Veterans Cemetery Benefit Correction Act

Floor Speech

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Mr. MORAN. Madam President, many of us this afternoon had the opportunity to see a screening of the HBO documentary ``For Whom the Bell Tolls,'' a tribute to Senator McCain. It is clearly a tribute, but it is also the story of his life and an expose of his sacrifice for his country. It is a moving story of Senator McCain's life and an inspiration to me and, I assume, to my colleagues for the commitment that he has made to always try to do right--putting his country above self.

I have had the honor of working with Senator McCain for the last several years in regard to legislation trying to improve the circumstances that our Nation's veterans face as they access healthcare within the Department of Veterans Affairs.

Senator McCain and I introduced legislation to accomplish a number of things related to this, particularly the Veterans Choice Program. Choice was passed back about 2014, at a time in which the VA was in a crisis and a time in which the veterans they were created to serve were harmed by decisions made at the Department of Veterans Affairs. The problems were highlighted in Senator McCain's home city of Phoenix at the Phoenix VA, in which a number of veterans may have died as a result of the inability to access healthcare in a timely fashion.

The solution to the problems exhibited in other places across the country--which included false waiting lists, in which the VA had determined a list that was not real but demonstrated that veterans who had no idea they had an appointment to see someone at the VA had an appointment, to camouflage the failures and the slowness of the Department of Veterans Affairs--resulted in a unanimous decision by the Senate to create a program called Choice.

Choice creates the opportunity for a veteran, under certain circumstances, to access healthcare in their home community at the veteran's discretion. This program, in my view, has significant potential to alter the opportunities that a veteran has to be cared for.

Those who served our country deserve the very best, and we want to make certain that happens both inside the VA and with a program that allows veterans to choose healthcare outside the Department of Veterans Affairs.

The Veterans Choice Program has expired since 2014. We have reauthorized it in a number of instances. I think three, perhaps four times. It needed funding, and we reauthorized the funding. Choice was a limited program in which for the veteran to qualify to receive Choice care in the community at their discretion and at their option was determined by whether or not that veteran lived within 40 miles of a VA facility or whether the VA could provide the services within 30 days of the time the veteran needed that care.

The committee here in the Senate has worked for a long time trying to reauthorize the Veterans Choice Program. It has been my position, with Senator McCain, that just to reauthorize Choice would be a significant error on our part and that in the authorization process, we should make community care work better for veterans.

I judge whether or not the VA is providing the care and services that our veterans need by what you would call casework--what we do on behalf of our constituents who have a challenge or a problem with a Federal agency or department. Our casework regarding veterans who are attempting to access care in the community has been exponential.

I checked the other day. At the moment, we have 80 cases for veterans in Kansas--not all related to this particular program but 80 veterans who contacted me and my staff and said: I need your help. Since I have been a Senator, that number is 2,650 veterans who have contacted me or my staff saying: I need your help. So when it came time for the Senate Veterans' Affairs Committee to begin the legislative process of determining how to alter the program, how to reform it, and, particularly, how to extend the program, I wanted to make certain that my input was based upon what veterans were telling me about how the program did and didn't work.

Our committee passed a bill out of the Veterans' Affairs Committee months ago. That bill was passed by our committee on a vote of 14 to 1. I was the one opponent. I say that for my colleagues today--some of whom have asked my view, some of whom I hope were interested in my view, and even those who may not care. I want them to know that the bill now in front of the Senate--and the majority leader just filed the proceedings for us to have a cloture vote next week on this legislation--is legislation I support. It does do something more than just extend Choice. It creates opportunities for that program to work much better. Most importantly to me was the issue of who decides whether or not a veteran has the option of choosing community care.

The legislation that we will consider next week allows for the Department of Veterans Affairs--in a sense, the Secretary of the Department of Veterans Affairs--to remain the gatekeeper. The VA has the opportunity to make the decision about who gets to have community care, but different than today, when the only criteria is 40 miles or 30 days. We create access standards in this legislation that the VA must abide by in determining whether or not a veteran can have care in the community, and that is a significant difference.

We had all kinds of challenges with the 40 miles and 30 days. We changed the definition of what a facility was in order to get the VA to allow individuals to have access to care at home. People may recall that the VA wanted to count the 40 miles as the crow flies. In addition to other challenges that the VA put in front of veterans, we have eliminated those and created a standard by which the VA must abide. So while the gatekeeper remains the Department of Veterans Affairs, it is not in the total discretion of the Department of Veterans Affairs. They must abide by criteria, and if the veteran believes he or she is denied care in the community, that veteran has the opportunity to appeal based upon a number of standards, including best medical interest of the veteran.

We are changing a program in which the VA made decisions that often denied veterans the access to care in their community that veteran asked for, and we are saying: You now asked the VA for permission. The VA has to make a decision to grant or deny that permission, but they can't do it solely at the discretion of the Secretary of Veterans Affairs. They must abide by criteria. That is a significant improvement.

Secondly, if you feel like you have received the wrong decision, you can appeal that decision.

Today--and we have plenty of examples of this in Kansas--when a veteran is denied community care by the Department of Veterans Affairs, their only appeal is to their Senator or their Member of Congress, in which we then have a new case to once again try to work our way through the Department of Veterans Affairs: Why did you deny this veteran his or her choice to have community care?

This bill is a significant improvement. It satisfies the concerns I had; my view that early on, we were mostly just trying to extend Choice as it was--as it is, and now this replaces it with really a circumstance in which veterans have rights, have standards the Department of Veterans Affairs must comply with.

In addition to the issues of who can access care, who is the gatekeeper, and determining the standards, this bill merges and modernizes all community care programs and puts them all in one category at the Department of Veterans Affairs instead of multiple programs. It simplifies it.

We have had too many instances in which, if you didn't access care under one program, you might be able to apply for another. This changes the circumstances that so many of my veterans have complained to me about, in which they get an authorization from the Department of Veterans Affairs, and they are allowed to see a physician in their home community, but then when they need lab work or an x ray--something that should be related to that visit--they have to go back to the Department of Veterans Affairs to get additional consent. This is more in the line of necessary procedures that should follow: one authorization that includes the things that are medically necessary for that appointment with the physician or that admission to a hospital. It just makes sense that these other things would be necessary if that physician whom the VA referred you to believes them to be necessary. It establishes a framework for the VA to build a high-performing healthcare network, and it implements new coordination so the veteran and the VA work together to determine what is in the best interest of that veteran.

It is something I have cared about a lot. We required that in the original Choice Act; that the healthcare provider be paid Medicare rates. Those of us who come from rural States recognize there are various rates under Medicare, and for our smallest hospitals, they are entitled to cost-based reimbursement. That is not happening under the current legislation, the law today. This legislation corrects the problem, keeping the circumstance more likely in which our hospitals and doctors would be financially able to see a veteran and provide that care.

This is not privatizing the VA. The VA serves a valuable and useful role. Many veterans choose to have care at the Department of Veterans Affairs, at their hospitals, and at their clinics. Again, it is the veterans' choice where he or she wants to go.

For those of us who come from rural places, the distances in which a veteran must travel, in many instances, have eliminated the ability for that veteran to ever access care from the VA. The VA has programs that are important to veterans--traumatic brain injury, amputation, things that may not ever be as available or as desirable in the community.

This legislation is supported by every veterans service organization I know of. We have come to the point in which it is time for us to pass this legislation. Memorial Day is approaching. The President has asked this legislation be approved prior to Memorial Day. We think it is appropriate to honor those who served our country at this point in May, where Memorial Day is around the corner, to provide the care they are asking for.

The other aspect of why it is important for us to move on the legislation now is that the funding for Choice and community care has diminished. I serve on the Appropriations Committee that funds the Department of Veterans Affairs, and it is necessary for us to get the money in place. The VA is already rationing care for those veterans who use Choice today, and this legislation puts the necessary dollars in place for Choice to continue in its new reformed and improved status.

It would be a shame for us to miss this opportunity. It would be wrong for our veterans. It would diminish the number of people who access care at the Department of Veterans Affairs and do so at a time in which the needs are great for those who have served our Nation.

Again, referring to my colleague from Arizona, Senator McCain, we would honor him if we answer this call to do our duty to see that our veterans are cared for, that promises are kept.

I appreciate the response that was given when the bill was suggested to be named in honor of Senator McCain. Both the House chairman and the House committee, along with Senator Isakson, the chairman here, and Senator Tester, the ranking member, have agreed to do that. This legislation is now known as the McCain Mission Act. Our colleague, for whom there are so many reasons to pay honor and tribute to, would receive another honor for his service to our Nation but of equal importance, his service to other veterans.

For so many reasons, it is time for us to act, to pass the McCain Mission Act, and do so with the promptness that has followed long deliberations to try to get it right.

In my view, too often the U.S. Senate, the Congress, politics, and government, in general, just put a bandaid on to get by. This legislation is significantly different than doing something to get by. It would improve the quality of life for those who serve our Nation. We should honor them, as we honor Senator McCain, prior to Memorial Day, at the end of next week.

I thank you for the opportunity to address the Senate.

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