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Floor Speech

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Mr. SANDERS. Mr. President, I rise today in strong support of the PACT legislation that we are now considering.

As a former chair and longtime member of the Senate Veterans' Committee, one of my highest priorities is to make certain that every veteran in this country, people who have put their lives on the line to defend us, get the quality healthcare and benefits that they have deserved.

This is an important piece of legislation, and I want to congratulate Senator Tester, chair of the committee, and Ranking Member Moran for their hard work on this. This legislation will improve healthcare, research, and resources for veterans who were exposed to deadly toxic substances and environmental hazards, including open-air burn pits, during their military service. This legislation will finally recognize and treat toxic exposure as a cost of war for the millions of veterans Congress has ignored for far too long. And we do that by adding 23 burn pit and toxic exposure-related conditions to the VA's list of service presumptions. This will mean that some 3.5 million veterans will now be eligible for VA healthcare, and that is very, very important.

It goes without saying that in the wealthiest country on Earth, where we spend more on defense than the next 11 nations combined, no veteran should be without the healthcare that they are, in my view, entitled to. I understand there is not the political support for this in Congress right now, but I happen to believe that in a world in which nation after nation guarantees healthcare to all of their people as a right--in fact, we are the only major country on Earth not to do that-- that the very least we could do is to make certain that every man and woman who has put the uniform of the United States of America on, put their lives on the line, are, in fact, entitled to healthcare because they served our country. That is my view. This bill does not do that, but this bill does at least enroll 3.5 million more people for VA healthcare, and it is a step forward.

In terms of this bill, clearly, it is unacceptable that we have exposed our military members to toxic burn pits and other dangerous substances on the battlefield. For decades, the Pentagon has utilized open-air burn pits to dispose of a wide variety of waste, including medical, human, and hazardous waste.

Way back in 2009, when he led the U.S. Central Command, GEN David Petraeus sounded the alarm ``about the effects of burn pits and airborne toxins on our servicemembers and civilians.'' Despite those concerns, DOD continued to expose U.S. forces to burn pits, leaving the VA with the responsibility of dealing with the consequences of these dangerous and deadly actions.

So the bottom line is, I am deeply supportive of this legislation. It is a step forward. But we can significantly improve this bill, and that is why I have introduced four amendments to this important bill that I hope will be supported by the Senate.

First, this first amendment that I have offered will expand permanent access to VA healthcare to members of the National Guard and Reserve who are not otherwise eligible. Right now, National Guard men and women who are activated on Presidential orders are eligible for VA healthcare, and that is good, but that turns out to be only a very small percentage of people who are in the National Guard and Reserve. And I happen to believe that if you are in the National Guard or Reserve and you could be called up at any moment to put your life on the line, I think you should be entitled to VA healthcare. And that is what that amendment does.

The second amendment deals with--what can I say--a pathetic and laughable bureaucratic nightmare that currently exists in the VA. And Rube Goldberg would have a hard time coming up with a system like this. This is really quite amazing. And that is, within the VA bureaucracy, which is itself difficult to overcome for many veterans, you have a system which now has over 3,000 income eligibility standards based on ZIP Codes.

So a veteran out there watching this says: You know, I would like to apply for VA healthcare. I served my country honorably. How do I do it?

Well, it turns out that, depending on your income and depending on the ZIP Code that you live in, you may or may not be eligible for VA healthcare. So, in other words, in Vermont you can have one veteran with an income of X living across the street from another veteran who has an income of Y, $3,000 more or less. One veteran will be eligible for VA healthcare; another will not. In a large State like California, you have literally hundreds of different income eligibility standards that veterans are going to have to overcome.

So if people go to a service officer in the VFW or the American Legion and ask: Am I eligible, it takes a lot of research to determine whether you are eligible. Look at the eligibility standards for San Francisco versus Los Angeles, for example. There are many, many thousands of dollars in differential. So you could be eligible in San Francisco--rather, eligible in Los Angeles and not in San Francisco. It really makes no sense. It is a nightmare.

This amendment simplifies it. It simply says that every State in the country takes the highest level of income eligibility and that is the standard. So you will have 50 standards rather than 3,000 standards, and I think that will make it a lot easier for veterans to access VA healthcare.

My third amendment is a pretty simple one. It says that the VA should maintain a dental clinic in every State in the country to provide necessary dental services for veterans. Right now, there are very few States that do not have at least one dental clinic. My own State of Vermont is one of those States, and I think every State should have that.

My fourth amendment again deals with the issue of dental care. One of the many, many crises facing the American dysfunctional healthcare system is that, by and large, we do not recognize dental care as being healthcare, and the result of that in the general public is there are many, many, many millions of people who cannot afford the outrageously high cost of dental care. These are people, including many seniors, who literally lose all of the teeth in their mouth; they can't chew their food properly. For younger people, they can't go out and get a job successfully because if you open your mouth and you don't have any teeth in it, it is kind of hard to get hired under those conditions.

Currently, out of the 8.9 million veterans enrolled in VA healthcare, only 16 percent--or 1.4 million veterans--are eligible for dental care, and that is because, within the VA, almost the only people eligible for dental care are those with service-connected problems. In other words, if you have a service-connected issue with your mouth, with your teeth, you are eligible for VA healthcare, but if you don't, if you are simply a veteran whose teeth are rotting in his or her mouth, sorry, you are not eligible.

And the limitations of that approach are not only that dental care should be considered as healthcare in general; if somebody is suffering with poor dental care, we should take care of that person because it is healthcare. But there is no question that dental problems, oral problems--infections, et cetera--have an impact on our overall health.

According to the VA, there are roughly 3.9 million veterans who have chronic diabetes and heart disease who are enrolled in the VA--3.9 million. Most of the veterans diagnosed with diabetes were exposed to Agent Orange during their service in the Vietnam war. Furthermore, the overwhelming healthcare consensus is that poor oral health worsens the symptoms of diabetes and heart disease. So what that means in English is that you have veterans out there who are struggling with diabetes, struggling with heart disease, and their problem is exacerbated by poor dental health, poor oral health; and yet they can't get the dental care they need, which not only should be an end in itself, but it also impacts their overall health.

So, without going into great detail, I would say that providing dental care to veterans not only eases pain, not only addresses overall healthcare concerns, but it ends up being a very cost effective approach. In a 2019 report to Congress on the cost of expanding dental care--something that I asked for--the VA stated--and I quote:

. . . the provision of dental services could result in some reduction in total health care costs.

Neglecting oral health can contribute to health problems including bacterial pneumonia, cardiovascular disease, and oral cancer.

In other words, when you treat oral problems, you are treating overall health issues; and you can keep people healthier and not have to expend a whole lot of money dealing with the health problems of those veterans.

During a VA briefing earlier this month, the VA's office of dentistry stated unequivocally that ``dental care is essential to overall health care'' while simultaneously advocating to maintain VA's dental eligibility status quo.

The bottom line is that it is not complicated; dental care is healthcare. By ignoring dental care, we cause other healthcare problems and we increase expenses to the VA.

So those are the four amendments, and I hope the Senate will give them serious consideration.

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