▶ 0:16:56Chair Moran: The hearing will come to order. Good afternoon, and welcome to our witnesses, as we discussed the department of veteran affairs request for fiscal year 2027 and advance appropriations for fiscal year 2028.
▶ 0:17:12Chair Moran: This budget request reflects record investments in the department, while at the same time secondary collins is leading a new contract for the veteran care program and compensation claims. Today I would like to hear how this budget request will support those and other efforts at v.a. To improve the delivery of care and benefits for veterans and their families.
▶ 0:17:42Chair Moran: This committee in congress as a whole has demonstrated its strong bipartisan support for providing the v.a. With all the resources it needs to deliver on its mission for those who have borne the battle. We have delivered strong bipartisan support for oversight of the department, its programs, and its budget. The v.a. Must work in partnership with this committee, the ranking member thune me, and all of our members -- the ranking member, me, and all of our members to ensure veteran success after their military service.
▶ 0:18:11Chair Moran: V.a.'s success relies on an empowered and motivated workforce. I know that v.a. Employees are some of the brightest and most dedicated public servants, and I hope to hear today how the v.a. Budget request will bolster the workforce and overcome hiring challenges that many sectors of our country are facing. For decades the v.a. Has relied on providers outside its own health care system to meet the needs of veteran patients.
▶ 0:18:39Chair Moran: We have consolidated the patchwork of seven different community care programs when we passed the mission act in 2018. Mr. secretary, under your leadership, the v.a. Is redesigning its community care program to be a purpose built system instead of treating it as a secondary add-on to the direct care system. I want to make certain that any changes to the implementation of community care programs lead to improved integration with the direct care system to make navigating both types of care more seamless for the veteran who uses them.
▶ 0:19:08Chair Moran: I want to make certain that any new budget taken for medical care such as consolidation accounts into direct care and community care for fy28 does not diminish the clarity and transparency in v.a.'s future budget requests. Thank you for being here to testify under fy27 budget request. I think this is your third appearance before this committee. I look forward to having the discussion we are going to have today.
▶ 0:19:38Chair Moran: I now recognize the ranking member of this committee, senator blumenthal, my friend, for his opening statement.
▶ 0:19:43Sen. Blumenthal: Thank you, Mr. chair manchin. I appreciate your leadership on this committee and our bipartisan approach to the work of our committee. As a result of bipartisan work across multiple administrations, and building on the historic achievements like the pact act, more veterans are receiving more health care and benefits than ever before.
▶ 0:20:08Sen. Blumenthal: That is a good thing, ensuring veterans and their families receive the care they deserve is a moral mandate. Part of the costs of war are the costs of caring for our veterans . And we need to face the additional costs of war that we are incurring right now in the iran war. It is a war, it is continuing.
▶ 0:20:41Sen. Blumenthal: And service members, now 400, have been injured, as well as the 14 tragically killed there. They will come home, those 400, with continuing effects of the injuries they suffered. And they deserve fairness and justice, as in the major richard starr act. I've been working and championing this bill.
▶ 0:21:08Sen. Blumenthal: The chairman and I I think are working together very cooperatively on it. I think we are approaching a solution. I was sergeant to hear the second -- I was hear tened to hear the secretary of defense and his testimony a week or so ago sitting where you are say that he supports the major richard starr act. I hope that is the administration's position, and that we will literally do it, even possibly before the fourth of july.
▶ 0:21:39Sen. Blumenthal: And we are here today because we need a v.a. Capable of delivering on the moral mandate, not only the major richard starr act, fairness to our veterans, so they are not docked dollar for dollar in their retirement pay for what they receive on disability benefits, but also more broadly, health care, job training, all of what we promise -- we do promise them, and a great nation keeps its promises.
▶ 0:22:10Sen. Blumenthal: And most especially we need to keep our promises to veterans. There is broad agreement, secondary collins, on many of the items in--secretary collins, on many of the items in your $488 billion budget requests. The proposed $2 billion increase in construction projects is needed to improve the v.a.s aging infrastructure. I welcome the department's commitment to advancing the electronic health record modernization.
▶ 0:22:38Sen. Blumenthal: I am concerned that the department's continued insistence on pushing more veterans into community care at the expense of v.a. Direct care may jeopardize the quality of both. And more than $8 billion of the $10.9 billion increase for health care services in fy27 is for community care. The difference is even more significant in the department's fy28 advanced request with the v.a.
▶ 0:23:08Sen. Blumenthal: Asking for a $17 billion increase in community care and near stagnant levels for direct care. Veterans depend on our v.a. Facilities for the gold standard health care they need and deserve.
▶ 0:23:30Sen. Blumenthal: And the potential shortchanging of those facilities and staff, the skilled and dedicated men and women who serve as nurses, doctors, schedulers, psychiatrists, custodians, the entire team, threatens the quality of care. Veterans typically prefer to receive health care at v.a.
▶ 0:23:55Sen. Blumenthal: Facilities come and yet the funding requests for direct care fails to keep pace with inflation. As we all know, a failure to properly fund and staff v.a. Health care facilities will force veterans into community care, internet system, rather than the v.a. Facilities. -- into that system, rather than the v.a. Facilities. That means they may be ill-equipped to care for the unique needs of veterans, it may be more costly, less desirable.
▶ 0:24:21Sen. Blumenthal: The budget request curtails v.a.'s medical research program with a $23 million budget cut, including cuts in "administrative priority areas," like suicide prevention, oncology, and brain health. I just want to say, the v.a. Over its entire history has pioneered and championed certain types of health care.
▶ 0:24:49Sen. Blumenthal: It is led the nation, in fact the world, on prosthetics, on traumatic brain injury, on, yes, oncology, and other kinds of work where it has a very clear mission including brain health and suicide prevention.
▶ 0:25:12Sen. Blumenthal: On the benefits I, the department plans to continue its expansion of automation and and ai. This is seemingly happening without regard for concerns raised by claims processors that it creates, and they may create extraneous and incorrect information.
▶ 0:25:33Sen. Blumenthal: In fact, the office of inspector general recently found that nearly all of the 8100 automated decisions for service-connected death claims it audited "contained at least one legal or procedural deficiency." I think that finding of the office of attorney general was very telling. Deficiencies and errors are a common trend in v.a.'s recent push to reduce the claims backlog.
▶ 0:26:02Sen. Blumenthal: And I want to focus for a moment on this very important area. V.a.'s own data indicates it has increased claims production. It is producing results faster. But it is denying more claims. And the effect is to increase more -- increase the number of appeals.
▶ 0:26:25Sen. Blumenthal: So it's a little bit like you all have children -- one of our children saying "I did my homework faster," and then have a do over in school when the teacher sees it, because that is what an appeal means. 77% increase in appeals. An 11% increase in denials. Why are more veterans being denied in those claims?
▶ 0:26:52Sen. Blumenthal: And that having to appeal and clogged that -- clog the v.a. Appeals system? The board of veterans appeals reports a 21% increase in the expected number of appeals this fiscal year. That is 1/5 more.
▶ 0:27:14Sen. Blumenthal: And it is more costly to have appeals and have to go through that additional process, and it grates more anxiety and pain for the veteran who is applying. This would be the first net increase in pending appeals since fiscal year 2022. Despite this reality, the department's budget calls for significant cuts to the board's budget and staffing. There is no way to square the two.
▶ 0:27:44Sen. Blumenthal: Increase in numbers of appeals, cuts in the budget for processing those appeals, unjust to our veterans. I'm also concerned that this budget prioritizes politics over accountability.
▶ 0:27:57Sen. Blumenthal: For instance, it cuts the staff at the office of inspector general by 143, below fy2025 levels, while doubling the number of employees in the secretary's office. So we have some issues. I hope we can reach common ground. I appreciate your being here. I look forward to discussing these concerns with you today.
▶ 0:28:28Sen. Blumenthal: Thanks, Mr. chairman.
▶ 0:28:29Chair Moran: Senator blumenthal, thank you. We are jointed today by the honorable douglas collins, secretary of the department of veterans affairs. He is accompanied today by the honorable richard topping. We welcome you both. Secretary, you are recognized for your testimony.
▶ 0:28:48Sec. Collins: Mr. chairman, thank you, and ranking member, it's good to be with you both. I appreciate the comments from both the chairman and ranking member. I think there is a lot of discussion, especially from the ranking member, a lot of things we are going to discuss today, into dealing with exactly what you are talking about, but also the facts and numbers we have that are showing an increase in not only efficiency, but accuracy, but also getting things done more clear. So I'm excited about that.
▶ 0:29:16Sec. Collins: I also am sitting with you for the first time as a veteran. Last saturday was my last day in uniform. My retirement date was the 16th of may. I now sit before U.S. a veteran of this country and out in a unique position to continue the work we have started in making the life of veterans better.
▶ 0:29:39Sec. Collins: There is no doubt in my mind this is what I am called to do at this point, and having to veteran perspective in our department makes it a better part --
▶ 0:29:47Chair Moran: Mr. secretary, thank you for your service.
▶ 0:29:50Sec. Collins: Thank you, Mr. chairman. I appreciate the service every member gives and it provides a unique perspective on how we serve here. I come to you, as I should a couple weeks ago with your probation's committee -- at that point it was a tale of two cities, tale of two departments, the one I inherited and the one we have now.
▶ 0:30:09Sec. Collins: As we look at this going forward today, there is a clear understanding that when we came forth and I set forth in his body and set that the veteran will come first at the v.a., was more than a statement, it was a focus on how we do everything we do. We can disagree on ways to get there, but at the end of the day it is going to be what is best for the veteran. The veteran is the mission and the mission is the veteran. That is all we do. If it is a choice between a structural issue at the v.a.
▶ 0:30:34Sec. Collins: And helping the veteran, the veteran's needs are going to win out in that. I believe in this committee and all committees expect results for every dollar appropriated and the budget is built around those expectations.
▶ 0:30:48Sec. Collins: When we look at the conditions before you today, and I'm looking forward to talking to you about, have to do with their workforce and a workforce that has changed over the last year, one in which it needed to, one because I first got there we had no idea how many employees we had, number two, we had no idea if they were supposed to be working because we had no document -- anybody in the military would understand that a manning document is essential to knowing where your people are and where they are not. We didn't have that.
▶ 0:31:19Sec. Collins: Now we do and we can make arrangements to put the best people in the best places at the best time. I want to say before we discuss the issues and the problems of the v.a., and I'm going to hear a lot of those today, I want to say thank you to all the v.a. Employees we have who have made amazing changes over the last year.
▶ 0:31:36Sec. Collins: They have taken a backlog of 260000 and brought it down to 75,000, average days to complete from hundred 37 277, at a 94% -- from 137 to 77, at a 94% accuracy rate.
▶ 0:31:52Sec. Collins: If you have more being decided, you have the same amount of appeals as you did when you were deciding last, yes, you will have more appeals coming, but at the same point we are getting them clear and using higher -level reviews to get things done inside the vba before they go to the board. The board is a situation I would love to talk to you about, chairman, ranking number, how we can make a more efficient in getting these claims out. Also I go to the vha.
▶ 0:32:20Sec. Collins: Our hospitals are doing amazing work in what we are doing and our hiring process I'm looking forward to talking about. There are two points that are points of pride. In the last month we had a 100% rating from -- we are the only integrated health care system in the country that can say that can 100% safety rating across the board.
▶ 0:32:40Sec. Collins: We have the highest cms ratings, which measures all hospitals, public and private, five stars and four stars significantly outweigh any in any of your states if you ask your public and private hospitals. We are by far more effective at what we do. I think the issues of community care and direct care are something that we can talk about. One, community care is a law. We are going to follow the line do that. -- follow the law and do that.
▶ 0:33:09Sec. Collins: It is a subject that is lost when we talk about that and we talked about community care and isolation. We are spending double the amount indirect care over community care. When we look at this as we go forward today, there is also an issue when we talk about staffing, talk about our work, something I brought up before and I'ma bring it up again, a 14% increase in fda's --- fet' 14% increase in fda's --- fete'. This is reflected in the budget presented by the president.
▶ 0:33:37Sec. Collins: One of the things is the 14% increase in fte's with a 6% increase in actual contact with patients. No hospital or other organization you have consistently outranks fte's and has less patient encounters. I have some facilities that have had 33% increases in staffing and -16 in actual patient encounters. We have to get this in balance. These are things we're going to be looking at. It is measurable outcomes and measurable resistance.
▶ 0:34:07Sec. Collins: The budget is 488.2 billion, an increase over 2026 numbers. I would like to stop here and finish up because we have lots of times for questions going forward.
▶ 0:34:21Sec. Collins: I would like to thank the ranking member for just recently -- this is where we can agree, sir -- sometimes we don't agree, but I agree with your recent letter to the editor in which he talked about what you stated a few minutes ago, that we are skewering more veterans and serving them better -- serving more veterans and serving them better. I look forward to answering the questions you have today. Thank you so much, Mr. chairman.
▶ 0:34:42Chair Moran: Secretary,, thank you for your presence and while I thank you for your service, let me say to your wife, thank her for her service and the families' contribution to our nation. If senator blumenthal doesn't ask you a question about something he said in his opening statement, I will follow up and do so. I am very interested in what he wants to point out about pushing veterans into community care.
▶ 0:35:11Chair Moran: That catches my attention because I spent most of my time in the senate trying to get the v.a. To treat community care fairly and to not try to discourage its use. I want to hear what you and senator blumenthal might talk about in that regard. And I want to know the concern of -- that he suggests about reducing the quality of both. I want to ask you just a couple of questions, and that I will turn it over to senator blumenthal.
▶ 0:35:41Chair Moran: I want to talk about just for a moment the v.a. Is proposing to move from four v.a. Health care accounts to just two, direct care and community care, doing that in 2028. The rise initiative is establishing two corresponding medical operation centers, one for direct care system and one for the community care system. What do you believe the benefits of this approach are?
▶ 0:36:04Sec. Collins: I will let richard answer that, but I believe community care -- it is v.a. Care -- I'd said this from my confirmation --v.a. Care whether it comes indirect form or community care. When we make a statement, I'd know it is not meant to be this way, but when you make a statement that the veterans will get less quality of care in the community, you do realize you are accusing your doctors in the community of being less >> ors-- less doctors.
▶ 0:36:35Sec. Collins: You gotta think about what you are saying. Veterans have specific needs, but one we have for the -- orthopedics and things like that, you are saying doctors in her community are not up to par. But to answer your question, richard will answer that.
▶ 0:36:50Mr. Topping: Thank you for the question. We have been part of this debate where somebody is saying direct care is more expensive than community care, higher or lower quality. The facts are nobody really knows because we don't track the data that way. The account structure v.a. Operates on today is a holdover from the direct care system. It does not account for v.a. Being the fourth-largest payor in the country behind medicare and medicaid and market place. In a payer program, there are three primary costs.
▶ 0:37:18Mr. Topping: There is the administrative costs, the day-to-day operations of the program. There is the contract costs, the fees we pay to the contractors. And then there's the purchase care cost, the reimbursement v.a. Makes to providers who treat our veterans. That is the only cost we actually show. The other two costs are commingled in other accounts. In direct care, direct care has three primary costs, facilities, personnel, and supplies.
▶ 0:37:43Mr. Topping: Those are commingled with the administrative and contract costs of purchase care and also commingled with the costs of national programs, such as housing, such as research, such as suicide prevention, law enforcement. Even fire departments. These are all important parts of the v.a. Mission, but they are not health care costs.
▶ 0:38:05Mr. Topping: The account structure we have proposed would break out a direct care cost vertical for the whole cost of care inside our medical centers and inside our clinics, and a purchase care vertical that accounts for the full cost of that care. Once we do that, we can then measure the quality using national standards, and weekend and account for what we are spending and what we are getting for it.
▶ 0:38:31Mr. Topping: When we do that, the administration and the congress can then have data-driven conversations about resource allocations, where we should invest in care, where we should drive efficiencies. Right now based on the account structure, all I can tell you is it is going to cost more and we don't know where we are managing to.
▶ 0:38:48Chair Moran: Thank you. I want to highlight something senator blumenthal said in his opening statement. I have great respect for the oig . They have been very valuable to me as a member of this committee, as a chairman and ranking member of this committee, and they have been very valuable helping me represent my constituents, my veteran constituents, by providing that kind of investigation that helps me help those people I serve.
▶ 0:39:19Chair Moran: And so I would expect -- we have the chairman of the subcommittee on appropriations and vice chairman of the preparations committee here -- speaking to both of you, I hope we can make certain that the ig at the v.a. Is adequately funded to provide oversight, audit hotline and investigative work.
▶ 0:39:44Chair Moran: And the reduction that is in the less funding that is in the budget request seems to me to be damaging to that possibility. I would highlight in veterans home grant program, there is a reduction of $100 million in the budget request. We have a backlog of more than $1.5 billion of proof priority projects, priority determined by the v.a.
▶ 0:40:14Chair Moran: And we are making little or no progress in working our way down that line. And I hope that you have a plan that would help us allow our state veteran home grant program to buy the money for the states that have been waiting, waiting, and waiting. Mr. secretary, any observations?
▶ 0:40:32Sec. Collins: Real quick observation -- we are working on that, that is an issue we are trying to work within our budget, but also work with the states. I've had many conversations with state directors about how they are not only -- they are approaching this issue, but we are approaching it from the community at large. The nursing home situation is not just a veteran problem, it is a long-term problem for communities as a whole. We returned to work in concert to make it better on our side.
▶ 0:41:03Sec. Collins: I want to say, about the oig. We have an excellent oig. She is doing a great job working on this and trying to clean up backlogs and do that. I think richard had agreed to this number, but of course always willing to work with this team. We support the president's budget and we feel like we can do everything we need to, but that was never agreed to by her as well. --was I never agreed to by her as well. -- a number agreed to by her as well.
▶ 0:41:30Chair Moran: Senator blumenthal .
▶ 0:41:32Sen. Blumenthal: Clearly what is happening with the v.a. On benefits is there has been a shift in backlogs from the claims to the appeals. In other words, the v.a. Is trading a claims backlog for an appeals backlog. And what disturbs me most is that the board of veterans appeals expects 21% more appeals. Overall there will be 77% more.
▶ 0:42:03Sen. Blumenthal: And yet it's being cut. What is the possible justification?
▶ 0:42:08Sec. Collins: A couple things. The board of appeals to the board of actually dropped -- they have not increased, they have dropped.
▶ 0:42:16Sen. Blumenthal: So you disputing --
▶ 0:42:18Sec. Collins: 102,000 at the board. We have to be talking about the same issues here. As I go back to discussing that I had as we went forward in this, you can't look at -- I mean, you can try, but the numbers don't bear it out. Opinions and facts are different.
▶ 0:42:38Sec. Collins: When you get the numbers of appeals -- the number of claims that have been adjudicated since we have been there from 260,000 to 75,000 -- by the way, that is taking into account the total number of claims, over a million when I stepped foot in this office --
▶ 0:42:53Sen. Blumenthal: My time is limited. The number of appeals pending has gone from 66,028, january 25, to 117,167 in may of 20 36. The average state to complete them has gone from 99 to 102.
▶ 0:43:23Sen. Blumenthal: And the number of appeals received by the board of veterans appeals has increased from 112,000 in 2025 to an estimate of 113 thousand -- I'm sorry, 92,057 to 150,000. 111,614.
▶ 0:43:53Sen. Blumenthal: It is projected to be 113,000. There is clearly been an increase here. I want to move ahead, but I would like an explanation for those numbers, and if you have better numbers --
▶ 0:44:05Sec. Collins: No, I will, and will quickly, there is nothing more aggravating and more confusing to look at the boards numbers in the three boxes of how they actually do appeals and how they move them. I will be very frank with you, since we have been in the chair, they dropped the number of days according to the recording. I want to get with you on this. I think it is worth a topic because we need to look at how we are board of appeals and change the way we do it.
▶ 0:44:35Sec. Collins: It can be more effective for veterans and the community, so I'm happy to work with you further on that.
▶ 0:44:39Sen. Blumenthal: Would you agree with me that veterans who prefer direct care ought to be given the choice?
▶ 0:44:43Sec. Collins: I believe the veteran get the choice. Thank you for agreeing with me.
▶ 0:44:48Sen. Blumenthal: And the underfunding of direct care is going to cause them to seek community care?
▶ 0:44:52Sec. Collins: I disagree completely with that.
▶ 0:44:55Sen. Blumenthal: That is what is happening in my view, because you have cut about 1000 positions of physicians, you have cut nurses' positions, you have cut all kinds of other support positions. And then you have failed to fill the vacancies that have resulted from cutting or furloughing or encouraging them to leave. So the workforce has diminished.
▶ 0:45:28Sen. Blumenthal: And in turn, veterans are encouraged then to seek community care as a result.
▶ 0:45:36Sec. Collins: Again, you are entitled to that opinion and perspective. It is not backed up by basically the facts. Just dealing with effect -- there is no risk for lowe's, however you -- furloughs, however you call it, there was a reduction -- 30,000 took early retirement.
▶ 0:45:57Sen. Blumenthal: 30,000 people. Call that whatever you want, but that was a reduction.
▶ 0:46:02Sec. Collins: Well, explain how way tems have gone down --
▶ 0:46:06Sen. Blumenthal: And you eliminated the positions so it didn't look like there was any vacancy.
▶ 0:46:10Sec. Collins: No -- senator, let's get back to the basis of understanding what we are trying to do. You are in the military, you also run an office, you know how many employees you have. You do not need three press secretaries, and if one day she decided to make that press secretary a legislative assistant, you are not going to say you are short on prosecutors, you say I felt the need--on press secretaries, you say I filled the need where I
▶ 0:46:40Sec. Collins: Need to have it. During this time we have lowered wait times and facilities and we got better care --
▶ 0:46:46Sen. Blumenthal: You don't think they have lost people they need?
▶ 0:46:48Sec. Collins: No, you know why I know that? If they need them right now, they can hire them right now. That is how I know this.
▶ 0:46:56Sen. Blumenthal: That's not what we are hearing.
▶ 0:46:59Sec. Collins: Well, I will go with you. I've been to every trip. Senator, unlike you, I've been to facilities in the past year and a half and I talked to the executive directors.
▶ 0:47:09Sen. Blumenthal: My time has expired, Mr. secretary --
▶ 0:47:15Sec. Collins: I have one quick question -- one thought, though, that you brought up the ig report pit I have to comment on that because you brought up an ig report released on april 30 in which inspector general mason told me they were releasing because it was being lost compelled, whatever in the system. The decision that you referenced in your opening statement was reviewed from september 2023 to august 2024. Unfortunately, you have the wrong secretary to ask why that happened. I yield back.
▶ 0:47:46Sen. Blumenthal: I will have more questions for the right secretary.
▶ 0:47:50Sec. Collins: I don't think he's coming back. [laughter]
▶ 0:47:52Chair Moran: Senator blackburn.
▶ 0:47:55Sen. Blackburn: Thank you, Mr. chairman, and I want to thank you, Mr. secretary, for being here. We are really grateful for the work that you are doing. When we talk to tennessee veterans, we hear that you are working to expand that access, you are reducing that backlog, you are improving the benefits processing. Those are all steps in the right direction. I also appreciate the efforts that you and Mr.
▶ 0:48:20Sen. Blackburn: Topping are making to modernize the system and strengthen that for the long term. That has been needed. And when we talk to veterans, they talk about the steps you have taken to access non-v.a. Providers for the veterans. And of course, community care is a big part of this.
▶ 0:48:48Sen. Blackburn: And I want to know what specific steps you are taking, and what that next iteration for community care contracts will be so that takes it easier for our veterans to access the care they need when they need it, where they need it.
▶ 0:49:06Sec. Collins: Thank you, senator, and I've enjoyed working with you over the years. One of the issues you just raised is how we make the system better result.
▶ 0:49:16Sen. Blackburn: Long term.
▶ 0:49:18Sec. Collins: This is why in just a moment Mr. topping can tell you about the community care contract -- which, by the way, we had 71 bidders. For those of you who remember, we had two. We had 71.
▶ 0:49:36Sec. Collins: That is going to give as a whole new network, and for your verbal states and areas that have trouble with community providers, this is going to provide a whole new access to what we can do for not only community providers, but there is going to be a switch over -- we are looking at rural health care committee can be a model as well. We look forward to working with you on that. But that is one step. The next step is the hrm. We had a phenomenal rollout in michigan.
▶ 0:50:06Sec. Collins: My only problem is I have more senators wanting to get ahead of the line than anything else because it is working. But that connection between the community and the v.a.'s electronic health records management is going to get veterans there. The last part is going to incorporate scheduling, where the veteran can have more active role in their scheduling, we don't have to hire schedules to do scheduling on a nine different screens.
▶ 0:50:31Sec. Collins: The veterans can go to their computer and schedule community care or direct care depending on their preference and time schedules. There was a lot going on here. Anything you want to add to that?
▶ 0:50:41Mr. Topping: No, sir, I think you said it well.
▶ 0:50:45Sec. Collins: Thank you.
▶ 0:50:46Sen. Blackburn: Wonderful. I want to thank you for your work and keeping that v.a. Clinic open. Can you speak for a little bit to how community care can help with that type situation? Because here was a clinic that was going to close. It was going to close may 31. You all jumped in. There veterans there wanted to retain that access to care.
▶ 0:51:15Sen. Blackburn: 78 of our 95 counties in tennessee are rural. So speak to how community care can help with that specific type situation.
▶ 0:51:24Sec. Collins: It provides an alternative, and getting into not only rural areas -- I do have to say this, and we have to make this clear, it was subpar in its treatment to its veterans. I know the veterans -- when you saw you know -- it was a contract clinic, it was not taking care of veterans. It had been going on for a while, longer than a year or more. We kept getting basically stonewalled by the contractors. That is why we are taking that over and putting v.a.
▶ 0:51:53Sec. Collins: People in that facility to make sure that veterans get the care they need. It also provides an opportunity to work with communities and doctors and clinicians in different areas. A statement was made earlier -- I think there are some veterans who prefer to get all their care from the v.a. Directly. But the younger veterans, of which I am a part of, will share a different opinion of that. They may get some of their care at v.a. But they may want to have care in the community. That is what the mission act provided for.
▶ 0:52:22Sen. Blackburn: I do want to mention my women veterans specialty care access act. This is something that we are working to improve care for our female veterans. Because as we see more of them and we have got some that are serving right now in operation epic fury, making certain that there needs are going to be met in the v.a.
▶ 0:52:46Sen. Blackburn: Command previously we have had really a big divide in the care that was available to our female veterans. So I would like for you to talk a little bit about how you are going to increase that care, and then also how community care can increase care.
▶ 0:53:08Sec. Collins: I think the biggest thing is -- we have about a million, give or take, enrolled women in our veteran programs, a little over 2 million veterans total that would be in our service. We have a program right now to where we have a goal of enrolling the next million.
▶ 0:53:28Sec. Collins: But there is also -- almost all of our new clinics have a women's specialty sides of the women have their own special side for their particular needs including that. There is also in our hospitals, many of them are retooling themselves -- I have been to several facilities that regional parts of their departments to have a women's health section. One of the things I did last year's I found out that our female veterans were having to go to their primary care doctor and then obgy care.
▶ 0:54:01Sec. Collins: There is no female in this room because private care who have to get. They go straight to the ob/gyn doctors. We took that out and said you don't have to go through what I thought was a foolish step to go to primary care to go to your doctor, and it was delaying care at that time. We took that out and that is well received. Female veterans can access community care. We have best medical interest which takes into account the needs of the veteran and their caregivers to eliminate that as well.
▶ 0:54:28Sen. Blackburn: Thank you. Thank you, Mr. chairman.
▶ 0:54:31Chair Moran: You are welcome. Senator murray.
▶ 0:54:34Sen. Murray: Thank you, Mr. chairman. Mr. secretary, in december 2020 when you were serving in the house, congress passed the veterans health care improvement act by unanimous consent, and it was signed into law by president trump during his first term. Section 5107 of the law says the secretary shall provide a form of child care assistance by january 5, 2026, to all veterans during their v.a. Appointments.
▶ 0:55:04Sen. Murray: Last year your budget request $22 million to open kids care sites at 13 v.a. Medical facilities. Congress delivered on that request. But you are only planning to use $1 million of those funds in fy 26. This year's budget request has one sentence about the program, which was our first notification that the v.a. Kids care program is no longer being in limited.
▶ 0:55:27Sen. Murray: V.a.'s own data shows that 58% of veterans with children have no-showed or canceled their appointment because of lack of child care. What is your plan to restart this program and comply with the law?
▶ 0:55:44Sec. Collins: I think, senator, to comply with the law, it was noticed in the previous administration, didn't move forward on this. We are trying to move forward on it. Richard can give you more information on the issue. This is what was left with us.
▶ 0:56:00Mr. Topping: We have two sites up and running in american like in chillicothe. We are pulling in the outcomes data so we can drive this forward. We are looking at reimbursement models as well. As we get the data, we can make the decisions and come back and that will be in our budget request.
▶ 0:56:15Sen. Murray: Let me be clear, this is a law. It's not a suggestion, it's a law. We have provided the funding you need to ensure that veterans have the childcare they need to get to their appointment. I will keep working to make sure we fund this program, and I will be following up to make sure that the mandate is followed.
▶ 0:56:34Sec. Collins: We agree it is hard. This was left for four years and never done anything with. We are trying to get it implemented and we are doing everything we can possibly do.
▶ 0:56:43Sen. Murray: Ok, moving on, secretary collins. Last month I had a roundtable with veterans in my home state of washington, and I heard from a number of them that wait times for behavioral health care can sometimes be up to 90 days. That is 90 days for behavioral health care. Unacceptable. Community care cannot be the answer because it takes community care providers longer to treat veterans than if the veteran remained with the v.a.
▶ 0:57:13Sen. Murray: The same advocates I met with told me it can take up to 10 months to fill certain positions, and yet v.a.'s budget is requesting 6000 fewer employees than vha had in 2025. I want to hear specifically from you what you are doing to help address this crisis. How many more doctors and nurses has the v.a. Hired since you took over?
▶ 0:57:37Sec. Collins: Are you -- ok, several questions. Which one do you want to go with first?
▶ 0:57:43Sen. Murray: Start with where you have an answer.
▶ 0:57:46Sec. Collins: Let's start off, first off, at the mental health side. There is nothing keeping any of our facilities from hiring mental health professionals they need. That can be hired at any point. Our overall v.a.-wide, they have come down two to three days --
▶ 0:58:04Sen. Murray: What do you mean, down? Wait times? You're trying to say wait times?
▶ 0:58:10Sec. Collins: Yes. Mental health has improved 2.8 days just this year from 17.8 to 15.
▶ 0:58:18Sen. Murray: Let me tell you, I heard it directly from veterans myself, and from v.a. Staff. One v.a. Nurse talked to me about how she had 3200 patients at one point. When she would get into the office, she said she would look at her screen and start crying, because she knew how many veterans were in crisis, and needed her. That is just overwhelming.
▶ 0:58:45Sen. Murray: So we are in this position because trump did push out many people, however you are going to characterize it. And now we are having the consequences. I am told that you are holding these clinical positions flat instead of hiring for providers that our veterans need.
▶ 0:59:03Sec. Collins: We are not. Here's the issue, you have a clinical provider telling you this but not bringing it up the chain to get something fixed --
▶ 0:59:11Sen. Murray: I'm telling it to you.
▶ 0:59:13Sec. Collins: Well, I appreciate that, but if you work in the system and listening to this today, you're working in the v.a. Facility and not letting your leadership or making sure your leadership is aware we need certain things, I got you have --
▶ 0:59:26Sen. Murray: I am listening to this woman, I'm pretty sure she was letting everybody --
▶ 0:59:30Sec. Collins: That we will address it and I look for to working with you to continue this. The biggest issue is looking at the facilities and looking at what they need and how we need to go about this.
▶ 0:59:39Sen. Murray: I just want you to be aware that out in the field where it counts, mental health is a real crisis, and I am hearing from our v.a. Themselves, I am hearing from veterans that there is a real crisis in staffing.
▶ 0:59:53Sec. Collins: And I appreciate that, senator. I'm on the road at least two weeks a month and I am and 71 hospitals and I go not just to the dog and pony show, I go to the waiting rooms, patient rooms, and we talk about this. The v.a. Is not perfect. I told you that the day we had our confirmation hearing. But we can get better.
▶ 1:00:10Sen. Murray: Limited time -- you need to be aware.
▶ 1:00:13Sec. Collins: I am aware. Thank you.
▶ 1:00:15Sen. Murray: One last question. In the first trump administration, washington state, it was a disaster. I'm glad to see that the most recent rollouts, as you mentioned a few moments ago, seem to go better. For my own of information, when is the last time you spoke to providers?
▶ 1:00:38Sec. Collins: I have not talked to a provider there recently, no.
▶ 1:00:42Sen. Murray: I would like you to, because we cannot ignore the fact that those original sites are still seeing problems and you need to be aware of that. As you move forward with the 13 new ones, I want to make sure that the budget supports both deploying to those new sites and making sure that the other ones out there are improving. I expect and would like to ask for a detailed plan --
▶ 1:01:03Sec. Collins: I will make sure he gets to that plan. We are trying to update the facilities. What happened in washington state was, frankly, wrong and bad, and he went facilities allowed to act as if they were independent and doing whatever they wanted to do. We have not had that -- we fixed that issue moving forward and we are going to go back and fix that. I will get you that information. I agree with you completely.
▶ 1:01:27Sen. Murray: I just have to say, I'm excited that you are not hearing complaints, that's great, but we still have problems at the original sites .
▶ 1:01:38Sec. Collins: And that is what drives me every day.
▶ 1:01:40Chair Moran: Senator tuberville. Sen. somervell congratulations on your retirement at an early age. You said younger veteran.
▶ 1:01:51Sec. Collins: And you still see me sitting here. [laughter] Sen. tupper Sen. tuppe--
▶ 1:01:58Sen. Tuberville: All of them are looking for more money to get better positions. Need more power at the local level, too much bureaucracy. It's gotten better, they say, but still too much bureaucracy, and they are afraid of the local level to make decisions, afraid to step on somebody's toes.
▶ 1:02:22Sec. Collins: I would love to answer that. We have the best -- let me say this quickly, something that probably a secretary has never said here before this committee. We have some of the best employees that's ever been, but over the past 30 to 40 years, me included, when I was across the dais as well, the main thing we focus on is what we do wrong, what's we get bad. I'm standing up for my veterans because this is what we got wrong.
▶ 1:02:49Sec. Collins: We really talk about the successes--we rarely talk about the successes. And even we get criticized for successes because they are not accurate enough. They have taken on more responsibility, they've opened 2 million more appointment times that did not exist previously, they've opened a 35 new facilities, ehrm which is going. They are doing this even when everybody else wants to say everything is bad at the v.a.
▶ 1:03:15Sec. Collins: I believe what happened to many of our employees over time -- talk about morale, you talk about that -- every time they tried something new, they would get a letter how bad something was or a veteran didn't get seen in a timely manner. A reminder to everybody in this room, we are the only health care system in the room that measures wait times. The only one. Nobody else does this. And you know the reason we did? Is because the v.a. Screwed up and didn't put people on a colonoscopy list.
▶ 1:03:43Sec. Collins: We as congress decided to make sure they are getting there. We put together wait times. Nobody else does this. Our new reorganization is going to empower those directors to be the senior leaders they are supposed to be and take control of their budget. I'm excited about where we are heading and I appreciate you acknowledging that. You did mention 1 -- senator king is hopefully going to talk about best dish it is our --it is our ologist problem.
▶ 1:04:15Sec. Collins: I'm capped by the president's pay. An ologist, I can't attract the best in that because they can go other places and make $300,000 to $400,000 more than what I can offer.
▶ 1:04:29Sen. Tuberville: Ok. Good explanation. Let's talk about electronic health records. I'm going to complain again, another complaint here. But I said as last time. --this last time. My v.a.'s but telling me they're having a tough time getting records from community care. They can't get it back into the system. Your thoughts?
▶ 1:04:53Sec. Collins: They are exactly right. Again, this is -- I'm old enough -- I'm just getting old -- I remember when you use the internet and you are the b-- heard the brrr and that's how you get internet. That is how we are working with other professionals in this cyber sphere, we are working at dialup.
▶ 1:05:21Sec. Collins: I support the president's budget fully in the years to come because until we have an ehrm system that is part of the 21st century, we can't talk to community providers. It is imperative for their community care network to do this. Here is the worst 1 -- you know our facilities can't talk to each other? Our current records system does not allow us to talk to each other, and we spent $700 million a year to keep it alive.
▶ 1:05:48Sec. Collins: I agree completely with the criticism, and as soon as we get the funds and the money and we move this forward, we will have them all done.
▶ 1:05:54Sen. Tuberville: The last part of my time, I want to give you time to talk about the money spent last fiscal year at the v.a. Your thoughts about all the money that we have given you and the direction it's gone?
▶ 1:06:10Sec. Collins: I think what's been given -- I appreciate the congress appropriate the budget the last two years, and increasing our budget both years, and did so anyway where we targeted what we need. Construction, the average age of our facilities is over 70 years old. We have increased our construction budget and we are looking at it to major construction and how we build hospitals.
▶ 1:06:34Sec. Collins: We are able to take that and make it better because we will reduce the bureaucracy in what we do. How we build stuff, we have extended our ehrm system and we will get 23 to 24 next year. The money has been spent -- I want richard to comment on this because it can't be said enough, how much we spent in community care and communities that support communities, but also in direct care as well.
▶ 1:07:00Mr. Topping: One of the things we are excited about in the president's budget is the $10.4 billion investment in construction, a continuation of the investment we have made in maintenance facilities this year. Average physical age of a physical plant in v.a. Is 60 years. The $5 billion we are spending this year is investing that infrastructure.
▶ 1:07:19Mr. Topping: The president's budget includes fight billing dollars in investment next year as well--$5 billion-an investment next year as well as well as new facilities in san antonio, manchester, as well as minor construction project, getting up-to-date with where we are at. We thank you for the support on electronic health records as well. That's an issue we have got going as well, too, so thank you.
▶ 1:07:42Chair Moran: Senator hirono.
▶ 1:07:44Sen. Hirono: Thank you, Mr. chairman. Mr. secretary, I think you would acknowledge that there is a need for beds in state veteran homes. That is why the department state home construction grant program is important. And the chairman manchin his good cash chairman --the chairman mentioned is concerned that this account has been cut by $105 million.
▶ 1:08:12Sen. Hirono: The state of hawaii secured a location on maui for increasing the number of beds, and they obtain the required match. But because of these cuts, they are now in the back of the line, possibly. How many projects are currently in the backlog for grants, where the state has met the fund matching requirements?
▶ 1:08:36Sec. Collins: I would have to get back to you on the exact number. I agree with you, this is a priority for us. I hope as we go through the appropriations process we will see that reflected. We think we can fulfill what we have now --
▶ 1:08:50Sen. Hirono: Well, right now you requested $171 million, which only takes care of maybe three of these projects out of a total of 89 in the queue. So there is a growing gap, and the fact that this account is over $100 million less than last year, if it is a priority, I would press that you take a look at this line and be fed up.
▶ 1:09:16Sec. Collins: Be happy to, senator.
▶ 1:09:19Sen. Hirono: This is something that chair and I definitely agree on and the other members of the committee acknowledge the importance of this program. So you need to increase the amount for the program. Next question, over two years ago congress gave the department the authority to provide direct care to U.S. veterans in three associated states. So that would be allowed, micronesia-- palau, micronesia, and the marshall islands.
▶ 1:09:49Sen. Hirono: We recruit from these estates and they sign up to serve our country in great numbers. Through the compact of free associations, we promise we take care of them and provide a certain kind of care. And it's been slow going. My understanding is that things are getting better, and that the v.a. Is on its way to providing the care that we promised to these veterans in these island nations.
▶ 1:10:15Sen. Hirono: Will you commit to working with congress and the department of state and interior -- that is one of the reasons you have to coordinate with three different departments to get this time. Will you commit to working with department of state and interior and obviously congress to ensure that v.a. Provisions in the compact are fully implemented in line with congressional intent we will definitely --
▶ 1:10:44Sec. Collins: We will definitely do that, and they will be meetings with interior, states of jurisdictions, but also appropriations committees to determine the best way forward and how we can provide it. V.a. Is not a stop to this. We have 130 known veterans and we have identified 47 more. The regulations on telehealth and some of the others -- we are committed to doing that.
▶ 1:11:09Sen. Hirono: We are supposed to provide pharmacy, telehealth, beneficiary, travel. They are not asking for that much. We should do better. Also, as we are looking at how much all of this is going to cost, I would request that the department pay close attention to the actual cost, as opposed to the kind of figures we have been getting as to what it would cost to provide veterans in compact nations the care he promised them.
▶ 1:11:39Sen. Hirono: I think the amounts have been vastly inflated. So we need accurate figures so we can provide the resources that it will take.
▶ 1:11:46Sec. Collins: I agree with you, that has been one of my frustrations when I came in when this was laid on my plate. Let me make one clarification, it is not as simple as telehealth and medicine pit we have to have agreements with those countries to be able to do that in the countries. We believe when we get everybody at the table, the state in particular could help us with that.
▶ 1:12:10Sec. Collins: We can't all of a sudden do some of these things without agreements in the countries of origin, especially when it is mail order drugs and things like that.
▶ 1:12:16Sen. Hirono: So if there's anything we can assist you with that kind of situation, we will do that, because there is no question that the compact nations are awaiting the kind of support that veterans deserve.
▶ 1:12:30Sec. Collins: I appreciate that. Anything that we work together on here will be beneficial.
▶ 1:12:36Sen. Hirono: One last question. Hawaii has several critical contracts that have been working their way through v.a.'s frankly onerous processes for many months. Are you tracking the impact of staffing reductions and capping how these kinds of changes are impacting the department's ability to turn around these contracts with outside vendors?
▶ 1:13:07Sec. Collins: If you have specifics, get those to me and I will find out where the contract issue is. It might be a way the contracting at v.a. And other agencies are slow.
▶ 1:13:18Sen. Hirono: Let me identify them. Sharing an agreement between the v.a. Pih, and the army to provide needed resources to the veterans and service members. This is a dual situation.
▶ 1:13:37Sec. Collins: Is this us working together on this?
▶ 1:13:45Sen. Hirono: I think --
▶ 1:13:45Sec. Collins: We are committed to this. I will bring up something you didn't ask for. Dha has an issue in how they restructured themselves. They have to depend on us for some of what they have to do. We are working those things out. There are issues of the system related issues on how we talk to each other but also how reimbursements are made.
▶ 1:14:14Sec. Collins: We have made great strides and we will continue to do so. I was in hawaii and talked about this issue. That should have been done. I appreciate you bringing it up. . I will find out why.
▶ 1:14:22Sen. Hirono: The senate contract relates to payments of the university of hawaii to the service for the center of pacific islander veterans. Those are the contracts we are having difficulty moving along.
▶ 1:14:33Sec. Collins: I would be happy to help.
▶ 1:14:35Sen. Tuberville: We agree on more than one thing. I agree on the issue of freely associated states. The secretary was in my office in july 2025 and met with me and senator boozman then senator risch, the committees that have jurisdiction and he assured us the v.a. Understood they should implement the law.
▶ 1:15:01Sen. Tuberville: We need to put pressure to see this happen at state and elsewhere. We are happy to work with you to accomplish that. Senator boozman.
▶ 1:15:15Sen. Boozman: Thank you you senator hirono for bringing that up. We are trying to accomplish the same thing. We have visited with the secretary on several locations recently and I appreciate the fact that we are moving forward under your leadership. Congratulations on your retirement.
▶ 1:15:43Sen. Boozman: We appreciate, we expressed an interest in accelerating the hrm rollout. Does the fiscal year 27 budget provide sufficient funding to further accelerate the programs rollout without sacrificing quality?
▶ 1:16:02Sec. Collins: It does. I will let richard aggress -- address that but we need this fully funded. There is no going back on the hrm. We are beyond that worried it has to be done. Richard, do you want to highlight that? We are talking about it now. >> the budget request includes implementing 26 additional sites.
▶ 1:16:32Sec. Collins: It is $60 million per site plus the cost of the program so this allows us to do that. If the funding changes we can do more or less but that is the ask.
▶ 1:16:43Sen. Boozman: The fiscal year 27 budget request investing substantially in direct community care spending. Community care serves as a vital complement to direct care helping ensure veterans receive timely access to services the v.a. Can't divide -- provided an appropriate time frame. How does it support industries in rural states?
▶ 1:17:17Sec. Collins: It is invaluable in terms of the investment in rural states and the holiday but also keeping communities intact. I think we serve with local doctors and working with that but there is a dollar effect. Richard can give you real dollar effects for several states to see how that affects.
▶ 1:17:35Mr. Topping: The tools we included allow us to measure quality, pay for value not volume, use the prop -- the tools to make sure the government is paying timely. It allows more providers to partner with us. This is important in rural areas. On average the v.a. Provides 5% reimbursement for rural providers. That is hospitals, doctors, nurses, home health agencies, mental health providers.
▶ 1:18:09Mr. Topping: They agencies often operate on margins of less than 1% and 5% of revenue. V.a. Reimbursement provides a critical role. 60% of veterans live in rural areas and this benefits v.a. And veterans. One example, in arkansas we invested $613 million.
▶ 1:18:27Sen. Boozman: Do you expect community care contract vehicles to better enable the department to enroll community care providers?
▶ 1:18:38Sec. Collins: Yes sir I do.
▶ 1:18:42Sen. Boozman: We appreciate your hard work.
▶ 1:18:44Sec. Collins: Thank you for your help.
▶ 1:18:47Sen. Moran: Senator duckworth.
▶ 1:18:49Sen. Duckworth: Secretary collins, you know like a majority of veterans I despise the idea of privatization of the v.a.. It would devastate the population of veterans returning from war with complex needs require comprehensive tailored care. Safeguarding the v.a. Can building its strength and resilience has never been more important than now. Despite promising the american people he would stop wars, donald trump illegally dragged to the U.S.
▶ 1:19:17Sen. Duckworth: Into war, wasting billions of taxpayer dollars to get us stuck in a quagmire that threatens to become a forever war that he promised the people he would avoid. The pentagon reported at least 406 members of the U.S. armed forces have been wounded in action in trump's were choice and the number is likely to grow. The v.a.
▶ 1:19:39Sen. Duckworth: Must prepare to care for the next generation of veterans that trump is unilaterally creating in iran by seeking investments that enhance direct care work force and infrastructure. The veterans I dedicate my life to serving in their care. They certainly didn't sacrifice to be headed up to corporate greed.
▶ 1:20:02Sen. Duckworth: Secretary, your proposed budget seeks a massive 17% increase in funding for private-sector community care, but only asks for a meager 2.8 in -- percent increase for direct v.a. Services. When you account for inflation, this would be a cut for direct care. The trump administration's bias towards privatization is opposed to the vfw independent budget which recommends congress increase funding for v.a.
▶ 1:20:31Sen. Duckworth: Services by 19.4 percent and reduce community care spending by 6.3%. The divergence between that budget and your budget doesn't end there. You propose a 5.1% cut to medical support and compliance in your department. The independent budget recommends a 2.8% increase to medical support and compliance. You propose a 2.3% cut to medical and prostatic's research. Budget recommends a 54% increase in prosthetics research.
▶ 1:20:58Sen. Duckworth: Proposed a 30.8 -- 37% cut to extended care facilities. The budget calls for a 118% increase. The irony in your effort to shortchange the department is the v.a. Patient wait time exceeds the department's goals while outperforming the community care providers. You propose to fund 12,500 fewer full-time equivalent employees than your department requested.
▶ 1:21:29Sen. Duckworth: In 2026i have yet to see a cost analysis for the rise initiative. Your denials of seeking privatization rings hollow because you promised me in february to provide me with $2 trillion direct care investment plan and you did that under oath, and you appear today empty-handed. Your homework from the, you gave me your word would provide, is three months late. Secretary collins you did donald trump wants to privatize the v.a.
▶ 1:21:58Sen. Duckworth: To enrich billionaire donors but actions speak louder than words and the trump budget will probably -- while probably the most honest document we received, clearly shows his abandonment of our veterans and is a clear. Privatization blitz the funding request would fail to keep up with inflation but he was set -- are seeking billions to create privatization slush fund to force more veterans to seek private-sector care even if they want to remain in the v.a. Center.
▶ 1:22:27Sen. Duckworth: I want veterans to have access to outside care but they need a robust direct care option first. It should not be a second or third. They shouldn't have to go to outside care and private care because there is no direct care option within the v.a.. Secretary collins, why did you reject the independent budget recommendation to increase investment in direct v.a. Medical services by 19.4% and instead reduce funding, why did you -- let me say that again.
▶ 1:23:06Sen. Duckworth: Why did you reject the independent budget recommendation to increase investment in direct v.a. Medical services by 19.4% and modestly reduce funding for private-sector community care by 6.3%? Why did you increase private-sector care and reduce v.a. Care?
▶ 1:23:15Sec. Collins: I worksec.
▶ 1:23:16Collins: Within the budget the v.a. Has and outside agencies are not responsible for anybody. . They can put down numbers anyway they want. They don't have to respond to workforce development or veteran care. I reject, you are entitled to your opinion but not your own facts and when you deal, when you say we are privatizing that is wrong.
▶ 1:23:32Sen. Hirono: You are increasing the budget and cutting v.a. --
▶ 1:23:37Sec. Collins: We pay double come over twice as much in direct care than we do community care. We are following the law. Are you asking me to break the law? Set -- do you want me to follow the mission act?
▶ 1:23:54Sen. Duckworth: I want you to increase direct care, not cut funding.
▶ 1:23:58Sec. Collins: What about veterans who are following this want to have a community care doctor?
▶ 1:24:04Sen. Duckworth: They go first to direct care and private care.
▶ 1:24:07Sec. Collins: Why?
▶ 1:24:12Sec. Collins: >> >> they don't have the option to go to direct care first. >> there needs to be a medical -- >> that is not true. You work at the v.a., you know better with whack I worked with the v.a. And I know better and I know with whack then why did you -- >> you are ignoring the independent budget -- >> I nodded with whack recommendations demonstrate under -- otherwise. Veterans -- reject veterans preferences.
▶ 1:24:40Sec. Collins: I strongly advise you provide meaningful evidence and consult congress. You promised me something and you haven't delivered it. You did it under oath. Your three months late.
▶ 1:24:52Mr. Topping: What did you ask for? I want to know.
▶ 1:24:58Sec. Collins: The political speech is over. We are done. >> thank you Mr. chairman and Mr. secretary. I have to say that on this back-and-forth, I don't know any billionaires enriching themselves at the expense of veterans in north dakota.
▶ 1:25:16Sec. Collins: To the degree that you might be keeping a small community hospital open with five or six more patients that don't want to have to drive a couple hundred miles to get care in fargo, thank you for that but enrichment? That is a little, that is a little rich for me. Excuse the pun. I want to ask about, in february the v.a.
▶ 1:25:40Sec. Collins: Implemented the new payment system for veterans receiving care at community nursing facilities. It makes substantial changes in how reimbursement works for veterans that reside in a facility for more than 100 days. I hope you are familiar with this. I appreciate the effort to modernize the system which I think we badly need. I'm concerned about a possible unintended consequences it relates to access.
▶ 1:26:13Sec. Collins: I want clarification on that and then asking if you would be willing to the outcome of those changes and see if there is perhaps unintended consequences.
▶ 1:26:22Sec. Collins: We would be happy to. If you would allow me a second we are going to look into this but the conversation I just had needs to be answered. You cannot go straight to community care is a veteran. That is false. You can't, I can't tomorrow decide to go to community care and to have a senator say that is not helpful to veterans who won't come to v.a. Because they hear about this. It is a lie.
▶ 1:26:53Sec. Collins: I would be happy to have the continued conversation but that is not true. You can't go straight to community care from the street. You can't. We are not a third-party payer. I'm stunned. We are going to look. At this we appreciate the pdm p, I'm sorry -- looking at it right now, it could be a long term issue that we are looking towards as we go forward so I'm willing to look at how we can help better communicate.
▶ 1:27:25Sec. Collins: Long-term health care inside our facilities or with community is something this country has to look at. >> no question about it. I appreciate that. That is why I appreciate modernization efforts. I see this as a possible challenge going forward and if we look at it sooner rather than later, if it needs to be tweaked I appreciate looking at it.
▶ 1:27:50Sec. Collins: Also, I know president trump reiterated his conviction about made in america as it relates to health care but to include of course not just facilities but equipment and the type of equipment available where we can get the supply chain and whatnot in the united states. Can you give me a sense of how the v.a. Is prioritizing procurement for domestic produced products, particularly medical equipment?
▶ 1:28:20Sec. Collins: We are following out from the white house direction to make sure we are securing our supply chain especially from the drug perspective but also from an equipment perspective. It is going through the process of making sure, a lot of that was not sourced in the U.S. and we are looking at ways ranging from gloves to a movement of ventilators.
▶ 1:28:40Sec. Collins: We are committed to making that happen in the areas where we can but I will be honest with some of our problems we have and this is something everybody up here knows about, sometimes we are bound by set-asides and other things that keep us from accessing, there is one set aside in particular that dominates gloves and others and they get their product from overseas but we still have to go through them because that is the way the procurement system works.
▶ 1:29:10Sec. Collins: >> there is no question it would be a transition but I appreciate his reiterating that. I do realize the challenge of getting everything domestically, we are better off getting something the not getting anything. It is a transition. At some point, I appreciate the visit yesterday in my office very much. I was encouraged by you bringing up the possibility of coming to north dakota.
▶ 1:29:40Sec. Collins: We have a ventilator company that manufactures ventilators in fargo so when we are visiting the hospital, perhaps you can come see. Core medical is what they are called.
▶ 1:29:47Always Sec. Collins: . --
▶ 1:29:53Sec. Collins: I have been to 71 so far and I will be happy to come going forward. >> senator king.
▶ 1:30:05Sen. Kaine: Thank you, Mr. chairman. I join you in the maid of america, I hope in the armed services committee we can ensure that a to warships. There is a proposal kicking around to build ships somewhere else. Thank you for joining us. I am with you on the pay issue. But I need a cosponsor from across the dais.
▶ 1:30:31Sec. Collins: I am an old baptist preacher, do I see a hand?
▶ 1:30:38Sen. King: Can I get a witness?
▶ 1:30:39Sec. Collins: The buses will wait.
▶ 1:30:41Sen. Moran: Senator king, have you been rejected?
▶ 1:30:47Sen. King: Yes and it hurts.
▶ 1:30:48I Sen. Moran: . This issue we are talking about, we have a caps on salary for physicians that is actually present -- preventing the v.a. From hiring specialists across the board whether it is cardiologists or rheumatologists or whatever and it is a serious issue. And -- >> I heard what he said and it -- >> I have the bill ready, Mr. chairman. You can make space for your name right there.
▶ 1:31:16I Sen. Moran: >> can I also come I don't want to interrupt but can I say quickly because this is brought up a lot when we talk about this. 300 set aside to help this pay gap increase. I have to say I appreciate congress doing that but that is 1.5% of doctors. We were picking winners and losers and losing. I had hospitals who didn't want to go through the process because they would lose doctors if they were paying more than others.
▶ 1:31:45I Sen. Moran: >> I will work with you on that and perhaps we can generate support. I want to compliment you, a press release came out two days ago from the v.a., v.a. Hospitals are in record high quality ratings in 2026. You spent time earlier talking about the quality of the v.a. Employees. This is data that supports that premise, that the v.a. Hospitals are actually, they score generally above hospitals in the private sector.
▶ 1:32:15I Sen. Moran: The fourth year in a row the v.a. Facilities have outperformed on v.a. Facilities. So that is the good news. Now, my concern is, slightly different than my colleague senator duckworth but, yes, direct care is now twice community care but that is changing rapidly. I have a chart.
▶ 1:32:44I Sen. Moran: The orange line at the bottom are patients. Patients in the v.a. The blue line is v.a. Health care. This is community care and this is percentage increase year-by-year. Community care really started in 2021 so of course you will see, but you see the rate of increase is a lot different. That is what concerns me about a subtle, perhaps not-so-subtle move towards community care.
▶ 1:33:14I Sen. Moran: Here is the other thing that is bothering me. In 2025, 35,000 vha employees including about 1000 doctors, 4500 nurses, this is -- if the data is wrong -- >> I will explain -- >> in fy 26 we have another 15,000 vha employees lost. Including 500 doctors.
▶ 1:33:41I Sen. Moran: What bothers me is, if you put these breadcrumbs together, it looks like you are reducing support on the v.a. Side and drastically increasing as a percentage on the non-v.a. Side. Right now, it is about double but that is changing rapidly.
▶ 1:34:00I Sen. Moran: In fact, in the 28 forward budget you submitted, there is a $17 billion increase for community care and a zero increase for v.a. Care. I think there is a slight increase but adjusted for inflation it is really a decrease. You put those things together, and I think -- I see a trend towards what looks like an abandonment, or a severe diminution of the role of v.a.
▶ 1:34:32I Sen. Moran: Direct care. . This is something we need to discuss. For the record, point blank, can you tell me there is no intention to gradually privatize v.a. Health care coverage?
▶ 1:34:43Sec. Collins: There is no intention to gradually, or accelerate or decelerate or no intention to privatize it all. >> can you tell me about the numbers? You cut 40,000 people out of the v.a. Health system, including over 1500 doctors and 4500 nurses and you see the trendline of the money that you are allocating. Somebody is predicting next year you will need $17 billion more for community care and no more for v.a. Care.
▶ 1:35:15Sec. Collins: That indicates to me you are expecting community care to gobble up the remainder, the lion's share of eventually of the v.a. Health care -- >> I will answer quickly because I want you to hear from richard on the numbers. The part of the numbers as far as employees, I have to go back to this, in numbers of employees, that is 90 will success at the v.a. Number of people does not equal success. They do not waste time.
▶ 1:35:44Sec. Collins: We are not moving with back there is an indicator of something that is happening -- >> it is an indicator of bad management for the past two years. That is what they are indicating. The numbers especially, by the way, we have people believe every day for no reason. Just like everybody else -- >> do you replace them? >> yes. >> every -- >> we are hiring every day.
▶ 1:36:12Sec. Collins: We have remodeled our entire hiring process which was less than 150 days. We are on the new model we implemented in the last few months he is getting it back into the industry average of 30-45 days. It was taking 145 days. >> I don't want to sit here in the future hearing and not have the press release that says v.a. Hospitals have a higher quality rating than non-v.a. Hospitals because of cuts to v.a.
▶ 1:36:36Sec. Collins: Staff -- >> the same press release takes into account last year when the discussion of the staffing issue is occurring so we are maintaining quality and what we need to do, maintaining a responsibility to community care as we look forward. As far as the numbers go. >> just to be clear we are investing in direct care and community care roughly 2-1 but the exact reason you brought up, the spending you are showing, is one element.
▶ 1:37:06Sec. Collins: That is why we asked what lack it is growing substantially and -- >> it is one element, only purchased care. The administrative and contact costs are come in bold with direct care and national programs. We have asked to break this out to the weekend if you apples to apples and tell you exactly what we are spending on community care and direct care.
▶ 1:37:30Sec. Collins: I can't do that -- >> I derived from your prior reports you were telling you don't include the nuances that you are discussing -- >> the advance request includes community care which is currently co-mingled with other costs. While we are asking is to provide you the transparency and predictability -- >> what is the justification for significant $17 billion increase whatever it includes an community care, whatever is included in the definition and essentially if lap or declining number for direct care?
▶ 1:38:00Sec. Collins: How does that square? >> larger percentage of the smaller number but what we proposed in 28 is all in on the cost of purchased care so we want to show you what it costs, administrative, contracts and purchased care -- >> you are not answering my question. . You increasing community care by $17 billion in direct care by zero.
▶ 1:38:22Sec. Collins: How is that not a direct incentive or indication of a trend toward supporting community care as opposed to, if you aren't increasing direct care expenditures, that will diminish the quality and you will wind up with people not wanting to go to the v.a..
▶ 1:38:40Sec. Collins: Those two numbers -- >> senator, when you look at the numbers on the quality and the increase we increased 145,000 new veterans since the first of the year, increasing those that come through direct care as far as through the primary care provider. This is just a concern that I think -- I'm not delaying your concern, not trying to deny it but when the numbers you look at the richard was talking about some of the direct care costs and co-mingled cost with community care is a hidden cost that is not reflected in these numbers -- >> we will see.
▶ 1:39:11Sec. Collins: >> we will but the bottom line is, I concern myself with one thing only and that is the veteran being taken care of. That is the only metric I look at. >> thank you.
▶ 1:39:23Sen. Moran: Yes. Senator? >> secretary collins I want to thank you on behalf of of every hoosier veteran for prioritizing the new indianapolis medical center and the outpatient center in the v.a. Budget. You visited, you have taken my requests seriously since day one to make this a priority.
▶ 1:39:51Sen. Moran: It is 75 years old and the staff of mountains to take care of our veterans, but the staff and most importantly the veterans deserve modern facilities. I sincerely appreciate you working with me to deliver on that. The v.a. Is taking a new approach in indiana. Replacing the big downtown hospital with a slightly smaller hospital, as well as in outpatient center in the suburbs where most veterans live.
▶ 1:40:20Sen. Moran: How will that better meet veterans needs and be more efficient?
▶ 1:40:24Sec. Collins: The biggest way is focusing on where we can get the veterans and where the veterans are located will stop people are not driving -- faces in 40 years ago where people enjoy driving downtown to get their health care. They want to -- and again I can't separate v.a. Integrated health care system as a whole from the actual integrated health care system of the country. There is no hospital in the world that is not building clinics or walk-in clinics or ambulatory clinics through their own systems.
▶ 1:40:54Sec. Collins: We have to reflect that for our own folks. This is going to give us a better opportunity. We are putting what we call all in funding which means we can fund it up front all the way instead of having the louisville of the world, the aurora, colorado with a 20 year project that costs billions of dollars in overruns. We started this last year with st. Louis and we are looking to do it in indianapolis.
▶ 1:41:21Sec. Collins: One other thing that I think will get the veteran care and help us on cost control is that vha for some reason decided the national building standards weren't good enough. All of a sudden we took national building standards and on top of that we saw this, they laid on top, our own standards and it ran up costs. We are stripping that out so we can get basically better costs.
▶ 1:41:47Sec. Collins: The example I use is my hometown hospital and comparing it to one we just built, $1.6 billion in st. Louis. My hometown build a bigger facility with ers and ors for $800 million in 24 months and it will take us five years. The craziness of how construction goes needs to be addressed. >> can you talk about the advantages of this project becoming a chip in type project?
▶ 1:42:14Sec. Collins: Any project, chip in is one of the greatest tools we can use to advance the direct care system and the hospitals to get better in modernizing facilities. We are getting ready to move into a facility that oklahoma state and the muskogee v.a. Partnered in and they are working hand in glove to cut costs for both and improve care for both.
▶ 1:42:40Sec. Collins: We have seen this in nebraska as well. I would love to see more chip in projects approved because that is putting the community with the providers, making it better for veterans and helping communities by providing expertise the v.a. Has. >> including private contributions under the chip in act, for the medical center in indianapolis, the budget must cover both projects fully funded. .
▶ 1:43:07Sec. Collins: Why is asking for full funding of around important as opposed to incremental funding over several years?
▶ 1:43:19Sec. Collins: This is the way we have built in the v.a. Forever and it will come to appropriations, we will come to the process and say ok, well, what I call it, making sure everybody was happy at christmas. Everybody gets a little bit. For indianapolis, we will give you $200 million. You buy the land and maybe we will give you $200 million to clear it and the next year we will give you $500 million for the next step. By the time you continue to do that over 5-10 years, the costs go from the original $1 billion to $1.6 billion, to $2 billion.
▶ 1:43:50Sec. Collins: Nobody builds that way. We are, the federal government is the only one that builds this way. It is stupid. But we do it all the time because, I will put my -- we all want to bring something home. We are working towards that but construction can't work this way. We have to build it at a single time. I'm not talking like a secretary of the department should, we have to fix the system.
▶ 1:44:19Sec. Collins: It is not functioning for veterans or the taxpayers.
▶ 1:44:22Sen. Banks: Thank you, I yield back.
▶ 1:44:25Sen. Moran: One of the things senator king but I learned from committee staff is that I thought we had done something about salaries, and a cap and we did. The elizabeth dole act provided the department with the authority to waive up to 300, have up to 300 waivers for individuals they are trying to hire. >> can I comment on that, Mr. chairman?
▶ 1:44:52Sen. Moran: Beginning the process -- >> I comment on that? We appreciate anything but that is like having three kids and saying we will give one kid deserved and not let the other 2 -- what was intended for good became a problem in the facilities because for instance, the four of us were anesthesiologists, richard leaves and we have to bring in another anesthesiologist. We are having trouble recruiting.
▶ 1:45:22Sen. Moran: I will pay the new one double what I pay for the three of us. I'm out of here, I will go somewhere else.
▶ 1:45:27Sen. Moran: You have to pay them all the same.
▶ 1:45:29Sec. Collins: That is what it is, this gave us 1.5% of doctors.
▶ 1:45:37Sen. Blumenthal: I have introduced a bill called the honor act that fully removes the physician pay cap. I think that is an appropriate way to go and I hope there will be bipartisan support for it.
▶ 1:45:51Sec. Collins: There are ways to go about this. We are willing to work on this in any way possible. It is something that I appreciate the ranking member, senator king, looking at this but even if we had the top six positions, whatever, because there is a financial cost. I'm not going to lie, there is a financial cost but I think there is a bigger cost if we don't address this long-term like senator king said for how we maintain our system.
▶ 1:46:18Sen. Moran: Senator hassan, I'm sorry, I intruded.
▶ 1:46:23Sen. Hassan: Thank you for the hearings, secretary collins thank you for being here. And I enjoyed your visit to manchester. As you saw during your trip, are 75-year-old facility faces serious challenges and as an example in recent years, failed plumbing has twice led to major flooding at the manchester v.a.
▶ 1:46:46Sen. Hassan: As you know I have been fighting for a new full-service hospital for years, alongside the other members of the congressional delegation and other leaders route the state. We want veterans to get the high level of care senator king referenced with the latest report on how the v.a. Outpaces the civilian sector. New hampshire is the only state in the lower 48 without a full-service va hospital and last week the v.a.
▶ 1:47:14Sen. Hassan: Share the v.a. Share a plan to build a new medical center in the granite state. I'm delighted we finally got the plan we have asked for. It includes many significant upgrades for new hampshire veterans although it doesn't propose what president trump promised and what his executive order laid out, which was to make sure new hampshire got a full-service va hospital and was no longer the only state in the lower 48 without one.
▶ 1:47:43Sen. Hassan: I want to talk with you about the v.a. Proposal for the new facility and how the v.a. Came to select this approach. Can you please describe the proposal for a new facility in new hampshire?
▶ 1:47:56I Sec. Collins: -- I would like richard to answer that.
▶ 1:48:08Mr. Topping: This is near and dear to my heart, that is my father's v.a., my sister received care and I was honored to work on the project. I'm glad the presidents budget honors his commitment. We have proposed a replacement medical center, utility plant, that is a huge issue as well as community living center and other infrastructure. When we looked at utilization and were fireman's at manchester, one thing we looked at is the issue around inpatient beds and services needed.
▶ 1:48:32Mr. Topping: That is the boston hospital market, so there is hot -- high demand for ambulatory care. We have a $1.3 billion facility to serve veterans in the region and that would meet the need that would be demonstrated and his work wired.
▶ 1:48:49Sen. Hassan: I want to be clear, the president eo did not call for this. It said we were to get a full-service hospital and that is what you were supposed to be working on. His campaign promise said the same. If you are differing from the eo because of what you found and you want to discuss that, that is fine but let's be clear and honest about with the executive order said. It said manchester was to get a full-service hospital.
▶ 1:49:19Sen. Hassan: What services will be offered including new services the proposed facility will have that are not currently available at the old facility?
▶ 1:49:25Mr. Topping: It will be a full-service facility. It doesn't have inpatient beds or overnight beds and that is because it is relatively low you position in the area. It is only about 12 million-dollar. In inpatient cost per year for the facility but it would include all of their services.
▶ 1:49:44Sen. Hassan: I think you just explained the difference between the facility you are proposing and what I would consider and I think most people hearing the term would consider a full-service hospital. He was explained why the v.a. Opted for that path.
▶ 1:50:03Sen. Hassan: I want to continue the conversation because I continue to have concerns about any approach that falls short of full-service inpatient hospital and reduces options for veterans to receive that highest quality care.
▶ 1:50:15Sen. Hassan: Part of my concern is that as I understand the plan as I have read it and what you have said about utilization, a reliance on civilian health care system that is facing great stress in new hampshire in no small part because of $2.3 billion in medicaid cuts in the next 10 years.
▶ 1:50:36Sen. Hassan: I have four rural hospitals on the brink of closing, hospitals like littleton and that have, that would be service areas for a number of veterans. I'm concerned that you are not taking the full health care picture in new hampshire into account. And I also want to continue the conversation with you.
▶ 1:51:01Sen. Hassan: What opportunities and addition to our conversation will granite staters have to redo -- review the plan and provide feedback?
▶ 1:51:09Sec. Collins: The biggest thing is we will continue to take the plan we have and communicate with folks in the area and continue the process.
▶ 1:51:26Sen. Hassan: I hope we can develop and drill down on the plan were veterans throughout the state, or rural areas or urban areas, will have a real chance to look at the plan. If the plan moves forward, what is the timeline? When would the v.a. Break ground?
▶ 1:51:34Mr. Topping: Depending on the budget, assuming we have the budget we will begin on the budget in fy 27. I want to go back to choice stressed rural providers. Part of the $200 million investment in community care in your state includes inpatient beds. If we put beds in this facility, veterans would no longer have a choice.
▶ 1:51:57Mr. Topping: They would need to meet standards to access health care outside v.a.'s a part of this was balancing veterans needs and how to meet those and taking into account the local infrastructure.
▶ 1:52:10Sen. Hassan: I understand that, there are people in my state, veterans who like the community care and don't want to lose it. That is something we can address. I think it is important that you are investing in inpatient beds in new hampshire but there is a real possibility that there won't be facilities for you to invest in, in places you need them to be because of these medicaid cuts that are devastating our state. How will the v.a.
▶ 1:52:36Sen. Hassan: Ensure that high quality interim medical care is available for veterans during construction or demolition?
▶ 1:52:46Mr. Topping: So our veterans will have access to both v.a. Facilities, we have the boston v.a. Facility in the region, plus -- >> nobody in new hampshire wants to drive to boston. >> I'm aware of that. At the same time the veterans that currently have choice and access and can choose between v.a. And community providers would be able to continue.
▶ 1:53:13Mr. Topping: We will fund that care as part of the contract and our commitment to rural and urban providers, we have that commitment to veterans.
▶ 1:53:22Sen. Hassan: I yield back and thank you for the indulgence.
▶ 1:53:25Sen. Moran: Senator. >> you have spoken positively about ptsd. I think my microphone is on. Hello?
▶ 1:53:48Sec. Collins: I thought my hearing had gone. >> let's try this one. You have spoken positively about therapy for ptsd including assisted therapies but funding cuts for the research is happening. Veterans are looking into v.a. To move faster in evaluating and supporting therapies showing promising results for veterans who have exhausted traditional treatment options.
▶ 1:54:16Sec. Collins: By legislation, the novel therapeutics act, ensures v.a. Is equipped to deliver emerging therapies to veterans. Can you discuss how the v.a. Is approaching innovative therapies including psychedelic assisted therapies for ptsd and what investments v.a. Is making in research provider trading -- training and access?
▶ 1:54:43Sec. Collins: We have talkedsec.
▶ 1:54:44Collins: About this before, I have been outspoken saying if it helps a veteran, we will do it. This is a combined effort between hhs and fda and cms has to be part of it, plus us. We are developing the standards on how we will be implementing this. The budget, that will facilitate that. The big issues we have right now is making sure we have proper protocols and rings in place to use these different psychedelic treatments.
▶ 1:55:15Collins: One of which we just started, I think it was this week or this month, we started another mdma treatment at a veteran facility. We are starting ahead of schedule. The big one, and I will be blunt, our next big one will take time to get because that has to come through fda first. We will prepare for that. We will have a federal source for it. We don't have a cost so we look forward to doing that.
▶ 1:55:44Collins: The budget supports anything we need to do to support that. >> I would love a commitment to work in congress on promising innovative therapies and veteran access to treatments because that is usually the gap for those exist. >> that is one thing I want everybody to come into with an open mind and heart. Whether it is private-sector or v.a., the trained physician, these are very clinically intensive treatments.
▶ 1:56:14Collins: Mdma requires almost 120 hours per patient with two psychiatrists. We are working to work up to speed and research, I have committed to doing that right now for us. >> on the other end you have less therapy, it stays on the other end because with good mdma therapy -- >> it works beautifully and I agree with the. >> when I asked in january about the v.a.
▶ 1:56:43Collins: Facility I was concerned it wouldn't deliver care. 3000 square-foot facility is set to open next summer and provide great care as you know. Staffing caps put forward by your department puts providers from other v.a. Facilities that are understaffed. I have yet to receive an answer about how this will work. I'm asking again because this is a rural community in arizona waiting for this to open.
▶ 1:57:12Collins: Can you commit to the new yuma facility opening by 2027 and be fully staffed and served rural arizona veterans?
▶ 1:57:21Sec. Collins: Any facility we open will be staffed to facilitate veterans and we will be hiring those who will need to work there. There is that keeps us from hiring doctors to open new facilities. There is unit documents where you know how many people you have and what we don't want is a facility where we know we need more people here, more doctors and that is what we are going to be looking at.
▶ 1:57:51Sec. Collins: >> this makes me feel better because I have been asking about this every time you come through. Someone within your staff, if they could talk about what the plan is, what the staffing plan is because that would be helpful. This area of arizona has been waiting for a long time for this and I think we would really appreciate making it easier to communicate with them that this will be a fully functional facility from day one.
▶ 1:58:19Sec. Collins: I looksec.
▶ 1:58:20Collins: Forward to that end I look forward to seeing you when I'm in arizona. I think your comment, your commitment is my commitment, to rural areas and building. Together so I appreciate your concern.
▶ 1:58:29Sen. Moran: Senator gallego.
▶ 1:58:31Sen. Gallego: --
▶ 1:58:35Sen. Sanders: Thank you Mr. chairman, Mr. secretary. A few questions regarding vermont. We have been on a list for eternity regarding the construction of two see box one in burlington and one in the state, maybe the brattleboro area or new hampshire. I'm told that the clinics will open up in 2029, may 2029.
▶ 1:59:11Sen. Sanders: I suspect you don't have that information in front of you but could you get back to me on that?
▶ 1:59:16Sec. Collins: I will. I know brattleboro is scheduled, we have been working on getting that open by september.
▶ 1:59:23Sen. Sanders: That one has -- >> we are trying your best. >> we are in line for two new seabocs. The bureaucracy has been horrendous. Let's see if we can speeded it up. Is that possible? >>? >> senator I'm willing to get rid of bureaucracy. To help veterans.
▶ 1:59:47Sen. Sanders: Will you get back to me on the status of those? >> we will.
▶ 1:59:54Sen. Sanders: I have long believed that's I think most americans do that dental care is a part of health care, correct?
▶ 2:00:00Sec. Collins: It always has been, yes.
▶ 2:00:03Sen. Sanders: Right now, and I think all of the service organizations, the american legion and the v.a. And the vfw, believe that dental care should be part of v.a. Health care. Right now it is just applies to service-connected folks. Any thoughts about how to move forward and make that part of v.a. Health care?
▶ 2:00:24Sec. Collins: As we look at expansion of services, at the time we expand that, we are going to do what is directed from their. We are using resources we have now under statutory limitations to make it available to as many people as we have. That is a good balance between our direct care and community care in dental. I'm committed to working with you, if it is the will of the congress.
▶ 2:00:50Sen. Sanders: Is that something you would support?
▶ 2:00:52Sec. Collins: I think there is a need. We need to determine what the need is and how we can afford it. There's a balance of giving something and being able to afford it so that is something we have to look at.
▶ 2:01:04Sen. Sanders: There is a real need. I talk to veterans and they will tell you that. Thank you.
▶ 2:01:10Sen. Moran: We will wrap this up with the exception of apparently senator king and senator blumenthal who have something to follow up on.
▶ 2:01:19Sen. King: There has been a lot of talk about see box and facilities. We have a beautiful new one in portland and new ones in small towns. The veterans are very enthusiastic and again, I want to complement, I want to send my compliments and thanks to those wonderful people who are staffing those facilities, including our oldest one in the country, the veterans hospital.
▶ 2:01:47Sec. Collins: We appreciate that. That is something that has been, we opened 35 new ones in the last year and a half and we have more plans.
▶ 2:01:56Sen. King: They are great facilities. Thank you.
▶ 2:01:58Sen. Moran: Senator blumenthal?
▶ 2:02:01Said -- Sen. Blumenthal: Just a few more questions. Talking about local facilities, the westhaven facility, it is under construction. Is the timeline meeting the projections as to when it will be done?
▶ 2:02:20Sec. Collins: As far eyessec.
▶ 2:02:21Collins: -- as I know, it is but -- >> if you could get back to me about the details. It is an important facility to all of connecticut. I would appreciate more information. We worked very hard for many years to make it possible. I appreciate your cooperation. I want to talk about national cemetery administration staffing as we go into memorial day.
▶ 2:02:52Collins: A lot of folks will be out at cemeteries celebrating the service of the fallen. And my understanding is that the fy 27 budget request calls for 2305 full-time equivalents at the national cemetery, slightly less than previous years. Again, we can compare numbers.
▶ 2:03:20Collins: Despite the continued growth at v.a. National cemeteries across the country at the same time, most recent v.a. Work force dashboard reports 2094 full-time on board at the national cemetery administration. My calculation is that the national cemetery administration is missing about 10% of the work force congress funded.
▶ 2:03:49Collins: I hope I'm wrong but that is what we have seen. Assistant secretary angle bomb briefed the committee that an additional 130 cemetery caretaker vacancies were cut. My question to you is will you work with undersecretary brown to make sure he has the resources to be at full staffing at the national cemetery administration?
▶ 2:04:17Collins: I admire undersecretary brown for the service he provides for this nation in a critical area. We are saying depth. I think it deserves that, for all of the families who are going to be commemorating, not celebrating but commemorating memorial day, our national cemeteries, including our cemetery in connecticut, is very much a concern.
▶ 2:04:45Sec. Collins: Senator, we have the same concern. We are working with, there were issues that developed over the previous few years in the budget dealing with nca. Now that we have consolidated management, we are looking at that. I can't just say, if you don't mind, I want to say something. Sam, I agree with you.
▶ 2:05:10Sec. Collins: I don't think there could be a better fit the role than a man who has the heart sam brown does. As we go forward and looking forward to working with him. For margarita devlin, who is running the v.a. Chamoli look at how we do disability payments and timelines, the challenges they faced, to overcome things has been incredible. I want to point them out.
▶ 2:05:37Sec. Collins: John running vha and people who are dedicated to doing that and I appreciate your concern on the nc a side as well.
▶ 2:05:47Sen. Blumenthal: I hope to get more numbers about the appeals process. I want to clarify the information I have is that the request for 2026 anticipated 92,000 appeals and the actual number has proved to be much higher.
▶ 2:06:11Sec. Collins: I look forward to -- the board issue is one that frankly, you deal with the problems we face trying to get everything squared away, the board has been one we have been dealing with and saying how do we fix it because there is lots of discussion. I know I'm work -- willing to work with your staff to get you the information to determine which slot they are getting in for builds. It is something I look at every week.
▶ 2:06:38Sen. Blumenthal: You committed I think at some point, or we asked for a comprehensive list of canceled contracts. Including contracts for veterans services like mental health, radiology, research, patient safety, infrastructure. You provided a list of 620 contracts in march. It seemed to be complete. Without going into the details here, I would like your commitment to provide those additional contracts.
▶ 2:07:08Sec. Collins: If you can point me to the contracts you feel like you are missing, we would be happy to. My direction was to release everything we have so if you have something you think you are missing, let us know.
▶ 2:07:24Sen. Blumenthal: I want to ask about a very important veterans housing program. In may 2020 five, without any consultation or oversight, you ended the veterans affairs servicing purchase program. Which was kind of a last resort tool for a lot of veterans to prevent foreclosure. There was no program in place to provide that same service.
▶ 2:07:52Sen. Blumenthal: As you know about this program, it steps in to situations where a veteran is about to lose their home. Unfortunately, the v.a. Is taking longer than expected to implement the partial, the bipartisan partial claim program. Recent data indicates that more than 15,000 veterans lost their homes since it was ended.
▶ 2:08:25Sen. Blumenthal: Another 90,000 veterans are at risk of losing their homes because they are in the process either of foreclosure or eviction. Will you commit to work with us, helping veterans who have lost their homes, especially those eligible for the partial claim programs, to stay in their homes?
▶ 2:08:46Sec. Collins: First and foremost, this is something the v.a. Never should have been in and it was, they came up with that in the previous administration. It was causing issues with backlog of assets and we had no idea how to deal with it. We are not in the real estate business. On the advice of congress including the chairman in the house and other people, we got out of the program we never should have been indented to start with.
▶ 2:09:13Sec. Collins: >> I was never asked about it -- >> I appreciate that, senator. But there was no consultation when they were starting it. That is the problem we have sometimes at the v.a. Is there should be better communication. From disagreement on partial claims. We were told we would have that with 9-12 months. It will be in place by june 15, ahead of schedule that we promised this body we would do. The v.a. Is about putting people in homes.
▶ 2:09:44Sec. Collins: We don't take people out of homes. Those are mortgage bankers. We don't take anybody out of homes -- >> I understand -- >> I appreciate your concern, we have concerns but people making payments, they have to make payments on houses many of which they are dealing with but we offer loss mitigation, forbearance, repayment plans, loan modifications, service incentives, well before the time the foreclosure occurs.
▶ 2:10:13Sec. Collins: We do everything we can to keep them from that. If the mortgage company decides to foreclose, it's not because we haven't done everything we can. This is a program that should not have been started the way it was and was adding liability areas we should never have been in. I want to work with you to find out a solution. I think partial times does that. We are doing it ahead of schedule and hopefully we will help those in need.
▶ 2:10:41Sen. Blumenthal: I take from what you just said that partial claim program will be in place, operating this coming month, correct? >> that is the indication I have gotten, june 15 ahead of schedule. >> that is a commitment. It will hold you to it. >> no problem. >> let me ask about v.a. Research.
▶ 2:11:09Sen. Blumenthal: Why are you asking us to cut $20 million from the research budget?
▶ 2:11:13Sec. Collins: Richard is here to discuss those issues in the budget.
▶ 2:11:16Mr. Topping: As you know the budget ask is $2.4 billion in budget authority, $979 million in direct funding for research projects. Last year at the house appropriations budget hearing, the secretary was pushed on $550 million in known waste in the program. As you know we have struggled to have control over that part of the portfolio. We funded breakthroughs that have benefited veterans and funded things like animal research.
▶ 2:11:46Mr. Topping: After we said we weren't doing it, you passed a law telling us to get hold of it. Last year legislation was proposed that would have us track research, spending and outcomes. 4300 77 research projects are being tracked. We can tell you where we are at and the outcomes. Seven thousand overall research we are supporting. The budget request supports that, is responsive to your demands.
▶ 2:12:16Mr. Topping: Budget request is there.
▶ 2:12:21Sen. Blumenthal: I don't understand what you just said to me. You are doing great work and now you're cutting it. I know you just gave me a lot of numbers. But why? The v.a. Has been a world leader in research. Why are you cutting it?
▶ 2:12:40Mr. Topping: We haven't we are accountable for the funding you give us in the research we are managing and the outcomes. We have done that at the budget west reflects that. It is $43 million difference of 1.5% -- >> you are saying people aren't asking you for research projects? >> we are saying the projects -- the president budget is, that is a request.
▶ 2:13:07Mr. Topping: >> I am kind of aghast because you have skilled, experienced, dedicated scientists, researchers, medical experts asking for money to in effect, advance medicine that applies not only to veterans by the way, but as you know, the v.a.
▶ 2:13:29Mr. Topping: Has provided an enormously important groundbreaking advances in medicine that benefited many people outside the veterans community. >> senator, there is no change in our research portfolio. We are accountable for the program. Our budget request reflects that. >> we can continue this conversation at an earlier time. In the day. On another day.
▶ 2:13:58Mr. Topping: I have one last, I will say this is a friendly suggestion but since you raised the topic, I'm going to follow up. Travel. I have no doubt you have traveled. He referenced my traveling. I have never been invited to travel with you.
▶ 2:14:24Mr. Topping: I have visited a lot of states where you haven't invited any of my colleagues. To be with you. As far as I am told. Arizona, wisconsin, colorado, pennsylvania, north dakota, I'm sorry, new york. Republicans have been invited. But no democrats.
▶ 2:14:52Mr. Topping: I would like to make this part of the record, Mr. chairman. A post from your account and members of congress reflecting your visits. Not saying we have a scientific study here, but just, if you are going to talk about traveling, and you visit states, I would respectfully suggest, friendly suggestion, you invite democrats as well as republicans.
▶ 2:15:23Sec. Collins: I was in colorado
▶ 2:15:24Withsec. Collins: Democrats. I have been with senator hassan. You can go to your own facilities in your own state.
▶ 2:15:30Sen. Blumenthal: I go all the time. >> not since january last year. >> I'm sorry? >> january last year. We have no record. >> you may not have a record of every visit I have made to a facility. >> I understand, we are good. We will go wherever we need to go but I am out there with, I don't understand what employees are saying, I'm not going to accept the premise of that question because this is all I do. >> thank you, Mr. chairman.
▶ 2:16:03Sen. Moran: On contract consolations, Mr. secretary, the v.a. Has not yet briefed us. There was a bipartisan ask on this. Am I missing something? My staff says that hasn't occurred.
▶ 2:16:18Sec. Collins: Maybe you said something I didn't understand, contract cancellations?
▶ 2:16:24Sen. Moran: U.n. Senator gallego -- >> we were in the house together. Before you left us we went to the house. We don't hear as much anymore -- >> senator blumenthal raised the topic of contract cancellations and there is a bipartisan request for us, which I'm told hasn't yet happened. >> I believe we have provided that.
▶ 2:16:46Sen. Moran: We provided the review of 76,000 contracts and identified contracts we terminated and 842 we didn't exercise options on. We provided the total and the $5 billion in cost avoidance. 1565 contracts I believe we provided. >> let me see what folks behind we have to say.
▶ 2:17:20Sen. Moran: >> you are working to schedule a meeting with the staff -- >> you one more -- you want to have a meeting? We are good. That is great. We give you the information. We will have that. >> I think it is in the works. >> appreciate it.
▶ 2:17:40Sen. Moran: My script says if there is no more questions and I will say there are no more questions, thank you for your presence today. Senators who would like to submit additional questions or statements for the record from today's hearing for today's witness have one week to do so. Ask witnesses to respond. Any questions for the record received following today's hearing in a timely manner of the hearing is adjourned.