can we expect to see some of the projects that were previously identified as priorities reinstated?

▶ 0:37:46Sec. Collins: Thank you, senator. It is always good to be with you and especially the historic -- we were just up there recently. Our undersecretary for health was examining it. We are looking at it overall and making sure we put that construction money -- as you know, having that older facility, that is one of our concerns as we look across our whole spectrum. We are reevaluating getting the needs where it needs to go and hopefully that is something we can do as we finish this budget and look ahead to the next one.

▶ 0:38:17Sec. Collins: We make it a read prioritization of that list, and maine will be a part of that reevaluation. Especially as we look at -- a reminder to members -- our average age of hospitals in particular is between 60 and 70 years old. That is unheard of in the health care system. We will continue to look at it.

▶ 0:38:35Sen. Collins: As I said, it is so much older. Last week, and you mentioned the assistant secretary for health being there, which we appreciated, I attended a celebration at the v.a. Medical center in augusta, maine, and I heard from a navy veteran named harry hall, who described his struggle with substance abuse.

▶ 0:39:04Sen. Collins: He had had to travel out of state just to get the care that he needed. Now, fortunately, there is a new residential treatment facility. So, veterans like harry will never -- will no longer have to travel far from their families, their talents, their support systems to get the care they need.

▶ 0:39:33Sen. Collins: This opening of a new residential treatment program facility is great news. The problem is, do we have sufficient personnel to staff it? That remains a real problem in the state of maine. Frankly, for our hospitals all over the state and rural areas in particular. But for togas as well.

▶ 0:40:01Sen. Collins: We need to hire the therapists, the doctors, the nurses, the other attica personnel to deliver for facilities like this one. The elizabeth dole act included a program that would allow the v.a. To issue waivers to go above the physician pay cap to support v.a. Facilities that are struggling to fill critical positions.

▶ 0:40:31Sen. Collins: What are you doing on workforce issues?

▶ 0:40:33Sec. Collins: Senator, I appreciate that concern. I appreciate one of the things you said there and I think it is something for all of the committee to understand and I know we will talk about this more. We are the largest integrated health care system in the country, but we are also part of the health care system and we have the strength -- the same struggles going on not only in recruitment -- we are better in many areas and I'm sure there will be more specifics -- and some areas are -- harder in rural areas.

▶ 0:41:04Sec. Collins: The dole act was a good band-aid to a whole. The problem was it was capped at 300 doctors. That is less than 1.5% of my doctors. And we are implementing it now. It is going through now, but what was happening is, I don't know if y'all -- I have three kids and at christmas she made sure every kid had the same number presents to open.

▶ 0:41:31Sec. Collins: I was always fighting and said, it doesn't matter, one kid could get a million dollars, but she wanted the boxes. That's all she cared about. There is the problem I had with this 300, which I appreciate. But if I go to an area and say, I hire senator boseman and I use the incentive to get him in to work, but senator fischer over here was already working in the facility, there are going to be inequitable outcomes in pay.

▶ 0:41:59Sec. Collins: Our concern among our staff and hospital and clinician staff was, and it is coming true in some ways, is where we are having to add we are running the risk of losing those we cannot bring up over 300. Because we had to spread 300 positions over 1.5% of our Dr. force. It was a great first step. There are some things I would love to talk with this committee about to say, let's take a certain number and say, on these five we raise the cap for all of them.

▶ 0:42:33Sec. Collins: Richard can bring you the numbers. But that way I can treat all of them the same instead of having a disparity and inequity set up with doctors, with this 300. I appreciate you bringing that up. It gives me a chance to explain it.

▶ 0:42:45Sen. Collins: Thank you. My time is about to expire, so I will submit the rest of my questions for the record, but I do want to focus you again this year on the highly rural transportation grants. Maine is one of the most rural states in the nation, and yet only one of our 16 counties qualifies for this program.

▶ 0:43:18Sen. Collins: And it is because the current rurals eligibility to counties is -- with fewer than seven people per square mile. That is really kind of absurd. If you go to northern, western, eastern maine it is very rural, and we have a high number of veterans throughout our state.

▶ 0:43:44Sen. Collins: So, I have a bipartisan bill that would expand the eligibility. It has cleared the veterans affairs committee with the v.a. Feedback, and I would just invite -- end by asking you to take a look at that. I hope you would endorse it.

▶ 0:44:00Sec. Collins: I don't see any problem I want. I come from georgia, and as the ranking member goes, you can go to my hometown, it is hard to get around. One of the things, if you don't mind, one of the things we are having is we are having to view this in a completely different scope because we are losing, as time and age gets for a lot of our volunteers who are drivers, we are losing that pool of drivers and I'm trying to do everything we can to get them in quicker.

▶ 0:44:30Sec. Collins: I look forward to working with you on that.

▶ 0:44:31Sen. Collins: Thank you. Thank you, Mr. chairman.

▶ 0:44:34Chair Boozman: Thank you. Senator ossoff.

▶ 0:44:37Sen. Ossoff: Thank you, Mr. chairman. Mr. secretary, you and I discussed this. I was pleased to see that your budget request includes more investment in construction that we have seen in recent years. I know this has been a priority for you. It is a share priority for both of us. You have requested more than $10 billion for major and minor construction and nonrecurring maintenance. Could you share more about your vision for the use of these funds?

▶ 0:45:03Sec. Collins: Thank you, senator, I would love to. Richard may have some numbers we are looking at. The biggest part for us is in the major and minor construction on the reoccurring maintenance issue. This is something that helps our hospitals further and those would incorporate, especially our or expansions, so we could use robotics. We are one of the leading research -- we do those, but some of our facilities, the or's are not built for what we are looking to do there.

▶ 0:45:34Sec. Collins: We are also expanding residential treatments that are coming. These are the things we are looking at moving forward. There are major projects in there in the budget. Indianapolis, also looking at new hampshire as well. And then also the beginning stages of san antonio. Those are the kind of things, but I will say we are looking at a make sure we are expanding where we need to. It's is the other thing I've tried to do with the v.a.. Have a large number of facilities across the country.

▶ 0:46:03Sec. Collins: Some are in different stages of how many patients are treating and how they are grown. That is one of the things for construction, to make sure they are growing in the ways they need to.

▶ 0:46:12Sen. Ossoff: Thank you. Looking forward to working with you to ensure that facilities that need to be built are built and facilities that need to be upgraded are upgraded efficiently and rapidly to the highest standard. It brings me to a concern I have, which is the potential closure of clinics. There are media reports -- and maybe you can provide some clarity, but reports this month that the v.a.

▶ 0:46:37Sen. Ossoff: Has informed veterans of the impending closure or scaling back of services at v.a. Clinics in tennessee, new york, maine, and arkansas. Our fiscal year 2026 appropriations law continued to include long-standing language prohibiting closure of any v.a. Facilities without analysis having been provided to the committee on the impact of those closures on veterans.

▶ 0:47:08Sen. Ossoff: Can you please provide the committee with some clarity on your intentions with respect to these clinics in tennessee, new york, maine, and arkansas, and confirm you will comply with the law requiring such analysis to be provided to this committee before there are any closures?

▶ 0:47:24Sec. Collins: Senator, I will be happy to because this is something that has been going on for years that, frankly -- I'm going to be -- one thing y'all are going to find out about me is I am brutally honest. The reason we did rise is because our hospital administrators said they could not do x without higher approval. They were doing these assessments on a regional level without really informing and getting a lot of input, especially from my office and others. We change that.

▶ 0:47:57Sec. Collins: I said, I have put a stop to any of these unless they are coming through my office or others because I want to make sure to not only comply with the law -- you feel like we are, by the way. Let me also explain something about this.

▶ 0:48:07Sen. Ossoff: I don't mean to cut you off. Whether or not, in fact, you intend to close or scaled-back services at these clinics in tennessee, new york, maine, and arkansas?

▶ 0:48:20Sec. Collins: That is the intentional nose. The contract clinics, especially. In tennessee, schenectady as well, and let me tell you why. When you see why you will agree. They make manville facility, which was a contract clinic, they were not living up to their contract. Schenectady, not living up to their contract for years. Our veterans were being handed off. There was no continuity of care. A lot of times the doctors were not showing up.

▶ 0:48:51Sec. Collins: We were having to schedule them in other places. This is a problem. So, I think the issue here is not are we closing a clinic. I'm not going to let a veteran step into a clinic that is getting care they should not be getting. It doesn't matter if you keep it open or not, I'm not going to put a veteran -- new new new

▶ 0:49:13Sen. Murkowski: Analysis analysis provided to this committee prior to such closures?

▶ 0:49:20Sec. Collins: I will be happy to work with this committee and follow the law. The v.a. Feels we have, but I will be happy to give you more, because when you realize -- the -- new

▶ 0:49:32Sen. Ossoff: We have not received that analysis. Do you have any intention to close or reduce services at any clinical facilities in georgia at this time?

▶ 0:49:41Sec. Collins: Not at this point. Let me say something about closure. And I think this needs to be said. We talk about closing the mcmahon bill facility, these veterans were already being accounted for in v.a. Facilities close by. They were never losing their continuity of care. Schenectady, the same way. Others that we have. They are always being moved to close or be a facilities or other clinics in the area.

▶ 0:50:07Sec. Collins: No one is being left in a "closure." I would like to term the closure relocation because they are not being left without care. Closure implies nobody's going to be there for them. That's not true. They are going to have what they need. They just do it at another facility.

▶ 0:50:24Sen. Ossoff: That analysis is precisely what is required by law to be conveyed to the committee, so I would suggest that you and your team send that to us as soon as possible. Thank you, Mr. chairman.

▶ 0:50:37Chair Boozman: Senator hoeven.

▶ 0:50:44Sen. Hoeven: I would defer to you for your insightful questions.

▶ 0:50:46Chair Boozman: I have been looking for to your questions.

▶ 0:50:50Sen. Hoeven: Thank you. Mr. secretary, thanks for being here and also to assistant secretary topping, thank you for being here as well. I also want to commend you. The go button from day one at veterans affairs, and it is noticed. Not just by me, but my colleagues as well. On both sides of the eye.

▶ 0:51:14Sen. Hoeven: He appreciated and it is through your good work, but also good work by folks on your staff, as you mentioned, and I certainly want to commend the undersecretary for memorial affairs. He has been a real champion. He hit the ground running and not only works hard, but obviously he cares and is fired up about doing everything he can for his fellow veterans. And also colonel lowder.

▶ 0:51:39Sen. Hoeven: I don't say that just because he is a marine, as my father was a marine, but he has been a tremendous help to us and you guys have been great. I want to thank you for the work on the fargo national veterans cemetery. You guys have been champs. And it is going to be pretty fantastic. I hope we can get you out there toward the end of the year, because we will have a nice dedication and I think you will be appreciative. That is not only north dakota, but western minnesota and south dakota as well.

▶ 0:52:09Sen. Hoeven: Really, the tri-state. It is a big deal and we appreciate it. Along with that, how can this -- just because I have been so impressed with what the national cemetery administration has done -- what can we do to help you -- how can this committee do more to support the national cemetery administration and your work?

▶ 0:52:29Sec. Collins: Senator, I appreciate that. Before you answer question I want to go back. Try to be very respectful of time. Senator ossoff, we have opened a 34 new facilities this past year as well. I want to add that in on the closing part.

▶ 0:52:45Sen. Ossoff: And I want to be clear that what the subcommittee needs is the analysis on the impact on veterans of these closures, because that analysis is required in the statute.

▶ 0:52:54Sec. Collins: Not a problem, and we appreciate it.

▶ 0:52:58Sen. Hoeven: I think that is a great example of why you are doing a good job. You're responsive own issues. It is a great example of what I'm talking about.

▶ 0:53:07Sec. Collins: I appreciate you bringing in ca up. I don't mean this in any way. I feel like I have the best cabinet position in the coverage. I get to take care of the best people. I get to take care of a lot of things. I get to take care of veterans like myself and others who serve. I have vha, which everybody talks about. Vba, that his disability claims. Then there is the ncaa. And we put sam brown there as undersecretary.

▶ 0:53:37Sec. Collins: Sam is an amazing individual. His life story is amazing, but he cares about those that are coming to our cemeteries, taking care of those. They have a motto that says they have one chance to get it right. And when I first heard that I said, that should be the motto of the entire v.a.. We have one chance to get it right. And they have done such a great job. How you can help us?

▶ 0:54:01Sec. Collins: Last year this committee and congress expanded the access for our grants program, which we work with states and it was expanded to where we could clear a lot of the backlog out. 60 million, is that not true? In that for this year? That is going to be well-use. Any extra help would be great because our population is aging. Have more needs and some of our cemeteries are filling up in that regard.

▶ 0:54:26Sec. Collins: And also working with states to identify areas in which we can partnership, just like we did in north dakota is a great way you'll can help.

▶ 0:54:33Sen. Hoeven: How about in the funding area?

▶ 0:54:36Mr. Topping: An additional ask would be construction. Where we might be downsizing clinics that are underperforming, but also too we have 4.3 billion dollars in requested construction for those facilities, one billion dollars in those other facilities. 500 million dollars request to expand national cemeteries in four different phrases -- places. We also have partnerships with our state-level agencies we do the grants as well.

▶ 0:55:05Mr. Topping: We would ask, we have a big construction ask in this budget. $10.4 billion. That includes $5 billion in deferred maintenance at our medical facilities. We would ask for the support that includes the expansion of those national facilities.

▶ 0:55:18Sen. Hoeven: The other thing want to touch on is access to long-term care. Only about 20% of the nursing homes in our state, and I don't think that is far off the national average, take v.a. Reimbursement for nursing home, for veterans. It makes a big difference because if they have to go on cms, medicaid, then they have to anticipate all of their assets first.

▶ 0:55:44Sen. Hoeven: We do have a veterans home in the southeast part of the state but in the northeast part we don't, and obviously you are talking long distances. We don't have nursing homes to take these folks and we are now working with v.a. On an assessment to look at veterans home in that part of the state. And want to make sure we have your committee that funds that, we will go through the processes. We will go through the study that is required.

▶ 0:56:16Sen. Hoeven: We would want your help and support.

▶ 0:56:17Sec. Collins: I agree. Richard laid out a great deal of the money, but this is also a bipartisan issue. Our aging population is going to need this. One of the things I'm not happy about and we are trying to work through is, one of the reasons for nursing homes do not take v.a. Patients is because we require a double inspection process, which is -- you know, I've already said, what do we do that is stupid? Congratulations, you found one. Got to get away from that.

▶ 0:56:46Sec. Collins: I'm working on getting away from that and that way we can assure veterans are getting clear. We are going to the national standards everybody else uses. We have the same problem in construction. We took national building code, and v.a. Decided to add another building code on top of it, which makes our costs astronomically high.

▶ 0:57:06Sen. Hoeven: That is right on, and I think you can have an impact. Appreciate it.

▶ 0:57:11Chair Boozman: The senator from wisconsin. >> thank you, Mr. chairman, and Mr. secretary, for your service. In 2025 my legislation to create a grant program to improve outreach to veterans through county and tribal veterans service officers was passed into law as section 302 of the dole act. Congress appropriated $2 million for that grant program last year and the v.a.

▶ 0:57:39Chair Boozman: Is currently going through a rulemaking process to distribute that funding. It is my expectation that the v.a. Will complete that process as quickly as possible so these funds can be stupid. The full skill -- fiscal year 2027 request says the v.a. Intends to exercise the full $10 million authorized for the grant program by law year. So, Mr.

▶ 0:58:07Chair Boozman: Secretary, if the office of military to civilian readiness, which will administer this grant program receives its full appropriation for fiscal year 2027, you commit to distributing the 10 million dollars in grants that are authorized that year?

▶ 0:58:24Sec. Collins: Senator, of course. One of the things I've always made it clear is, we will work to do whatever is appropriated to us.

▶ 0:58:31Sen. Baldwin: Thank you, Mr. secretary. What you think the benefit is of a veterans receiving outrage from the county and tribal veterans officers?

▶ 0:58:41Sec. Collins: A brutally honest statement? They could be a matter of life and death.

▶ 0:58:47Sec. Collins: I'm not trying to be dramatic about that. The transition periods are some of our highest issues when we have those who are struggling. Death by suicide. Just the other day I was talking about this and, you know, I have been a reservist all my career but I deployed. Next month I am actually retiring from the air force after 20-something years. Some but he asked me about it.

▶ 0:59:15Sec. Collins: I had never put it in the perspective of transition, because it was a civilian-military transition. I was leaving from an air force and getting in my car to leave. A senior sergeant came up and saluted. A colonel, she saluted. I saluted back. I took a step away and it hit me. And I turned around and I had one of my coins.

▶ 0:59:42Sec. Collins: I gave her one of my coins and said, you have no idea why I'm giving you this, but you just gave me the last salute I will ever have in uniform. In an active role. And it hit me that in just a few weeks am not going to say I am a member of the air force anymore. Multiply that by a million, those coming off of active duty that had other deployments who have been 25, 30 years. That is why I say this is so important.

▶ 1:00:10Sec. Collins: I value our officers and would love to see it expanded in other states.

▶ 1:00:13Sen. Baldwin: County veterans services are a vital part of making sure veterans know about the resources and have the resources that they need after leaving the military. They are responsible for processing more than 85 billion dollars in compensation pension, health care claims each year, and are often the first way that a veteran comes aware of the potential benefits that they are due.

▶ 1:00:41Sen. Baldwin: I was also pleased to see that v.a.'s fiscal year 2027 budget request includes consistent funding for jason's law. We talked about that last year. Not just jason's law, but other v.a. Programs dedicated to ensuring that medications like opioids are being properly prescribed and veterans can have their pain safely managed.

▶ 1:01:09Sen. Baldwin: But this money is only effective if you have the staff in place to implement the programs. And, as we know, the v.a. Lost tens of thousands of employees in the first year of this administration. How many staff responsible for implementing pain and opioid management programs left the department last year? And do you intend to hire replacements for them?

▶ 1:01:35Sec. Collins: Senator, the second answer is easy, yes. We will hire every need we have in the department. There is no hiring freeze. The new rise set up is set up to where our hospitals have the autonomy to higher where they need and what they need going forward. So, we will continue that. To get you an exact number, unless richard has one I will not give you one off-the-cuff.

▶ 1:01:59Sen. Baldwin: We can follow up. I just want to go a little bit further on your answer. The v.a. Also announced that the beginning of this year that it would be eliminating approximately 30,000 unfilled positions, including direct medical positions like doctors and nurses. But many of these positions were filled until last year.

▶ 1:02:23Sen. Baldwin: Are you eliminating any unfilled positions on pain management teams and any other position responsible for opioid safety?

▶ 1:02:32Sec. Collins: I will get you that direct answer, but I will answer your overall question is, 26,000 came off of our manpower. When I first came in last year I talked about a tale of two departments. I didn't have the manpower. We were hiring at the v.a. Based on possibilities and needs, not on actual assessments.

▶ 1:02:56Sec. Collins: Yes, some of those that were in the new manning documents at some facilities would say they had a doctor in december. That doesn't mean we needed that doctor in january. If that doctor left nobody was like go, there was no force reduction. It was a manpower document manning statement. As I told congressman wasserman schultz, I said, one of things you have to understand -- I'm going to use an example.

▶ 1:03:25Sec. Collins: Let's say there was a position eliminated him a podiatrist. The fourth one retired and it was a move from their manning document if that executive director says I have had an influx of veterans with bad feet, they can hire that fourth doctor. It doesn't permanently take it away. It is simply a way we can assess what we need. Here the situation.

▶ 1:03:47Sen. Baldwin: I'm out of time, but I will look forward to getting those numbers from you as follow-up. And I don't have time for my final question. I will submit it to the record, but I'm going to be seeking your commitment to following all court orders and injunctions related to restoring and upholding v.a. Employee collective bargaining agreements. I will submit that question for the record and look forward to your response.

▶ 1:04:13Sec. Collins: We already are, and I appreciate it.

▶ 1:04:16Chair Boozman: Senator rounds.

▶ 1:04:20Sen. Rounds: Thank you, Mr. chairman. Secretary collins, I want to thank you for the amount of attention you have provided to our concern about the condition of the v.a. Medical center at hot springs and the fact that at one point here recently we were looking at actually losing our dialysis unit there that serves both veterans and civilians in the southwestern south dakota.

▶ 1:04:45Sen. Rounds: I know that you have already committed $1 million to reinstate that and it looks like we are hopefully still online are opening up on june 1 or in june of this year. Thank you for that commitment. I just want to share with you, I just talked to a daughter of an 85-year-old who lives there in that region who had been receiving services there at hot springs who was driving back and forth to rapid city to receive dialysis and is really looking forward to once again receiving those.

▶ 1:05:13Sen. Rounds: I want to thank you for that commitment you have made and I presume we are still on target for hitting that time in june?

▶ 1:05:19Sec. Collins: As far as I know everything is on target. That is a great partnership. It goes to something like our new community care contract and also our facilities is helping us not only with our rural outreach, but also other -- the private and public sectors as well.

▶ 1:05:37Sen. Rounds: Thank you. Even with the fact that the budget is up 7.7%, or almost $35 billion, you have defended some canceled contracts as a source of savings and efficiency.

▶ 1:05:57Sen. Rounds: Would you identify the major canceled contracts, the services they supported, the amount saved, and the evidence that those functions are still being performed adequately without harming utterance? -- harming veterans?

▶ 1:06:11Mr. Topping: Senator, we have taken a very measured approach. We understand the background of this and initial claims of 76 thousand contracts reviewed, potential terminations. We have taken a very measured approach. Have gone back and looked at those. We provided a briefing and had a procurement where we came in and the total contract eliminations were contracts that were redundancies, or in some case triples. It is a matter of hundreds of contracts.

▶ 1:06:41Mr. Topping: Contracts were de-scoped, and savings was not the lens of dollars but tens of millions of dollars. We were careful that it would be better in safety, patient-safety first, facility-safety first. We are making investments in the agency as we go forward in our infrastructure and workforce to ensure that patient safety and veteran care do not lack. Even on things like dialysis.

▶ 1:07:06Mr. Topping: We are working on our direct care system too, but also be a spent 355 million dollars investing in community providers in your state last year to ensure veterans receive that care.

▶ 1:07:20Sen. Rounds: In south dakota we have been dealing -- and it is an ongoing challenge we have had with postal service within our stay. Quite frankly, it sucks. Because of that we have had veterans that have not received notification of appointments in a timely fashion.

▶ 1:07:42Sen. Rounds: We have had in some cases veterans that can't get their prescription drugs in time, from when they request them to the time it is actually received in the mail. I wish I could say that is not the case, but the postal service has got a problem in our state. Veterans are suffering because of it. You and I talked the other day about this. Can you share a little bit about other options?

▶ 1:08:08Sen. Rounds: I think our veterans at some stage in the game, either through community care or otherwise, should have access to their local, independent pharmacies to get those prescriptions. I think you may feel the same way. Can you talk about that a little bit, please?

▶ 1:08:21Sec. Collins: I don't necessarily disagree with that statement at all. I think in almost every state represented up your has a strong independent pharmacy network. They had strong care they could get in some of those pharmacies, some of the most devoted community leaders we have. There are a couple of things we could look at from that perspective. It is not just your state.

▶ 1:08:45Sec. Collins: I have a letter, a first-class letter sent from five miles from my house for my sister-in-law to my wife and it took seven days to get there, ok? This is a problem. And of the things we can look at is allowing refills to be done quicker, to allow, unfortunately, allow for this lag time. We are also looking at policies of when we can work with community pharmacists or other pharmacy outlets that we can do this.

▶ 1:09:12Sec. Collins: One of the things you will always find for me is I'm going to start off with, I don't know, maybe, let's get it. I'm not going to start with no. I'm going to start with, how can we make this work?

▶ 1:09:23Sen. Rounds: Mr. secretary, you would make a world of difference for a lot of veterans out there that wonder whether or not they are going to get those perceptions on a timely basis and they would love to have the professional expertise of a local pharmacist available to them as well. I appreciate that and I look forward to working with you. Just wish you could help us with that mail service as well, sir. Thank you. Thank you, Mr. chairman.

▶ 1:09:54Sen. Rounds: >> I want to thank you, Mr. secretary, for being that person that stepped up in taking this position, because you were reeling -- really doing a good job and your heart is right there, and that I appreciate. Across mississippi we have 180,000 veterans in mississippi, and so many of them live in rural areas.

▶ 1:10:23Sen. Rounds: And they deserve the quality care and access to that care. I want to thank you for the department and your support for the infrastructure projects, for the mississippi veterans home and pearl, mississippi. You know, it was very needed and very much appreciated. I applaud the record investments that the v.a.

▶ 1:10:45Sen. Rounds: Is making to modernize, to repair, and upgrade health facilities nationwide, and I certainly thank you for the projects in my state in biloxi and montgomery medical center in mississippi this year. This funding is truly a step in the right direction to address the backlog that we have always had and the infrastructure that the v.a. Faces. Question is, what are the next steps the v.a. Is looking at to address the backlog issue?

▶ 1:11:16Sen. Rounds: And how can we ensure that rural v.a. Clinics are also being prioritized to receive funding?

▶ 1:11:22Sec. Collins: Senator, again, I love the work being done in mississippi. There is a great collaboration between state and the v.a. Down there, and we have seen that played out. It is amazing. I have more former governors from mississippi call me about projects in mississippi for veterans almost than any other state in the country. I think it is twofold.

▶ 1:11:49Sec. Collins: Number one, since last year, through our opening up more employments, opening up that are scheduling, from a backlog perspective, and utilizing community care networks, which is, how much to be do in mississippi lester?

▶ 1:12:03Mr. Topping: $855 million invested.

▶ 1:12:08Sec. Collins: That is over top of all of the direct care that is provided there as well. We have got more people in. We are able to see more folks. We are going to continue to make sure our wait times are in line with the rest of the community, but also an issue of quality. We will fulfill the law on wait times. The other part is the backlog. I wish senator baldwin was still here. She made a great point about the county advisors.

▶ 1:12:41Sec. Collins: Which helped through the backlog. Two things. I shared where the backlog was, but I have a better one for you. For those that have been on this committee for a long time, one of the things I have found that I say is stupid is, our application for veterans to apply for disability benefits was 18 pages and had all of this legal jargon at the end. I use the standard of my dad. He would never fill that out.

▶ 1:13:10Sec. Collins: He would get scared, would not fill it out, or think he has to get help. Nobody should have to pay anybody or do anything to get their benefits claim started. I instructed the dba to say, shrink this application. We are in the final stages of this. This is something cool. Hopefully we are going to get bso to look at it. And get that application by july 4. It will be three to four pages, that is it.

▶ 1:13:40Sec. Collins: They will be able to get their application in, get their time down. There is one more that is specific to this. We have a large contingency of growing issues in our military. Especially those getting out of military sexual trauma. Both men and women.

▶ 1:13:58Sec. Collins: It has been brought to my attention by many of those who have applied and were dealing with this is that the way our application and discussion of this is set up that they were having to fillset up as they weg having to fillset up as they weo fill out their dramatic experience more than one time, and that is wrong. We can get what we need mainly in the one. So also looking at how we can shrink what they have to take with one of their worst experiences of their live and not have to relive it simply to get the benefit that they have earned.

▶ 1:14:28Sec. Collins: So those are all areas we are looking to work on and focus on as we go forward, and again, it is all about veterans.

▶ 1:14:35Sen. Hyde-Smith: Wow. The second, I want to ask about the proposal to lower the disability rating based on medication and treatment. I know you've gotten tons of calls on that, as we have. That has raised concerns, because many conditions are managed, not cured, and changes like this could affect their compensation and access to care, so many of them don't even realize when they head down that path.

▶ 1:15:05Sen. Hyde-Smith: What was the department trying to accomplish, and do you plan to revisit that proposal going forward?

▶ 1:15:10Sec. Collins: That one is easy, no. That is done. We removed it. It is off the books. Let me take a second to explain it, because this is very important. If we had a case, the ingram case, came out of our cabinet cords that basically looked at the way we do a lot of our examinations. Always up for us at the v.a., we build the claim based on the impairment.

▶ 1:15:42Sec. Collins: Medications have been always involved, always the baseline for what is the impairment. The court opened it up, if you want to do this vehicle, here's how you would do it. There was a discussion about an ifr, set forth on this, to say how do we adjust? The issue became, though, is that we are, by the way, ingram was always being applied. With the court told us to do, not taken into account, was being applied all along.

▶ 1:16:13Sec. Collins: When it got to the point of saying ok, how do we look forward and fix this, nobody -- let me say a couple of things, number one, nobody has lost a single dime. That was an unfortunate untruth that was put out there early on through social media and others. Nobody was going to lose anything that they currently have.

▶ 1:16:36Sec. Collins: If anything, it might have been, going forward with new claims, but we said, look, I also want to show you, those running the v.a. For a long time, we put it out in good faith thinking we were trying to help, and basically the cords, one of my disability claims people, to hypothetically determine what something would look like.

▶ 1:16:55Sec. Collins: I do not want 14 people across the country hypothetically determining how much benefits you would get on a different case could so you will get one claim, you would get one claim, why? Because, hypothetically, they were having to make a judgment. That was one of the reasons behind it. We said no. The minute we put it out, we got kicked back. Most of it was, frankly, not true come on the losing the benefits side.

▶ 1:17:25Sec. Collins: Within 24 hours, I suspended the rule. I said we are not going to do it. Let's see if we can fix this, as far as making sure we will remove it. It became even more evident. There was no way that what we were trying to do was ever going to work. Within 72 hours, roughly, we immediately pulled the rule completely off the books, never go back to it, because it goes back against my basic premise, if the veterans did not understand it, I was not going to put them through anything else.

▶ 1:17:57Sec. Collins: That is why we pulled it. That is out, it is gone, it is done, and we are continuing to focus on that as we move forward.

▶ 1:18:03Sen. Hyde-Smith: Great. Thank you for that answer. Thank you, Mr. chairman.

▶ 1:18:13Chair Boozman: Senator gillibrand.

▶ 1:18:16Sen. Gillibrand: Thank you, Mr. chairman. Secretary collins, thank you for being here. The pack act has been beneficial to veterans who may have been exposed to bring pets and other toxins that were released while during their war fighting. But I continue to hear concerns that many veterans are not being diagnosed with respiratory conditions, including cancers, until the disease has already significantly progressed.

▶ 1:18:48Sen. Gillibrand: Is the v.a. Aware of these concerns, and are there any efforts to improve the screening for toxins in veterans?

▶ 1:18:56Sec. Collins: Senator, this is important to me, because I am one of those under the pact act, I am a burn veteran. We are seeing a calculus of what the doctors need, what the procedures are. We will always make changes to make sure we can adequately address, in fact, the medical conditions.

▶ 1:19:18Sen. Gillibrand: What is the best way for patients to reach out to you or the v.a., your team, to express their concerns? I've been hearing about it for a while, and perhaps may be the intake system is not robust enough to take their concerns.

▶ 1:19:39Sec. Collins: And every one of our facilities, we have a veteran advocate. We have an advocate in our hospitals. Frankly, I have people reaching out directly on my social media. If they put something on our social media, I actually have people monitoring my social media to say if they have a problem, we actually average somewhere between 30 and 35 cases a week of people who just reach out that way. That's not the preferred way. They reach out whatever way they can. They can call your office, which I believe for us is a mistake, because that means we are not doing what we should be doing at the v.a.

▶ 1:20:09Sec. Collins: We are happy to do what we can to help you.

▶ 1:20:11Sen. Gillibrand: I will submit some of these specific concerns directly to you via letter, and then you will have some specific examples to follow up on, at least as a starting place. Then you can assess, what about the intake system is not working?

▶ 1:20:30Sec. Collins: I will take it a step further, I will have our office reach out to your office.

▶ 1:20:36Sen. Gillibrand: Great, we will start there. I'm also concerned about the closure of the schenectady v.a. Clinic this august, given that, you know, 1500 veterans in the region rely on that specific lytic. For the affected veterans, this means they will have to arrange transportation to their new place of care and build relationships with new physicians and medical staff to care for them pin what is the v.a.'s plan to ensure continuity of care?

▶ 1:21:03Sec. Collins: Right now, the clinic in schenectady was not fulfilling the needs of the v.a. Standard, taking care of patients in the way they should be getting taken care of. They were being passed around by the doctors, contract clinic, that was a contract clinic that for years was not fulfilling its requirement to have doctors and nurses available. They were canceling appointments regularly. They were not filling the role.

▶ 1:21:27Sec. Collins: Really, senator, my choice is, when we look at it from a hospital standpoint, I will never put a veteran into a facility that is not into the standard of v.a. Care. That clinic was not up to standard. . We are moving them to a nearby facility. They are not losing here we are giving them the opportunity to have better connectivity.

▶ 1:21:49Sec. Collins: Yes, change is different for everybody, but I cannot continue, and I don't think you would want me to continue, to have a clinic that consistently for years avoiding the conflict -- contract they were under. This was not an overnight decision. This actually came in many years of working at it. We are happy to provide information.

▶ 1:22:19Sen. Gillibrand: What is the plan for the continuity of care? Do you have a special, individualized plan for veterans, or are they all being dumped in albany? What is your plan for the continuity of care in this closure?

▶ 1:22:24Sec. Collins: They have been reaching out to all the veterans who have been at that clinic in determining where they would like to go.

▶ 1:22:31Sen. Gillibrand: Each veteran is being called?

▶ 1:22:33Sec. Collins: They are being reach out to individually.

▶ 1:22:36Sen. Gillibrand: Phone calls?

▶ 1:22:37Sec. Collins: It's my understanding, yes. For me, the bigger issue is we are making contact with these veterans. They are not being left without care. But I cannot in good conscience send them to a clinic that for years has basically milked the federal government for money and not given them the gifts.

▶ 1:22:55Sen. Gillibrand: I understand your concern about schenectady, so my only request that is to continue to have that level of concern in getting that to the care that you have promised to get them, to make sure they don't fall through the cracks, not ignored, and actually get the care that they need. Because I expect you will see some challenges, not only is there a significant drive time.

▶ 1:23:19Sen. Gillibrand: These are rural areas that people from probably a 50-mile radius come to use the schenectady facility, that they now have to drive to albany, they may be driving two hours. It is going to be a challenge, because you are losing a site that served 1500 people.

▶ 1:23:42Sec. Collins: I'm losing a site that was underperforming and not being what it was supposed to be.

▶ 1:23:44Sen. Gillibrand: Understood.

▶ 1:23:44Sec. Collins: This may be an opportunity for us to take a look at, is there an ability for us to put our own clinic there, not a contract clinic? That is something we look at. You and I are on the same page of this. I leave no veteran behind.

▶ 1:24:00Sen. Gillibrand: I would definitely urge you to look at putting your own clinic there. It's relevant. In rural areas, and rural america, drive times are highly relevant come up with gas prices as high as they are, this could be much more expensive for them, much more stress for them, because they were having to travel for another part of the state to get the care they need. So please, if you are willing to do a different type of facility at the v.a. Site, that would be the best of both worlds.

▶ 1:24:24Sec. Collins: Well, we have the best of both worlds not only with what we can do as we look forward in the future, but also we have our community aspect that we can make sure they get anything they need.

▶ 1:24:36Mr. Topping: There is a care continuity team inside the v.a., giving those veterans the opportunity to go to another facility, albany, if they choose to go, but we are also spending, last year alone, $805 million inside new york, so that those veterans who want to stay local and use a local provider also have that access, and that care is coordinated with v.a., too. So, we are entering there's no drop, no continuity of care, and the veterans have a choice, a local community or go to a v.a.

▶ 1:25:07Mr. Topping: Facility.

▶ 1:25:07Sen. Gillibrand: What in with your time and become a Mr. secretary, if you decide to do your own run clinic at that site? What is the timeline for if you make that decision, and what would your hope be?

▶ 1:25:19Sec. Collins: At this point in time, I'm never going to give you a number that I can't back up, right? This will let me look into as far as what we can do. We are just in the process, again, I'm going to be blunt, I'm frustrated and took several years for this to happen. This should've happened, frankly, several years ago. And now I'm having to deal with it on our watch out for the facility, we're been trying to make every possibility to help these veterans. We will work out a plan.

▶ 1:25:47Sen. Gillibrand: I love that. Mr. topping, if I could follow up with you on if I have any veterans that are finding they aren't finding that continuity of care, I can console both of you directly about where troubleshooting may need to take place.

▶ 1:26:02Mr. Topping: Yes, ma'am, absolutely.

▶ 1:26:05Sen. Gillibrand: Thank you very much. Thank you, Mr. chairman.

▶ 1:26:08Chair Boozman: I think with senator hagerty's permission, senator fischer.

▶ 1:26:16Sen. Fischer: Thank you, Mr. chairman. Mr. secretary, I have a number of questions for you. I'm going to make a statement. Both senator hagerty and I have to get to other hearings, and he is gracious enough to let me go first, so I thank you very much. First of all, I just appreciate the call we had yesterday, and I was glad to hear you talk about decluttering the construction process at the v.a.

▶ 1:26:40Sen. Fischer: As you know, a proven tool that we have is that chip in for events act that is out there. I was really proud to leave the original chip in and act in the senate that enabled the omaha community to work with the v.a. To construct a new ambulatory care = center ahead of schedule, and $34 million under budget.

▶ 1:27:05Sen. Fischer: So I appreciate your commitment to me on that phone call yesterday, that you will be engaging with the omaha community on that to see whether c.h.I.p. I.n. Can be used for that new medical center in v.a..

▶ 1:27:28Sec. Collins: I appreciate that. We are just finishing c.h.I.p. I.n. At the tulsa facility. It is amazing here and we need to do more of it.

▶ 1:27:35Sen. Fischer: Thank you very much. Thank you, Mr. chairman. Thank you, senator hagerty.

▶ 1:27:41Chair Boozman: Said senator hagerty.

▶ 1:27:46Sen. Hagerty: Thank you Mr. , chairman. I will go quickly, for the reasons senator fischer mentioned. I want to thank you for your background, not only as a member of congress but now secretary, the energy you brought to this is refreshing.

▶ 1:28:03Sen. Hagerty: In tennessee, we have 4400 veterans that are being served, and for too long, I think, many of the veterans have told me in so many sad stories about weight times and not being able to access the quality of care that they want and need. You come in and put veterans first, you are refocusing the department, and you are actually making certain that the v.a. Is working for them. I've been so pleased with your opening statement in the data I've heard so far.

▶ 1:28:31Sen. Hagerty: I would love for you to give us a quick overview as to how you've been able, what are the key leaders, I guess I should say, that have allowed you to come in and in such a short time and improve the efficiency of the v.a.

▶ 1:28:45Sec. Collins: Thank you, senator. Our partnership goes back a number of years. It sounds almost too good to be true, but it goes down to unleashing a bureaucracy to it all he saw was bureaucracy.

▶ 1:29:03Sec. Collins: Very much a department that, frankly, to be really honest, it had been beat on for so long, and I mean that in the best and kindest way, they were told what they did wrong, how many backlog, they got to be to the point where they thought they could not fight back. I'm not that way. You are the largest, biggest integrated health care system in the country.

▶ 1:29:29Sec. Collins: We need to act like if you and I gave them more focused and I think that is one thing people don't understand about me. They may disagree with me, but we had no focus at the v.a. It was always about self-preservation, making sure the organization, how much did we have, how much money did we have, instead of, what was the outcome? Nobody seems to care about the outcome. We gave lip service to it, but we never put it forward if you're one of the things we simply did was say, do your job.

▶ 1:29:59Sec. Collins: The rise program, which is basically the senior leadership we are effecting, I found so many times I would go into the executive director's offices, and I would ask him about a problem and say, well, did you ask for help? And they said? I sent it up to vision, central office. Well, what did you hear? >> I did not hear anything. When did you send it up? They said, a year ago. This is ridiculous.

▶ 1:30:26Sec. Collins: One of the things is for rural health care, urban health care, we take in our medical consolidations and consolidated it into one, we take our visions, reducing to 5, so they can administrate the work that needs to be done, then added hsa, health service accounts, who now have smaller areas in which they will have five to six hospitals and that is all they will focus on.

▶ 1:30:52Sec. Collins: Someone worried about rural health care come of this is actually the best thing that happened to rural health care, because those hsa's are now going to help our rural hospitals with a similar problem, so you don't have a vision director who has atlanta and dublin, and then they have columbia. For us, it was just a matter of focus. It was a matter of doing what and unleashing the talent that was already there and taking the appropriations that this committee and congress has given us and say, how do we spend this wisely with one person?

▶ 1:31:25Sen. Hagerty: I certainly appreciate the focus could you mentioned the talent. I know that skilled workforce is an increasingly challenging situation across america but particularly in health care. I would love to hear you comment about how you address improvement and the skill set, scaling up of your workforce.

▶ 1:31:41Sec. Collins: We are actively recruiting in every aspect of what we are doing. If somebody is watching, a doctor or nurse, I will give you a job. Here's one of the issues we have. In many areas, we were actually better, my home state of georgia, we are better than average of recruitment, but across the country, we are in part is that health care system that you are very familiar with as well. Our problem was where we are not as good as when we offered a job, we were taking way too long to hire the person.

▶ 1:32:12Sec. Collins: I mean, it was taking us 130 days, 140 days. I actually have one facility hiring for food service workers, 190 days.

▶ 1:32:20Sen. Hagerty: That's crazy.

▶ 1:32:21Sec. Collins: So what we did is right now we are in the process of hiring across v.a. Total, between 30 and 40 days. We will have doctors hired, nurses hire, food service workers higher, quicker than that. We simply took an approach of, what is the rest of the world at? We were taking 20 days on credentials. It was taking fingerprints almost a month. What we said is, what we have to do to get them a field card? What do we have to do to get them in the door?

▶ 1:32:48Sec. Collins: Do that upfront, make sure all the security boxes are checked, credential boxes are checked, which is about five days to seven days. . Then we will get them in the door, and they fill out the rest. Did you realize chairman, ranking member, we were making human resources folks in our hospitals taken occupational health exam? I said, what for? To know how to open a file? To type on a computer? We were actually making nurses take an exam to wear if they could pick up 50 pounds.

▶ 1:33:21Sec. Collins: I said, let me ask a question. Did they fill out an application? Yes. Are you sick for the job you are applying for? It does. Did they sign it under a penalty? If a nurse is hired and cannot pick up 50 pounds, we fire them. We don't keep them on. This was the problem. So, hopefully, we've already got eight pilots going now, across the country.

▶ 1:33:47Sec. Collins: We will hopefully expand it out through the end of the year were average hiring will be 30, 40 days in the v.a. Line that will help us with our recruitment, retention, and bringing in new people.

▶ 1:33:59Sen. Hagerty: That is certainly common sense, and I appreciate your sense of urgency. I want to close with this. I appreciate the services that the v.a. Offers in my home state. I look forward to continue to work with you. We talked continue really -- we talked considerably about memphis. I would like to talk with you across the state and particularly memphis, and I know we will. Thank you, Mr. chairman.

▶ 1:34:23Chair Boozman: Senator peters.

▶ 1:34:26Sen. Peters: Thank you, Mr. chairman, ranking member. Mr. secretary, I thank you for your time this morning. In your opening statement, which I appreciated, michigan has been the home to the latest duration of the electronic health care record modernization effort, with employment in locations across the state, go and why earlier this month, as you mention.

▶ 1:34:51Sen. Peters: Reports have been very positive from the folks in michigan, and I appreciate that I'm also cautiously optimistic that future rollouts are going to be just as successful as what we've seen so far. But I'm concerned the accelerated deployment schedule for record modernization may impact that, and I want to ask you about that. The transition, as you know, I want to make sure the folks of michigan can continue to have the support that they need to continue that.

▶ 1:35:20Sen. Peters: My question for you is, how are you ensuring that facilities have adequate clinical and I.t. Staffing, training time, and on-site support to safely adopt the system without compromising patient care? So as personnel, for example, in michigan who are transitioning to ohio for the next of, what steps are being taken to ensure the facilities retain the staffing levels and expertise they need.

▶ 1:35:50Sen. Peters: It has been going well, but as you know, it is not over until it is over.

▶ 1:35:52Sec. Collins: And also, I will say, senator, I am, again, you talk about being on pins and needles waiting for something to happen, that was one for us. It was one of those things, if you ever had a bad experience, you cannot get the bad experience out of your head until that perception come that reality is changed. I think we are in the first steps of changing the bad change of what happened in our previous ehrm rollout.

▶ 1:36:23Sec. Collins: We are getting there. We are going to be leaving behind all that we need to, and some of those are from the positions that will be in the facilities to keep that rolling, and I will go forward into ohio, as we look at that come all the way to alaska, actually, in the rollout as well.

▶ 1:36:43Sec. Collins: How I know this is working and how I know people are getting comfortable is that I'm having executive directors and employees at what is supposed to be next year facilities, hearing from their colleagues, and they are saying, we are ready to go now. We've been training, we've been doing this. We are ready to speak of our training. We are ready to do the things we need to do to get help. I'm not making this up. Is not coming from me. It's coming from these employees and these facilities.

▶ 1:37:15Sec. Collins: I cannot say this enough, the four facilities that went live, I commend them greatly. They took on what was told to them would be an impossible task because of past failures. They overcome past failures are not only raised the bar, they pushed the bar further. Your state is getting us on our way to think of your veterans all across the country.

▶ 1:37:36Sen. Peters: That is great to hear. Thank you for saying that you don't want to make sure I heard that in your comments, that the positions are they are necessary to continue that momentum are not going to be pulled out even though you have to continue to rollout in other states. That is encouraging to hear. Secretary, the v.a.

▶ 1:37:55Sen. Peters: Office of inspector general released a report last summer, indicating that every single medical center reported what they consider to be "severe occupational shortage." the ann arbor health care system, for example, reported staffing shortages in key areas such as psychology and nurses assisting.

▶ 1:38:18Sen. Peters: The battle creek had shortages in practice and primary care providers as well as nonclinical roles such as police officers and custodial workers bid to saginaw reported shortage in internal medicine, psychiatrically, geriatric providers. Another reported shortage in anesthesiology, psychology, psychiatry, social work.

▶ 1:38:43Sen. Peters: The john b ingle medical center in detroit reported an even lengthier list of staffing shortages, including nurses, social workers, nutritionists, occupational and physical therapists, podiatrists, in addition to a whole bunch of nonclinical roles.

▶ 1:39:00Sen. Peters: So I put out these lists, and they are by no means exhaustive, but they certainly demonstrate the overall staffing shortage across michigan facilities come across michigan, they are 76 occupations that have been identified as severe shortage. Despite that, the clinical staffing has declined from fiscal year 2025 to today, and your fiscal year 2027 budget leaves staffing below prior levels.

▶ 1:39:28Sen. Peters: Your staffing levels are going even lower while we are experiencing these shortages. My question is, how are our veterans going to be better served by staffing levels that remain below last year's staffing level, when just last year, you're oig found severe shortages? I know there's recruitment and getting people on board, but the overall numbers are decreasing, which makes no sense given the problems we're having right now, what I'm hearing back home in michigan.

▶ 1:39:53Sec. Collins: Yeah. Number one, the issue is the malaise honestly address numbers as we go had good ann arbor in the last five years, we had a 34% increase in sde, and they had a 10% increase in veteran encounters. Battle creek has had a 21% increase in fte counts and a zero increase in veteran encounters. This way, 24% increase in fte counts, 2% increase in veteran encounters. 32% at saginaw and 4%.

▶ 1:40:23Sec. Collins: We've actually added those percentages more fte's into those facilities that have have basically no equivalent in work. That's what we have to look at our staffing numbers. V day is like any other health care system. There's not a hospital in michigan that does not have shortages of doctors and nurses, not a one. We are all in the same ecosystem. We are doing better in many ways than others.

▶ 1:40:52Sec. Collins: We have to take a look at where we are appropriately staffed and where we we not. I would say what you are seeing in the four we just talked about is excellent work, given by the staffing that is currently there. With that report is looked at, it also looks at and I'll deal -- at an ideal setting. Is also an older report that came before I got there. Right now, we are hiring every position that needs to be higher. There no hiring shortage or hiring freeze.

▶ 1:41:21Sec. Collins: They need the people, they can hire the people. So, again, when I go to the facilities and they say they need somebody, I asked, are you actively recruiting? We are actively recruiting at every one of our hospitals can and we will continue to do the at.

▶ 1:41:38Sen. Peters: Well, I appreciate that. That's not to say anything negative on the people in those facilities. They are working very hard. In fact, they are working extra, because they have to cover certain occupational areas, you have fte's, I get that, but related to those occupational areas, and certainly that's where we should be looking at. I understand some of these are hard to recruit for and hard to hire, so I understand that, but also you are taking down the numbers in the budget as well.

▶ 1:42:07Sen. Peters: And I don't know where that comes from. I'm concerned, trying to figure out what the real number is and recruit to it. Because another key factor, as you know very well, retention is the biggest thing, and if people are overworked and overstressed, that's where they go somewhere else.

▶ 1:42:21Sec. Collins: Well, I think the difference here, senator, and, again, we can use different language, I think the levels of being autonomy and work and having the proper numbers there, one of the issues that was talked about earlier today is the issue of Dr. pay, especially in recruitment, and we talked about the goal in the 300 applied to come 1.5% of all my doctors in the v.a., sitting in an equity.

▶ 1:42:51Sec. Collins: I would love to work with you and others on this committee to say, let's look at our four or five top problems and raise back cap. Some may not understand this did you realize that some of the doctors we are hiring, we are recruiting right now, I'm offering them 300,000 dollars, 400,000 dollars less than they can make in the open market. I mean, I'm sorry, they have to take care of their own family. They're not going to come to the v.a. If they can make $400,000 down the street. And we are seeing that a lot.

▶ 1:43:24Sec. Collins: I'm willing to work with anybody on this kid I'm not opposed to putting proper staff were proper staff needs to become and we will always higher we need.

▶ 1:43:30Sen. Peters: Great. Thank you.

▶ 1:43:33Chair Boozman: Senator murkowski.

▶ 1:43:35Sen. Murkowski: Thank you, Mr. chairman. And thank you, secretary, for what you shared with senator peters about how we pay our providers at the v.a. It is something that we have had challenges in alaska, as we have in other areas, in recruiting, particularly some of these specialists. And it just, as you have outlined, they can go down the street and make so much more.

▶ 1:44:03Sen. Murkowski: So we want to make sure that our veterans get that care, but we also have to look at the pay scales as well. I appreciate your commitment to that and making sure that we have the staffing that we need and our veterans deserve. Thank you for the call the other day and discussing some additional issues that we won't have time for this morning.

▶ 1:44:27Sen. Murkowski: I wanted to share with you, this relates to an electronic health records and the modernization going on. But we've heard from several members of the alaska vso's who utilize the joint doj/va hospital, and they continue to report difficulties transferring

▶ 1:44:58Sen. Murkowski: Their health records between the treatment facilities they are when they are trying to utilize different facilities available to them. So it is right there. They are connected. It should just be easier, and I know that we recognize it, but v.a. Is going through their process, dod is going through their own process, updating their medical record technology, but we just need to know that it is going to be better. So can you give me that assurance?

▶ 1:45:27Sec. Collins: Yes, it is going to get better. It will get better by this fall. Anchorage is part of that.

▶ 1:45:35Sen. Murkowski: Well, I'm a little nervous about it.

▶ 1:45:38Sec. Collins: Look, I share your nerves. I'm like an inspection data on all of this. I want it to happen. The big thing is to come of joint facility, you've got 4, 1 that dod has already done there is, we've now got ours. We still have the system in which we are putting $750 million in every year just to keep it alive. Not improve it, just keep it alive.

▶ 1:46:08Sec. Collins: So, it is chevy and ford talking. By the end of the year, my preference, ford and ford will be talking.

▶ 1:46:14Sen. Murkowski: Great. I can't wait to see that. This is something that has been a long-standing frustration. We know it. So to hear the commitment that you are putting forward, I appreciate it.

▶ 1:46:35Sen. Murkowski: On the reorganization, I'm encouraged that, as I understand it, what is happening is we will see some of these multiple layers of bureaucracy that have accumulated. Adding additional flexibility it those v.a.

▶ 1:46:56Sen. Murkowski: Employees who are on the alaska system, I'm hearing from our veterans that they are very satisfied with their care. V.a. Employees consistently rank our facilities among the best places to work. I attribute that to some good decisions that some of our directors have had in the past.

▶ 1:47:22Sen. Murkowski: When I think about the positive news coming out of alaska, we kind of judge it on, what is the complaint level we are hearing? Perhaps he gets all the way up to you. But overall, we have seen much better satisfaction, still some frustration when it comes to those veterans who are using the community care in having to wait for the v.a.

▶ 1:47:47Sen. Murkowski: To approve their referrals for additional care that the primary care provider deems necessary, so I know we are working through that. But can you share with me, I guess, give me the assurance that our rural veterans them as we look at this reorganization, we are not going to be leaving them behind?

▶ 1:48:09Sec. Collins: No. In fact, one of the reasons for rise to an hour reorganization plan, it was our rural, or our struggle, not our -- there's an hsa dedicated only to alaska. It will be the only ones that has a singular focus in alaska because of our unique needs.

▶ 1:48:39Sec. Collins: We look at our call center in alaska, when people get a call and say, you need to drive over here, well, I'm on an island come I cannot drive there. I get it.

▶ 1:48:47Sen. Murkowski: Is a huge thing.

▶ 1:48:49Sec. Collins: By the way, this is an interesting number. We have the mixed situation. We have our direct care, how much did we spend last year?

▶ 1:48:59Mr. Topping: $355 million.

▶ 1:49:02Sen. Murkowski: 350 $5 million in addition to our direct care, which was, again, over and above our direct care which we have in jber and others. For us, it's a matter of focus. The organization -- the rise organization helps us invent our hospital and inside our collective bargaining, so when you have a collective group that has similar interests and they can all come together and say hey, we've got this need, we need to fix this, these are areas we can share with.

▶ 1:49:33Sen. Murkowski: I'm excited about this, about 25 years past due. So I think we are good where we are at.

▶ 1:49:39Sen. Murkowski: Well, I appreciate that, and I would just note to my colleagues it's not that we are particularly needy in alaska were aggressive in pushing our v.a., secretary, but alaska holds the largest number of veterans per capita in the country, and we are very, very proud of that. But obtaining services can be challenging, when you have 83% of your communities that are not on a road.

▶ 1:50:08Sen. Murkowski: And how you access a level of care, and this is why flexibility within systems has been greatly appreciated and how we are communicating between systems. So, Mr. secretary, thank you for your commitment. We are going to keep our fingers crossed on the fact that ford is going to meet ford, and it is all going to work.

▶ 1:50:26Sec. Collins: Also you mentioned a trust core. Our trust core right now, this is among veterans, veterans rating veterans in the v.a. Right now is the highest it has ever been.

▶ 1:50:37Chair Boozman: Thank you. I let my colleagues go first, and so I'm really pleasantly pleased, we had great participations. Most of the questions I was concerned about, you have already answered, very, very well. I will say that I'm very pleased with the results that we are getting in michigan. It is a great start, and especially to hear from my colleague in michigan, you know, to back that up.

▶ 1:51:09Chair Boozman: The other thing I will say is, you mentioned having a bad experience in getting that in your mind, and it makes it difficult. In this case, it is bad experiences, experiences, and you have wrestled with it forever. For many administrations. This is not a democrat or republican thing, this is many administrations over the past couple of decades. So we really appreciate you taking that on.

▶ 1:51:38Chair Boozman: It is just so important, and it will make us a lot more efficient. Just a little bit, many of us are involved in working with the legislation to establish the staff sergeant parker suicide prevention program.

▶ 1:52:02Chair Boozman: According to the v.a.'s december 2020 five support, 25% of veterans supported by this grant needed v.a. Services, an 80% of veterans within the program have shown decreased suicide. Budget for this year extended the program along with advanced appropriation requested.

▶ 1:52:27Chair Boozman: Can you just take a second, secretary collins, and talk about the importance of the program and what other current initiatives we are doing? This is another thing we worked so hard for so many years to get a handle on, to erase some of the negative trends we are seeing.

▶ 1:52:43Sec. Collins: I want to take a moment, one of the things is the fox grants are very important. But I was concerned about accountability. We were giving money to different groups that we really were not making the metrics what we needed to have. What gets measured gets done. Richard can talk to you in a second about that, but I want to tell you from suicide, the veterans a suicide issue, we are really going after it, and it is targeting toward that breach. 60% of veterans who have death by suicide are not in the v.a.

▶ 1:53:16Sec. Collins: System. We had a tool that we had over a year, or longer, before I got there, that allowed us to actually check in email veterans that we were not connected with. We started using that full force at the end of the year and spent january's now, we've added over 100 25,000 new veterans that were not in the system, just in this year, through that. I will leverage or talk a little bit about that, but accountability is our big issue.

▶ 1:53:40Mr. Topping: 727 million dollars on investing in that is the first part. Suicide prevention, getting our veterans into the program or we can care for them. We have a $17.7 billion investment in mental health to get them in, 640 $4 million investment in rehab, building facilities and so we can bring veterans income I get them into care come and meet their needs.

▶ 1:54:04Mr. Topping: This is a holistic approach to make sure from the time a veteran is in crisis, the time of ever in a stable, they are in the v.a. System, and we have got the resources to do that.

▶ 1:54:13Chair Boozman: I agree, metrics are the key. Both of these outside groups, and again in the v.a.. I know that you are working hard to do that. Senator ossoff has just a few things, and then we are going to hopefully get you out of here early.

▶ 1:54:31Sec. Collins: I appreciate that, Mr. chairman. It has been a long week.

▶ 1:54:36Sen. Ossoff: Thank you, Mr. chairman. Mr. secretary, real quickly, something you are passionate about, obviously a key issue in georgia and across the country. As we build this appropriations bill, will you just commit to working with me in the subcommittee to make sure that we are strengthening the foreclosure prevention and veteran homelessness prevention programs that I know are important to you come important to the v.a., important to the folks back at home.

▶ 1:55:05Sen. Ossoff: We are looking for a clear commitment from you on that.

▶ 1:55:07Sec. Collins: We are, and trying to find a right way to do that.

▶ 1:55:10Sen. Ossoff: Thank you. I appreciate that commitment. And, you know, I don't think we have time to get into all the details here today. There is some information that I've requested with respect to the medical center in augusta, but I know you recently visited, which has been struggling.

▶ 1:55:33Sen. Ossoff: Many of these issues, I want to be clear, and interest of fairness, predate your tenure, but I sent a letter earlier this year requesting some specific information about the management of that facility and have not yet received the detailed responses to that letter. Can you just commit to me to get that information to the subcommittee as swiftly as you can assemble it?

▶ 1:55:55Sec. Collins: I would be happy to do, and, senator, I will send you a letter as well, because some of the comments that were also made locally in the media and others in the caves and problems at the augusta medical center but did not have names attached. My job is to fix problems, not talk about problems. So I will get you what information you need, if you would give me the information you have on the suppose it issue there, I would be happy to fix those.

▶ 1:56:24Sec. Collins: I'm not looking for either one of us, I think we share the commonality of, let's fix the problem. But I will say this about augusta, because I think it needs to get on the record, it is before me, but since I've been there. I've been there twice in person in the last year. Once was unannounced. They did not know I was coming, because they had a problem down there. We've also fired people that were in that position. My first time going to augustine was with senator isaacson -- augusta was with senator isaacson. This is something we are working on a long time.

▶ 1:56:53Sec. Collins: If you will commit to me is welcome if you have an issue with specifics at augusta, please come to me. Don't have a more fix issues of death or other things that we hear about in the media, and then when we ask about it, you don't actually give us information to fix it. I will be happy to be transparent with you if you will be transparent with me.

▶ 1:57:16Sen. Ossoff: Mr. secretary, these are not amorphous claims in the media.

▶ 1:57:18Sec. Collins: But you have not given me the specifics.

▶ 1:57:20Sen. Ossoff: I do not want a public confrontation on the subject today, but if you want to have one, we will have one. These are not amorphous claims in the media. The inspector general, and, again, I was very clear in my question, this predates your tenure, but statements from the inspector general at the v.a. About hinder collaboration on patient safety efforts come about their is to limit the ability of staff at the augusta v.a.

▶ 1:57:45Sen. Ossoff: To track,, trend, and address issues that affect patient safety come about refusals to consider subject matter expertise that contribute to low employee satisfaction and patient safety concerns some of these predate your tenure, but they are the v.a. Inspector general. And when my office, Mr.

▶ 1:58:02Sen. Ossoff: Secretary, hears from patients, the family members of patients, staff and providers at this facility about persistent failures with potentially life-threatening impacts.

▶ 1:58:20Sen. Ossoff: And we know, again, through the work of the inspector general, that there is a "threatening and abusive communication style," retaliation for employees sharing concerns with leaders at this facility, I'm not about to come and identify those who are blowing the whistle at your request, when we are trying to investigate what is going wrong with this facility.

▶ 1:58:43Sen. Ossoff: So, here is all I need from you today, I asked a number of specific questions of the medical center leadership at this facility. We have not received the answers to those questions. I believe you when you say you are working in good faith to improve outcomes here. I know you recently visited the facility, but I need the answers to the questions I've asked and not yet received, so I just need a yes or no answer, will you provide an answer to me into the subcommittee?

▶ 1:59:14Sec. Collins: I have always said I will provide the information. But, Mr. chairman, in all due respect, I will give him his yes no answer, but I need to explain. You just mention two things, it would put it out in public setting, threatening and abuses, and employee fire, has been fired for two years almost to make your to have, that person is gone. I had two leadership teams replaced during my tenure there.

▶ 1:59:39Sec. Collins: The things in the oig report, which by the way are from september 24 through september 20 six, of 2024. I don't mind being held accountable for things that came before me. I will take all responsibility for what we are doing right now, and, frankly, this is where it is frustrating, and, look, you and I can have a great relationship. I want to.

▶ 2:00:08Sec. Collins: But when you put it website up, asking for people to send you problems, and then when there is an implication in the media from your office that there was a death in a facility that could have been negligent, but yet we don't get the patient name, we don't get anything about it, where I can fix it, that's a problem. And by the way, I have visited. I would encourage you to come in to actually go to the facility.

▶ 2:00:24Sen. Ossoff: Mr. secretary and, I have come up from the outset --

▶ 2:00:30Sec. Collins: I do not interrupt you, and I'm not finished.

▶ 2:00:35Sen. Ossoff: Go ahead, Mr. secretary.

▶ 2:00:38Sec. Collins: I got the oig report that was closed out on the 2024 report, let's sit down and talk about where we are at right now, and that is what we fix. I went down there, do you realize -- I've never been a secretary that runs from anything. The people from augustine do not think it is worth fixing the hold in the roof, and we lost a lot of equipment because they would not fix a hole in the roof? We fired those people. We governed of those people.

▶ 2:01:07Sec. Collins: I send a new management team in there, just in the last 60 days. No one is more upset about augusta than me. It is my hometown. It's my home area. So I would appreciate it, but I just appreciate the implications, and maybe I'm sensitive to it, I will give you that, but I think you're being a little big grand standing it, because I asked for information, the staff asked for that information from you.

▶ 2:01:35Sen. Ossoff: Mr. secretary, may I? I opened this question by acknowledging that many of these issues predated your tenure come in the interest of fairness, and then pointed out that there were a series of questions about the management of this facility where, as you just noted, very serious issues persist, and asking for a commitment to provide that information to the subcommittee. That is the commitment that I seek.

▶ 2:02:03Sen. Ossoff: Now, when we have a facility that has a pattern, a clear pattern of retaliation and intimidation, for folks who raised concerns within the facility, and I recognize that many of these issues predate your tenure. I'm not hanging this around your neck, Mr. secretary, and there's no need for you to be defensive about this.

▶ 2:02:21Sen. Ossoff: In that context, I'm not going to provide the names and identities of people who are blowing the whistle to the subcommittee into my office at the request of the v.a., particularly where there is communications just recently as a few months ago going out to providers at this facility, telling them improperly, in my view, that they should not suggest to their patients that they bring their concerns about the quality of care they are to their elected representatives in congress.

▶ 2:02:51Sen. Ossoff: I want to be very clear, because that's wrong. Here is -- yes, it is wrong. And here is the email that went out to providers at the facility, ok? My point, Mr. secretary, is not that you are to blame. My point, what began this entire thing, is that we had a clear problem at the facility. This problem predates you. I believe you when you tell me you are working to fix it.

▶ 2:03:19Sen. Ossoff: I'm also working to do my job to oversee these facilities and the v.a. And there is information that I need and have requested that I have not received. I appreciate the commitment that you made at this hearing to provide that information to the subcommittee and to my staff.

▶ 2:03:35Sec. Collins: I appreciate it. I think honestly, you and I in some ways are talking about two different issues. I have no desire -- whistleblower -- I don't get involved -- if people want to complain, go ahead. That's what you are therefore.

▶ 2:03:52Sec. Collins: What my problem was, and I think this is the issue, there was implications in the media, and I think you will acknowledge this, there were implications in the media of a wrongful, negligent, or somehow problem death in the office of the, of which we just honestly asked if there was or there's some concerns, I don't care about the whistleblower, I don't care about the management, there was a bad situation there. I'm going to step back. You and I can both step back.

▶ 2:04:21Sec. Collins: I was upset about one thing, you are upset about another, I get that. We will work together to resolve augusta, because augusta should be the premier site in this country. You and I both agree on that. It's got a cultural problem. That's why we've changed leadership twice down there, and the new leader down there is fighting and swimming in the sharks everyday. So, in fact, if you and I would like to go together to visit the v.a. At augusta, I would be happy to go with you, and we can talk about this in any way you want to.

▶ 2:04:49Sen. Ossoff: I appreciate that offer. Let's began b please getting the information I requested to my office. Thank you.

▶ 2:04:58Chair Boozman: And this has been a conversation, and certainly, you know, our staff has been willing to jump in and do anything we can. The nice thing about, you know, this is everybody is working together for veterans.

▶ 2:05:14Sec. Collins: I don't disagree with you, and I agree with you, and I ag appreciate you and the ranking member. I just wish I could get on the golf course down there to play badly.

▶ 2:05:26Chair Boozman: We will let you get out of here. One thing I want to mention, there was mention some sort of closure in maine.

▶ 2:05:32Sec. Collins: There is no current or planned closures in maine. If I came across wrong, I take responsibility.

▶ 2:05:41Chair Boozman: Noted. We do appreciate you being here. This has been a great hearing with us. Really good attendance. You understand how busy it is right now. There's a lot of stuff going on.

▶ 2:05:55Sec. Collins: Yeah. I have a friend of here.

▶ 2:05:57Chair Boozman: I think it really illustrates how important it is, and how seriously many of us take it. So, we look forward to working with you through the rest of the appropriations cycle.

▶ 2:06:15Chair Boozman: For members of the subcommittee, any questions for the record should be submitted to the subcommittee staff no later than close of business on monday, may the 11th. Thank you. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]

Title

Fiscal Year 2027 Veterans Affairs budget and RISE reorganization oversight

Purpose

The Senate Appropriations Subcommittee (chaired by Sen. Boozman, with Sen. Ossoff as ranking member) held this hearing to examine Secretary of Veterans Affairs Doug Collins' fiscal year 2027 budget request of $488.2 billion and the fiscal year 2028 advance appropriations request, alongside VA Chief Financial Officer Richard Topping. Senators questioned Secretary Collins on clinical staffing levels, the "RISE" administrative reorganization, electronic health record modernization, clinic closures, and rural veterans' access to care. Begins at▶ 0:19:10

Who spoke

• Chair John Boozman (R-AR)▶ 0:19:10: Opened by outlining the $488.2 billion FY2027 VA budget request, a 7.7% increase over FY2026▶ 0:19:37, and previewed topics including electronic health record rollout▶ 0:21:34 and the RISE administrative consolidation proposal▶ 0:21:52; later closed by confirming no planned VA clinic closures in Maine▶ 2:05:32.

• Sen. Jon Ossoff (D-GA), Ranking Member▶ 0:24:04: Raised concerns that FY2027 staffing requests show fewer physicians and nurses than FY2026▶ 0:25:49, flagged a 17.2% increase for outsourced/privatized care versus ~2% for direct care▶ 0:26:17, and pressed on unfunded programs like child care during appointments and CFA-states health care▶ 0:26:46; later pressed Secretary Collins on clinic closures in Tennessee, New York, Maine and Arkansas and demanded the legally required closure-impact analysis▶ 0:46:12▶ 0:50:24; had a heated exchange with Collins over Inspector General findings of retaliation and intimidation at the Augusta, Georgia VA medical center▶ 1:57:16▶ 2:02:03.

• Secretary Doug Collins, VA▶ 0:28:39: Said the department is "the only retail agency in the cabinet" and put veterans first under RISE▶ 0:30:36; cited a 100% safety rating from the Joint Commission▶ 0:31:28 and a 14% staffing increase from 2019–2025 against only a 6% rise in patient interactions▶ 0:31:58; described the disability-claims backlog dropping from 125 days/average 138 days to 77,000 pending at 70 days▶ 0:32:51; announced the recent successful electronic health record rollout in Michigan despite a tornado hitting the facility▶ 0:34:17; stated the Dole Act pay-cap waiver of 300 doctors is too small (1.5% of the physician workforce) and creates pay inequities▶ 0:41:04; confirmed contract clinics in Manville/Tennessee and Schenectady, NY are being relocated, not "closed," due to years of contract non-performance▶ 0:48:20▶ 1:21:03; said the proposal to lower disability ratings based on medication/treatment was suspended within 24 hours and pulled entirely within about 72 hours▶ 1:17:25; cited a 34% FTE increase at Ann Arbor with only 10% more veteran encounters, and similar imbalances at Battle Creek, Saginaw and other Michigan facilities▶ 1:39:53; defended the Augusta, GA medical center record, noting two leadership teams replaced and a facility employee fired over a roof-leak equipment loss▶ 2:01:07.

• Mr. Richard Topping, VA Chief Financial Officer▶ 0:54:36: Detailed a $10.4 billion construction request including $5 billion for deferred maintenance▶ 0:55:05; said VA spent $355 million on community care in Mississippi last year▶ 1:12:03 and $805 million in New York▶ 1:24:36; described $727 million invested in suicide prevention and a $17.7 billion mental health investment▶ 1:53:40.

• Sen. Susan Collins (R-ME)▶ 0:36:10: Noted the Togus, Maine VA facility is the oldest in the country and cited $594 million in self-identified infrastructure needs against only $226 million budgeted for Maine▶ 0:36:56; raised workforce shortages affecting a new residential substance-abuse treatment facility▶ 0:39:33 and pushed for expanded rural transportation grant eligibility via her bipartisan bill▶ 0:43:18.

• Sen. John Hoeven (R-ND)▶ 0:50:44: Praised progress on the Fargo National Veterans Cemetery▶ 0:51:39 and asked how the committee can better support the National Cemetery Administration▶ 0:52:09; also raised long-term care access, noting only about 20% of nursing homes accept VA reimbursement▶ 1:25:18.

• Sen. Tammy Baldwin (D-WI)▶ 0:57:11: Discussed her Dole Act Section 302 grant program for county/tribal veterans service officers and sought a commitment to distribute the full $10 million authorized▶ 0:58:07; asked how many opioid-safety staff left the VA and whether the department is eliminating unfilled pain-management positions amid the announced elimination of ~30,000 unfilled posts▶ 1:01:09▶ 1:01:59.

• Sen. Mike Rounds (R-SD)▶ 1:04:20: Thanked Collins for restoring the Hot Springs, SD dialysis unit with a $1 million commitment, targeted for a June reopening▶ 1:04:45; pressed Topping on the specifics of canceled contracts and savings▶ 1:05:57; raised postal delays affecting prescription delivery and appointment notices in South Dakota▶ 1:07:20.

• Sen. Cindy Hyde-Smith (R-MS)▶ 1:09:54: Highlighted 180,000 Mississippi veterans and infrastructure projects in Biloxi and the state veterans home in Pearl▶ 1:10:23; asked about the disability-rating-reduction proposal tied to medication/treatment▶ 1:14:35.

• Sen. Kirsten Gillibrand (D-NY)▶ 1:18:16: Asked about screening gaps for toxin-exposure-related respiratory conditions and cancers under the PACT Act▶ 1:18:48; pressed extensively on the Schenectady clinic closure affecting 1,500 veterans, seeking an individualized continuity-of-care plan and urging VA to open its own clinic at the site▶ 1:20:36▶ 1:23:19.

• Sen. Bill Hagerty (R-TN)▶ 1:27:46: Praised Collins' management overhaul, asked him to detail the leadership/organizational keys behind efficiency gains▶ 1:28:31 and about workforce skill-building▶ 1:31:25; noted 4,400 veterans served in Tennessee and cited slow past wait times▶ 1:28:03.

• Sen. Deb Fischer (R-NE)▶ 1:26:16: Asked about using the CHIP-IN Act to build a new Omaha ambulatory care center, referencing an earlier CHIP-IN project completed under budget▶ 1:26:40.

• Sen. Gary Peters (D-MI)▶ 1:34:26: Praised the Michigan electronic health record rollout but questioned adequate IT/clinical staffing for the accelerated schedule▶ 1:35:20; cited an IG report finding "severe occupational shortage" at every VA medical center, including specific gaps in Ann Arbor, Battle Creek, Saginaw and Detroit's John D. Dingell Medical Center▶ 1:37:55▶ 1:38:43, and challenged why FY2027 staffing levels remain below FY2025▶ 1:39:00.

• Sen. Lisa Murkowski (R-AK)▶ 1:43:35: Raised difficulty transferring health records between VA and DoD at the joint Anchorage/JBER facility, seeking assurance of improvement by fall▶ 1:44:27; asked about protecting rural Alaska veterans under the RISE reorganization given Alaska's dedicated Health Service Area▶ 1:47:47; noted VA spent $355 million on Alaska community care last year▶ 1:48:59.

Key moments

• Secretary Collins stated a 14% increase in VA hospital staffing from 2019–2025 produced only a 6% increase in patient interactions, with some facilities seeing double-digit staffing growth alongside negative patient-interaction changes▶ 0:31:58▶ 0:32:26.

• Sen. Ossoff and Secretary Collins clashed over clinic relocations/closures in Tennessee, New York, Maine and Arkansas; Ossoff said the required statutory impact analysis has not been provided to the committee, while Collins insisted the facilities were being "relocated," not closed, due to years of contract non-performance▶ 0:46:37▶ 0:50:24.

• Collins disclosed the VA suspended and then, within about 72 hours, fully withdrew a proposed rule lowering disability ratings based on medication/treatment after backlash, asserting "nobody has lost a single dime"▶ 1:15:10▶ 1:17:25.

• Collins said the Dole Act's physician pay-cap waiver, capped at 300 doctors (1.5% of VA's physician workforce), risks creating pay inequities among clinicians and proposed working with the committee to expand it▶ 0:41:04▶ 1:42:21.

• Sen. Peters cited an OIG report finding every VA medical center reported "severe occupational shortage" (76 occupations in Michigan alone), while Collins countered with FTE-growth-versus-encounter-growth figures showing large staffing increases without proportional patient-volume growth at Ann Arbor, Battle Creek, Saginaw and elsewhere▶ 1:37:55▶ 1:39:53.

• Sharp exchange between Sen. Ossoff and Secretary Collins over the Augusta, GA medical center: Ossoff cited IG findings of "threatening and abusive communication style" and retaliation against whistleblowers▶ 1:58:20; Collins said two leadership teams have been replaced and offered to jointly visit the facility with Ossoff▶ 1:59:39▶ 2:04:21.

• Sen. Gillibrand pressed for an individualized, phone-call-based continuity-of-care plan for roughly 1,500 veterans affected by the Schenectady clinic closure, and urged VA to open its own clinic rather than rely solely on Albany▶ 1:22:19▶ 1:24:00.

• Topping disclosed the VA reviewed roughly 76,000 contracts for potential termination, ultimately eliminating "hundreds" as redundant, saving "tens of millions of dollars"▶ 1:06:11▶ 1:06:41.

• Collins said hiring timelines are being cut from 130–190 days to a target of 30–40 days department-wide by removing redundant steps such as occupational-health exams for HR staff and strength tests for already-hired nurses▶ 1:32:12▶ 1:33:21.

• Collins reported the VA disability-claims backlog fell from over 125 days average processing (138 days at its worst) to about 77,000 pending claims averaging 70 days▶ 0:32:51.

Metadata

Committee	Senate Appropriations Subcommittee on Department of the Interior, Environment, and Related Agencies
Chamber / Congress	Senate · 119th Congress
Date	2026-04-30
Type	Open Hearing
Witnesses	(none listed in event metadata)
Video	senate-isvp
Transcript	323 caption blocks · 16,743 words · 2:06:46 runtime
Event	Congress.gov 338357