Hearings to examine the President's proposed budget request for fiscal year 2027 and 2028 advance appropriations requests for the Department of Veterans Affairs.

The hearing will come to order. Good afternoon and welcome to our witnesses as we discuss the Department of Veterans Affairs request for fiscal year 2027 and the advance appropriations for fiscal year 2028. This budget request reflects record investments— this budget, uh, requests record investments in the department, while at the same time Secretary Collins is also leading a reorganization of the Veterans Health Administration, a new contract for the Veterans Community Care Program, and faster decisions on disability compensation claims. Today I'd like to hear how this budget request will support those and and our other efforts that are at VA to improve the delivery of care and benefits for veterans and their families. This committee and Congress as a whole has repeatedly demonstrated its strong bipartisan support for providing the VA with all the resources it needs to deliver on its mission to care for those who borne the battle.

We've also demonstrated strong bipartisan support for oversight of the department, its programs, and its budget. The VA must continue working in partnership with this committee. With the ranking member, with me, and toward— with all of our members toward our shared goals of making certain we both continue supporting veterans to achieve success after their military service. VA's success relies on an empowered and motivated workforce. I know that VA employees are some of the brightest and most dedicated public servants, and I hope to hear today how the VA's budget request will bolster the workforce and overcome some of the hiring challenges that many sectors in our country are facing.

For decades, the VA has relied upon providers outside of its own healthcare system to meet the needs of veteran patients. We finally consolidated the patchwork of 7 different community care programs when we passed the MISSION Act in 2018. Mr. Secretary, under your leadership, the VA is now 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 and make navigating both types of care more seamless for the veteran who uses them.

I also want to make certain that any new budgeting for medical care, such as consolidation of accounts into direct care and community care for FY28, does not diminish the clarity and transparency in VA's future budget requests. Thank you for being here to testify on behalf of your FY27 budget request. I think this is your third appearance before this committee, and I look forward to having the discussion that we are going to have today. I now recognize the ranking member of this committee, Senator Blumenthal, my friend, for his opening statement. Thank you, Mr. Chairman.

I, uh, I appreciate your leadership on this committee and our bipartisan approach to the work of our committee. In fact, as a result of bipartisan work across.

Across multiple administrations and building on the historic achievements like the PAC Act, more veterans are receiving more healthcare and benefits than ever before. That's a good thing. Ensuring veterans and their families receive the care and benefits they deserve is a moral mandate. Part of the cost 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's continuing. And service members, about 400, have been injured, as well as the 14 tragically killed there. They will come home.

Of 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. The chairman and I, I think, are working together very cooperatively on it, and I think we are approaching a solution, but I was heartened to hear the Secretary of Defense in his testimony just about a week or so ago, sitting where you are, say that he supports the Major Richard Starr Act. And I hope that is the administration's position and that we will do it, literally do it, uh, even possibly before the Fourth of July. And we're here today because we need a VA capable of delivering on the moral mandate, not only the Major Richard Starr Act, fairness to our veterans so that they are not docked dollar for dollar in their retirement pay for what they receive on disability benefits, but also more broadly, healthcare, job training, all of what we promise.

We do promise them, and a great nation keeps its promises, and Most especially, we need to keep our promises to veterans. There's broad agreement, Secretary Collins, on many of the items in your $488 billion budget request. For example, the proposed $2 billion increase in construction projects is needed to improve the VA's aging infrastructure. I welcome the department's commitment to advancing the electronic health record modernization. I'm concerned that the department's continued insistence on pushing more veterans into community care at the expense of VA direct care may jeopardize the quality of both.

And more than $8 billion of the $10.9 billion increase for healthcare services in FY '27 is for community care. The difference is even more significant in the department's FY28 advance request, with the VA asking for a $17 billion increase in community care and near stagnant levels for direct care. Veterans depend on our VA facilities for the gold standard healthcare they need and deserve. And the potential shortchanging of those facilities and the 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 healthcare at VA facilities, and yet the funding request for direct care fails to keep pace with inflation.

As we all know, a failure to properly fund and staff VA healthcare facilities will force veterans into community care, into that system rather than the VA facilities, and that's— means that they may be ill-equipped to care for the unique needs of veterans It may be more costly. It may be less desirable. The budget request also curtails VA's world-class medical research program with a $23 million budget cut, including cuts in, quote, administrative priority areas, end quote, like suicide prevention, oncology, and brain health. I just want to say the VA over its entire history has pioneered and championed certain kinds of healthcare. It's 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.

Prevention. Now, on the benefit side, the department plans to continue its expansion of automation 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. In fact, the Office of Inspector General recently found that nearly all of the 8,100 automated decisions for service-connected death claims it audited, quote, contained at least one legal or procedural deficiency. I think that finding of the Office of Attorney General is very telling.

Deficiencies and errors are a common trend in VA's recent push to reduce the claims backlog. And I want to focus for a moment on this very important area. VA's own data indicates it has increased claims production.

It's producing results faster, but it's denying more claims, and the effect is to increase more— increase the number of appeals. So it's a little bit like— we 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's what an appeal means. 77% Increase in appeals and 11% increase in denials. Why are more veterans being denied in those claims and then having to appeal and clog the VA appeals system.

The Board of Veterans' Appeals also reports a 21% increase in an expected number of appeals this fiscal year. That's one-fifth more, and it is more costly to have appeals and have to go through that additional process. And it creates more anxiety and pain for the veteran who's 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's no way to square the two. 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.

For instance, it cuts the staff at the Office of Inspector General by 143 below FY 2025 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.

Thanks, Mr. Chairman.

Senator Blumenthal, thank you. We are joined today by the Honorable Douglas Collins, the Secretary of the Department of Veterans Affairs, and he's with He is accompanied today by the Honorable Richard Topping. We welcome you both. And, Secretary, you're recognized for your testimony.

Mr. Chairman, thank you. And Ranking Member, it's good to be with you both again today. I think there's a lot of things I appreciate, the comments both so far from both the Chairman and Ranking Member. I think there's a lot of discussion, especially from the Ranking Member. There's a lot of things we're going to discuss today in dealing with exactly what you talked about, but also dealing with it from the facts and numbers that we have that are actually showing an increase in not only efficiency, but also an increase in accuracy, but also getting things done more clear.

So I'm excited about that. I also am standing, sitting before you the first time as a veteran. Last Saturday was my last day in uniform. My retirement date was the 16th of May. I now stand, sit before you as a veteran of this country and now in a unique position to continue the work that we have started in making the life of veterans better.

There's no doubt in my mind this is what I am called to do at this point, and I think having the veteran perspective in our department makes it a better part, but also working—. Mr. Secretary, thank you for your service. Thank you, and I appreciate all the services that every member gives, and I think it provides the unique perspective of how we.

Serve here. But also, I come here today, as I shared a couple of weeks ago with the Senate Appropriations Committee, I come— it's almost as at that point as a tale of two cities, a tale of two departments, the one that I inherited and the one we have now. And I think as we look at this in going forward today, there's going to be a clear understanding that when we came forth and I set forth in this body and said that the veteran will come first at the VA, it was more than a statement, it was more than a slogan. It was really the focus on how we do everything that we do. We can disagree on possibly ways to get there, but at the end of the day, it's always going to be about what is best for the veteran.

The veteran is the mission and the mission is the veteran. That's all we do. And so if it's a choice between a, a structural issue at the VA and helping a veteran, the veteran's, uh, needs are going to win out in that, because I believe this committee and all committees expect results for every dollar appropriated, and the budget is built around those expectations. When we look at this, the conditions that are coming before you today, and I'm looking forward to talking to you about have to do with a workforce and a workforce that has changed over the last year. One, in which it needed to.

One, because when I first got there, we had no idea how many employees we had. Number two, we had no idea where they were supposed to be working because we had no manning document. For anybody in the military would understand, a manning document is essential to knowing where your people are and where they're not. We didn't have that. We now do.

And we're able to now begin to look and make arrangements to where we can put the best people at the best places at the best time. Also, I just want to sit here and say, and before we discuss the issues and problems of the VA, and I'm going to hear a lot of those today, and that's fine, that's the discussion we have. I want to say thank you to all the VA employees that we have who have made amazing changes over the last year. They have taken a backlog of 260,000 and brought it down to 75,000, an average days to complete of 137 down to 77 at a 94% accuracy rate, and also at a same percentage of the same ones that were being appealed as the same ones now. So if you have more that are being decided, you have same amount of appeals as you did when you were deciding less, yes, you're gonna have some possibly some more appeals coming, but at the same point, we're actually getting them clear and actually using higher-level reviews to get things done inside the VBA before they have to actually go to the Board.

The Board is a situation I would love to talk to you continually about, Chairman, Ranking Member, about how we can redo some of the Board to make it more efficient. In getting these claims out. But also, I just go to the VHA. Our VHA, our hospitals are doing amazing work in what we're doing, and we're hiring. We got a— our hiring processes I'm looking forward to talking about.

But also, there's two points that I want to point some pride. Just in the last month, we have had a 100% rating from independent outside source on safety. We're the only integrated healthcare system in the country that can say that. 100% Safety rating across the board. We also have the highest CMS ratings, which measures all hospitals.

Public and private. Our 5 stars and 4 stars significantly outweigh any, in any of your states, if you ask your public and private hospitals. We're 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 law.

We're going to follow the law and do that. Also, we're still spending double direct care over what we spend on community care. That's often a subject that is lost when we begin to talk about this, when we talk about community care in isolation. We're still spending double the amount in direct care over what we're spending in community care. I tell you, when we look at this also as we go forward today, there's also an issue when we talk about staffing, we talk about our work, and something that I brought up before and I'm going to bring it up again.

We have a 14% increase over the last 5 years in FTEs. And by the way, this budget reflects an increase in FTEs even in our VHA and our healthcare. This is reflected in the budget presented by the president. But one of the things is 14% increase in FTEs while we have had a 6% increase in actual contact with patients. No hospital, no other organization you have consistently outranks FTEs or full-time equivalents and has less patient encounters.

I actually have some facilities that have had 33% increases in staffing and negative 16% in actual patient encounters. We actually have to get this in balance. These are the things that we're going to be looking at. It's measurable outcomes and measurable resistance. This is what we're going to look at.

The budget is for $48.8 billion, which is a $34 billion increase over 2026 numbers. And I just like to stop here and finish that because we're going to have lots of time for questions and going forward. But I would like to thank the ranking member for just recently— and this is where we can agree, sir, where sometimes we don't agree, but I agree with your recent letter to the editor in which you talked about what you just stated a few minutes ago, that we are serving more veterans, serving them better, and we're doing it with the capacity of the great employees that we have, and I'm looking forward to answering questions we have today. So thank you so much, Mr. Chairman. Secretary, thank you very much for your presence, and while I thank you for your service, let me also say to your wife, thank you for her service and your family's contribution to the safety and security of our, of our nation.

I want to make certain that if Senator Blumenthal doesn't ask you about the— ask you a question about what something he said in his opening statement, I will follow up and do so. But I'm very interested in what he wants to point out about pushing veterans into community care. That catches my attention because I've spent most of my time in the Senate trying to get the VA to treat community care fairly and not to try to discourage its use. And so I want to hear what you and Senator Blumenthal might talk about in that regard. And I want to know the concern about— that he suggests about reducing the quality of both.

Um, I want to, um, ask you just a couple of questions, and then I'll turn it over to Senator Blumenthal. Uh, I want to talk about just for a moment, the VA is proposing to move from 4 VA health care accounts to just 2, direct care and community care, doing that in 2028. Uh, the RISE initiative is similarly establishing 2 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? Uh, there's a couple.

I'm gonna let Richard answer that, but I wanna answer very quickly what you just talked about, and 'cause it is a concern. I believe community care is a vital part. It is VA care. I've said this from my confirmation forward. VA care is VA care whether it comes in direct form or it comes in community care.

Um, also it is sort of interesting to me when we make a statement— I know it's not meant to be this way— but when you make a statement that veterans would get less quality of care in the community, You do realize you're actually accusing your doctors in the community of being less doctors. That's— you got to think about what you're saying when you get that. Veterans do have specific needs, but when we have impact care, orthopedics and things like that, you're saying that the direct care doctors that treat everybody else in your community are not up to par. We got to be very careful at how we word that. But in the direct answer to your question, this is a really a good part of where we're going.

Richard's going to answer that. Senator, thanks so much for the question. We've all been part of this debate where, where somebody is saying that direct care is more or less expensive than community care, uh, community care higher or lower quality, and the facts are nobody really knows because we don't track the data that way. Uh, the account structure VA operates on today is a holdover from when we were primarily a direct care system. It does not account for VA being the fourth largest payer in the country behind Medicare, Medicaid, and Marketplace.

And in a payer program, there are three primary costs. There's the administrative cost— that's the day-to-day operations of the program. There's the contract cost, the fees that we pay to our contractors. And then there's the actual purchased care cost— that's a reimbursement that VA makes to providers who treat our veterans. That's the only cost we actually show.

The other two costs are commingled in our other accounts. Likewise, in direct care— direct care has three primary costs: facilities, personnel, and supplies. Those costs are commingled with the administration and the contract costs of purchased care. They're also commingled with the cost of national programs such as housing, such as research, such as suicide prevention. Fourth mission, law enforcement, even fire departments.

These are all important parts of the VA mission, but they're not healthcare costs. The account structure that we have proposed in our advance for FY28 would break out a direct care cost vertical for the whole cost of care it takes to deliver care inside our medical centers and inside our clinics, and a purchased care vertical that accounts for the full cost of that care. Once we do that, we can then measure the quality using national standards, HEDIS, AHRQ, where we can then account for what we are spending and what we are getting for it. 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.

But right now, based on the account structure, all I can tell you is that it's going to cost more and that we can't manage to it because we don't know where we're managing to. Thank you.

I want to highlight something Senator Blumenthal said in his opening statement. I'm a— 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've been very valuable in helping me represent my constituents, my veteran constituents, by providing that kind of investigation that helps me help those people I serve. And so I would expect— and we have the chairman of the MilCon VA Subcommittee in Appropriations, we have the vice chairman of the Appropriations Committee here— I hope to— speaking to both of you, I hope we can make certain that the IG at the VA is adequately funded to provide oversight, audit, hotline, and investigative work.

And, um, the reduction that's in— the less funding that's in the budget request seems to me to be damaging to that possibility. I'd highlight.

In Veterans Home Grant Program, there's a reduction of $100 million in the budget request. That— we have a backlog of more than $1.5 billion of approved priority projects, priority determined by the VA, 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 provide the money for the states that have been waiting, waiting, and waiting. Mr. Secretary, any observations? Yeah, just real quick observation on those.

Yes, we're working that. That's an issue that we're trying to, again, work within our budgets but also work with the states. And I've had many conversations with state directors and also of— in state homes about how they're, uh, not only they are approaching this issue, but we're approaching it from a community writ large. This is a healthcare— the nursing home situation, long-term care is not just a VA veteran problem, it's a long-term problem for our community as a whole. So we're trying to work in concert with how we can make it better for our side, getting those grants out as best we can.

I do want to say a comment about the OIG. We have an excellent OIG. Cheryl Mason is doing a great job working on issues, trying to clean up backlogs and do that. This was a number, and I think Richard has talked— had agreed to this number, but of course, always willing to work with this team. We support the President's budget.

We feel like we can do everything we need to in that. But that was a number that was also agreed to by her as well. Senator Blumenthal. Thank you.

Clearly what's happening at the VA on benefits is that there has been a shift in backlogs from the claims to the appeals. In other words, the VA is simply 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'll be 77% more, and yet it's being cut. What is the possible justification?

Well, a couple things. Number one, the Board of— the appeals to the Board have actually dropped. They've not increased, they've dropped. So they went from 190,000 to 102,000 at the board. So I mean, we got to be talking about the same issues here.

And again, as I go back to the discussion that I had in, you know, as we went forward in this, the— you can't look at— I mean, you can try, but the numbers just don't bear it out. Opinions and facts are different here. When you actually get the numbers of, you know, appeals that we the number of claims that have been adjudicated since we've been there from 260,000 down to 75,000. That's more, by the way, that's also taking into account the total number of claims were over a million when I stepped foot in this office. They're now at 500,000.

You know, my time's limited, Mr. Speaker. The number of appeals pending has gone from 66,028 January 25 to 117,167 in May of '26. The average day to complete them have gone from 99 to 102, and the number of appeals received by the Board of Veterans' Appeals has increased from 112,000 in, uh, 2025 to an estimate of 113,000— I'm sorry, uh, 92,057 to 113,000, uh, 111,614, and it's projected to be 113,000. So there's clearly been an increase here, and I, I want to move ahead. Okay.

But I would like an explanation for those numbers, and if you have better numbers—. No, I will. And I think, Senator, let me just real quickly— I want to get to your other questions real quick. There is nothing more aggravating and more, uh, confusing to look at the board's numbers in their 3 boxes of how they actually do appeals and how they've moved them. I'll be very frank with you, since we've been in the chair, they've actually dropped the amount of days over 500 days according to their own reporting.

We've actually looked at how they said— I want to get with you on this. I think it's worth the topic because I think we actually need to look at how we do our Board of Appeals and actually change the way we do it. I think it could be more effective for veterans and for the committee. So I'm happy to get with you further on that. Would you agree with me that veterans who prefer direct care ought to be given that choice?

I believe the veteran gets the choice. Thank you for agreeing with me. And the underfunding of direct care is going to cause them to seek community care? I disagree completely with that. When you're spending double in direct care what you're spending on community care, that's what is happening in effect, in my view, because you have cut about 1,000 positions of physicians.

You've cut nurses' positions. You've 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, and in turn, veterans are encouraged then to seek community care as a result. That's— again, you're entitled to that opinion.

I respect it. It's just not backed up by basically the facts. And again, let's deal with the fact of, uh, there's, uh, you know, no risk furloughs, however you want to call it. There was a reduction. But what we're actually seeing, and I think what we say is about We took— there was about 30,000 who took early retirement.

Yes, 30,000 people. Yes. And, uh, but again, whatever you want, but it was a reduction. Well, explain to me how our wait times have gone down in VHA in almost every category. Eliminated the positions so it didn't look like there were any vacancies.

No, there's no—. Or there's still vacancies, but just not the same. Senator, let's, let's get back to the, the basis of understanding what we're trying to do. You're in the military. You're also running office.

You know how many employees you have, and you know how many you have them. You do not need 3 press secretaries, and if one left and you decided to make that press secretary a legislative assistant, then you're not actually, you know, cutting. You're not going to say you're short on press secretaries. You're going to say, I feel the need where I need to have it. What did you turn those physicians into?

Right now we're waiting to let the actual facility find out what they need instead of just throwing money and people at them. Because during this time right here, we've actually lowered wait times in facilities. We've actually got better care. Don't think they have lost people they need? No.

But you know why? Hearing from veterans. You know why I know that? Because if they needed them right now, they could hire them right now. Well, that's how I know that.

I mean, that's how I know this. That's not what we're hearing. Well, I'll go with you. I've been to every trip. And Senator, you know, unlike you, I've been to facilities in the past year and a half, and I've actually talked to the executive directors.

I've actually talked to them. My time has expired, Mr. Secretary, but I'm sure we'll be—. I have one quick question, though. One thought, though, that you brought up an IG report, and I do have to comment on that because you brought up an IG report that was released on April 30th in which, uh, Inspector General Mason called me and told me they were releasing because it was being lost, held, or whatever in the system. That the decisions that you referenced in your opening statement were reviewed from September of '23 to August of '24.

Unfortunately, you got the wrong secretary here to ask why that happened. I yield back. Well, I'll, I'll have more questions for the right Secretary. Thank you. I don't think he's coming back.

Senator Blackburn. Thank you, Mr. Chairman, and I want to thank you, Mr. Secretary, for being here. We are just really grateful for the work that you are doing. And when we talk to Tennessee veterans, we hear that you're working to expand that access. You're reducing that backlog.

You're improving the benefits processing. Those are all steps in the right direction. I also appreciate the efforts that you and Mr. 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've taken to access non-VA providers for, for the veterans. And of course, community care is a big part of this. And I want to know what specific steps you are taking and what that next iteration for community care contracts will be so that it makes it easier for our veterans to access the care they need when they need it, where they need it. Thank you, Senator. I've enjoyed, you know, working with you over the years.

I think one of the issues that you've just raised is how do we make the system better as a whole? And there's a lot of frustration. Total term. Total term and long term. And we're making it where we go.

This is why in just a moment, Ms. Topping can tell you about the new community care contract that we just got let, which, by the way, we had 70, 71 bidders. For those of you who remember the Mission Act, we had 2. Who are third-party administrators. We have 71. That's going to give us a whole new network.

And for your rural states and for some of your areas that have trouble with community providers, this is going to provide a whole new access for what we can do for not only community providers, but there's also going to be a switchover. And for the ranking member of the Appropriations Committee, this is something we're looking at. Rural healthcare can actually be a model for as well. So we're looking forward to working with you on that. It's going to be.

Something really good, but that's one step. The next step is EHRM, which we haven't had a chance to talk about yet, but we're going to. We just had a phenomenal rollout in Michigan so far. My only problem I have right now in the VA is I have more centers wanting to go ahead and get ahead of the line than anything else because it's actually working, but that connection between not only the community and the VAs and electronic health records management is going to help get our veterans there. The last part of this is going to incorporate scheduling and where the veteran can have a more active role in their scheduling.

We don't have to hire schedulers to do scheduling on 9 different screens. The veteran themselves can actually go to their computer, go to their phone, and actually schedule either community care or direct care depending on their preference and time schedules. So there's a lot going on here. Uh, anything you want to add to that, Richard? No, sir.

I think you said it well. Thank you. Wonderful. I do want to thank you, uh, for your work in keeping that McMinnville VA Clinic open. We thank you for that.

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, uh, it was going to close May 31st. You all jumped in. The veterans there wanted to retain that access to care. 78 Of our 95 counties in Tennessee are rural.

So speak to how community care can help with that specific type situation. They can. I think it just provides an alternative in getting into not only rural areas, but McMinnville is in a way. I do have to say this, and we need to make this very clear, that McMinnville was subpar in its treatment to its veterans. And I know the veterans were sort of, you know, close to it, but again, when it's all you know, that's where you want to be.

But it was a contract clinic that was not taking care of veterans as it should. It had been going on for a while, longer than a year or more, and we kept getting basically stonewalled by the contractor. So that's why we're actually taking that over, putting VA people in that facility to make sure that our veterans get the care that they need. But I think it also provides us an opportunity to work with communities and their doctors and clinicians in different areas for those that don't. A statement was made earlier.

I think there are some veterans who prefer to get all their care from the VA directly. But the younger veterans, of which I'm a part of, and many of the GWOT veterans will share a different opinion of that. They may get some of their care at VA, but they may then want to also have care in the community. That's what the MISSION Act all provided for. I do want to mention my Women Veterans Specialty Care Access Act, and this is something that we're working to improve care for our female veterans because as we see more of them and we've got some that are serving right now in Operation Fury, making certain that their needs are going to be met in the VA. And previously, we have had a really a big divide in the care that was available to our female veterans.

So I'd like for you to talk a little bit about how you're going to increase that care and then also how community care can increase that care? Thanks, Senator. I think the biggest thing is, is just to focus on— we have about a million, give or take, enrolled women in our veterans program. There's about 2 million, a little over 2 million veterans totally that would be in our service. We also have a program right now to where we have a goal of enrolling the next million.

So this is a process to get the female veterans in. But there's also every— our new clinics, most all of our new clinics are having a women's specialty side so that the women have their own special side for their particular needs, including that. There's also in our hospitals, many of them are retooling themselves to have, you know, I've been into several of our facilities that retool parts of their departments to have a women's health section. But also one of the things that I did last year is I found out that our female veterans were having to go to their primary care doctor then to go to OB/GYN care, that they were having to make a second stop. There's no female in this room who gets private care who has to do that.

They go straight to their OB-GYN doctors. We took that out and said, no, you don't have to go through this. This what I thought was a foolish step to go through a primary care to then go to your doctor. And it was delaying care in that time. So we took that out.

That's being well received. And again, female veterans can also access community care. We've also laid best medical interest, which takes into account the needs of the veteran and the caregivers many times in that situation, to eliminate that as well. Thank you. Thank you, Mr. Chairman.

You are welcome. Senator Murray. Thank you very much, Mr. Chairman. Mr. Secretary, in December of 2020, actually when you were serving in the House, Congress passed the Isaacson-Roe Veterans Health Care Improvement Act by unanimous consent, and it was signed into law by President Trump during his first term. Section 5107 of that law says that the secretary shall provide a form of child care assistance by January 5th, 2026 to all veterans during their VA appointments.

Last year, your budget requested $22 million to open Kids Care sites at 13 VA medical facilities. Congress delivered on that request, but you're only planning to use $1 million of those funds in FY26. And this year's budget request has one sentence about the program, which was actually our first notification that the VA Kids Care Program is no longer being implemented. Now, VA's own data shows that 58% of veterans with children have no-showed or canceled their employment. Why?

Because of lack of childcare. So I wanted to ask you today, what is your plan to restart this program and comply with the law? Thanks, Senator. We're fully complying with the law, as I mean, sort of obviously noticed on the previous administration didn't move forward on this. We're trying to move forward with it.

Richard can give you some more information on that issue, but we're— this is where it was left with us. And ma'am, you do know we've got two sites up and running, American Lake and Chillicothe. We are pulling in the utilization demand and outcomes data so that we can drive this forward. We're looking at reimbursement models as well. As we get the data, we can make the decisions and come back, and that'll be in our budget request.

But we are moving to implement the law. Let me be clear, this is a law. It is not a suggestion, it's a law, and we have provided the funding you need to ensure that veterans do have the childcare they need to get to their appointments. So I just want you to know I'm going to keep working to make sure we fund this program. I got you.

And I will be following up to make sure that the mandate is followed. I appreciate it. We agree that it is part— again, like I said, this was left for 4 years, never really done anything with. We're still trying to get it implemented and we're doing everything we possibly can to do it. Okay, moving on.

Secretary Garland, 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 healthcare can sometimes be up to 90 days. That is 90 days for behavioral healthcare. Unacceptable. Community care can't be the answer because it often takes community care providers longer to treat veterans than it would if the VA remained— if that veteran remained with the VA. Those same advocates that I met with told me that it can take up to 10 months to fill certain positions, and yet VA's budget is requesting 6,000 fewer employees than VHA had in 2025. So I want to hear specifically from you what you're doing to help address this crisis.

How many more doctors and nurses has the VA hired since you took over? Are you talking— okay, let's— can I— there's several questions there. Which one do you want to go with first? Well, you start with where you have an answer. The—.

I think that— let me just start off first off at the mental health side. There is nothing at this point keeping any of our facilities from hiring the mental health professionals they need. That can be hired at any point. Our overall VA-wide, our mental health appointments have come down. In fact, they have come down 2 to 3 days wherever across the country.

Wait times? I'm sorry. You're trying to say wait times? Yes. Well, I am—.

In fact, mental health has improved 2.8 days. Just this year from 17.8 to 15. Well, let me just tell you, I heard directly from veterans myself and from VA staff, and one VA nurse actually talked to me about how she had 3,200 patients at one point. And when she'd get into the office, she said she'd just look at her screen and start crying because she knew how many veterans were in crisis, and she— they and needed her. And that's just overwhelming.

So we're in this position because Trump did push out many people, however you're going to characterize it. And now we're having the consequences. And you— I am told that you're holding these clinical positions flat instead of hiring for providers that our veterans need. We're not. And I think here's the issue is you have a clinical provider that's telling you this, but yet not bringing it up the chain.

And to the proper areas to actually get something fixed. So I'm telling it to you. Well, I appreciate that. But also, if you're working in the system and you're listening to this today and you're working in the VA facility that I'm over and you're not, you're not letting your leadership or letting you making sure that your leadership is aware that we need certain things, then I got to, I got to have the employees that will listen to this woman. I'm pretty sure she was letting everybody know.

Then we will, we will address it and look forward to it. And I look forward to working with you to continue this. I think the biggest issue here, though, is looking at the facilities, looking at what they need and how we need to go about this. 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 VA themselves, I'm hearing from veterans that there's a real crisis in staffing. And I appreciate that, Senator.

I'm on the road at least almost 2.

2 Weeks a month. I've been in 71 hospitals and I go not just for the dog and pony show. I actually go through waiting rooms. I go through patients' rooms and we talk about this. There are issues.

The VA is not perfect. And I told you that the day we had our confirmation here. But the one thing is we can get better and we'll continue to. I have limited time here. I just want you to say—.

Thank you. No pressure. You need to be aware that—. I am aware. This is a huge problem.

Now, let me— one last question. As you know, when the first Trump administration rolled the EHE, are out in Washington State. It was a disaster. Yes. And so I'm really glad to see that the most recent rollouts, as you mentioned a few minutes ago, seemed to have gone better.

But I want you to— I just, for my own information, when was the last time you spoke directly with providers at Mann-Gradstaff? I have not talked to a provider there recently, no. Okay. I would like you to because we can't ignore the fact that those original sites are still seeing problems and you need to be aware of that. So 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 old ones that have been out there are improving.

And I expect and would like to ask for a detailed plan on how we can—. I will have Dr. Lawrence make sure he gets you that plan because we are trying to update the facilities. Look, what happened in Washington State was, was frankly wrong. It was bad. And you had 6 facilities that were allowed to act as if they were independent, not connected, and do whatever they wanted to do.

And you had some system software problems. We've not had that problem. We've fixed that issue moving forward, and we're going to go back and fix those as well. So I'll get you that information. I agree with you.

I agree with you completely. Check back with Mann Grant staff, because I just have to say, I'm excited that you're moving out and not hearing complaints. That's great. But we still have problems at the original sites. And that is what drives me every day to make sure we get it right this time.

Thank you, Senator Toverville. Thank you. Thank you, Mr. Secretary, for being here. Congratulations. Retirement at an early age.

I heard you say younger veteran. That's—. And you still see me sitting here. That's right. Uh, going around to my, my VAs, just a few thoughts and what I'm hearing.

Better competitive physician pay. Uh, you know, all of them are looking for more money, obviously, for, you know, to get better physicians. Um, need more power at the local level. A little bit too much bureaucracy. It's gotten better, they say, but it was still a bit too much much bureaucracy in there.

They're afraid— the local level's afraid to make any decisions. Uh, they're afraid to step on somebody's toes. So I'm just giving you some ideas of, of what I'm hearing. Yeah, can I— I'd love to answer. Go ahead, go ahead.

We have the best— I, I, let me just state this quickly. I'm going to show something that somebody, probably a secretary, has never sat here and said 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, and this committee as well. The main thing we focus on this is what we do wrong.

It's what we get bad. It's how I'm standing up for my veterans because this is what's going wrong. We rarely talk about the successes. And even today's successes have been criticized by saying, well, they're not as accurate enough, which is not true either. I want to stand up for my VA employees and tell them that I believe they're the greatest in the world, that over the last year they have lowered wait times.

They have taken on more responsibility. They've opened 2 million more appointment times that did not exist previously. They've actually opened 35 new facilities. We've actually— EHRM, which is going. And they are doing this even when everybody else is want to say everything's bad at the VA. And I believe what happened to many of our employees over time, you talk about morale, you talk about that, is every time they would try something new, they would either get a letter saying how bad something was or one veteran didn't get seen in a timely manner.

Also, by the way, a reminder to everybody in this room, we're the only healthcare system in the world that measures wait times. The only one. Nobody else does this. And you know the reason we did? It's because the VA screwed up and didn't put people on a colonoscopy list.

And we as a Congress decided we had to figure out a way to make sure that they were getting there. So we came up with wait times. Nobody else does this. So I want VA employees, and I've told everyone down to our center directors, this is what RISE is going to do. Our new reorganization is going to empower those VAMC directors to be the senior leaders they're supposed to be.

And that is take control of their budget, take control of their FTEs, and make it right. I'm excited about where we're heading. I appreciate you acknowledging that going forward. You did mention one, and I think Senator King hopefully is going to talk about this. It's our ologist problem.

It's a pay problem. I'm capped at the president's pay. An ologist, by the way, and you can fill in your blank— cardiothoracic, anesthesia, whatever you want to put to 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. Okay. Good explanation.

Let's talk about electronic health records. I'm going to complain again. Another complaint here. Your fault. But I said this last time, you know, my VAs are telling me they're having a tough time getting records from community care.

They can't get it back in the system. Your thoughts? They're exactly right. Yeah. I mean, again, this is— I'm old enough in here, everybody else isn't, I'm just getting old.

I remember when you actually used to use internet and you heard the "brrr," you heard the sound because you had to get the DSL number and you had to say, "Hey, have I got internet?" That's sort of the way we're working with other professionals in this healthcare sphere, that they're working at cyber speed, we're working at dial-up. And so, the EHRM is so important and I'm looking forward to supporting the President's budget fully and in the years to come. Because until we are able to actually have an EHRM system that is part of the 21st century, we can't talk to community providers. It's going to be imperative for the community care network that we do this. But here's the worst one.

Do you know our— and I'm just being honest here— you know our facilities can't talk to each other?

Our current record system does not allow us to talk to each other, and we spend $700 million a year just to keep it alive. I agree completely with that criticism, And as soon as I get the funds and the money and the construction and we move this project forward, we're going to have them all done. All right. In the last part of my time, I want to give you a little bit of time to talk about, you know, the money spent in the last fiscal year, the VA, your thoughts about all the money that we've given you and the direction it's gone. I think that what's been given— and I appreciate the Congress appropriating a budget for the last 2 years that has come from President Trump.

There's been an increase in our budget both years. And he did it and went so in a way in which we actually targeting what we need. Construction. Our average age facilities is over 70 years old. We've increased our construction budget.

We're looking ahead not only to major construction and how we build hospitals. We're actually then able to take that and make it better because we're going to remove some of the bureaucracy out of what we do, how we build stuff. We've actually taken that money and expanded our EHRM system. We're actually now going to get 13 in this year, upwards of 23 to 24 next year. The money also has been spent, and I want Richard to comment on this because we— it can't be said enough how much we spend in community care, in communities that support communities, but also how much we spend in direct care as well.

Senator, so one of the things we're excited about in the President's budget is the $10.4 billion investment in construction. That includes a continuation of the $5 billion in investment we've made in maintenance in our facilities this year. As you know, average physical age age of physical plant in VA is 60 years. That $5 billion we're spending this year is investing in that infrastructure. President's budget includes $5 billion in investment next year as well, as well as the addition of new facilities, facilities in Indianapolis, San Antonio, Manchester, as well as our minor construction projects, getting up to date on where we're at.

So we thank you for the support. We've been able to do that. We thank you for the support on electronic health records as well. That allows us portability, this interplay issue that we've got going as well too. So thank you.

Senator Ruono.

Thank you, Mr. Chairman. Mr. Secretary, I think you would acknowledge that there is a need for beds in state veterans homes, and that is why the Department of State Home Construction Grant Program is important. And the chairman mentioned his concern that this particular account has been cut by $105 million. $1 Million. So the State of Hawai i secured a location on Maui for increasing the number of beds.

They obtained the required match. But because of these cuts, they're sort of now in the back of the line possibly. So my question is, how many projects are currently in the backlog for state home grants where the state has met their fund matching requirements? Senator, I would have to get back with you an exact number. I'm not going to guesstimate at that number.

I agree with you, this is a priority for us. It's one that we are having to work through. We hope that as we go through the appropriations process, we will see that reflected. We think we can fulfill what we have right now through the bill. Right now, you requested $171 million, which only takes care of maybe 3 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's. If it is a priority, I would request that you take a look at the— this line and, uh, beef it up. Be happy to, Senator. Okay, so this is something that the chair and I definitely agree on, and I would say probably the other members of the committee acknowledge the importance of this grant program.

So, uh, you need to increase the amount for the program. Next question: over 2 years ago, Congress gave the department the authority to provide direct care to U.S. veterans in the freely associated Freely Associated States. So that would be Palau, Micronesia, and the Marshall Islands. And we recruit from these Federated States or Free— Freely Associated States, and they sign up to serve our country in great numbers. And so.

Through the Compact of Free Associations, we promised that we would take care of them, provide certain kind of care, and it's been slow going. But my understanding is that things are getting better and that, and that the VA is on its way to providing the care that we promised to these veterans in these island nations. So will you commit to working with Congress and the Department of State and Interior? I mean, that's one of the reasons that, you know, you have to coordinate with 3 different departments to get this done. But Will you commit to working with the Department of State and Interior and obviously Congress to ensure that VA provisions in the compacts are fully implemented in line with congressional intent?

We definitely are going to be doing that, Senator. Let me just let you know, over the next few weeks there's actually going to be several meetings with not only Interior, State, and the committees of jurisdiction, but also VA, plus also the SVAC committees and HVAC committees, but also Appropriations committees. To determine the best way forward and how we can provide it. VA is not a stop to this. We have 147 known service-related veterans in these freely associated states.

We've identified about 47 more. We're willing to do it. The regulations on telehealth and some of the others, we just need help. But we're committed to doing that. We're supposed to provide with mail pharmacy, telehealth, beneficiary travel.

I mean, they're not asking for that much. So, but we should do better. And also, as we're 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 that we have been getting as to what would— what it would cost to provide the veterans in the compact nations the care we promised them. I think that the amounts have been vastly inflated, so we need accurate figures so that we can provide the resources that it will take. I agree with you.

That's been one of my frustrations when I first came in and began to look at this. This was laid on my plate as to actually what the costs were. Let me do make one clarification. It's not as simple as telehealth and tele— and medicine. We have to have agreements with those countries to be able to do that in their countries.

That's been one of our whole— and we believe when we get everybody at the table, this state in particular could help us with that. But we can't just all of a sudden do some of these things without some agreements in the countries of origin, especially whether it's mail order drugs or things like that. So if there's anything that we can assist you with, with that kind of assistance, situation. We'll do that because there's no question that the compact nations are, are really awaiting, uh, the kind of support from VA that, uh, their veterans deserve. I appreciate that.

I think anything that we work together on here will, will be beneficial. Oh, one, one, one last question. Hawaii has several critical contracts that have been working their way through VA's historically lengthy and, uh, frankly onerous processes for many months, and Um, are you tracking the impact of staffing reductions and capping, um, how these kinds of changes are impacting the department's ability to turn around these contracts with outside vendors? Uh, Senator, I'll be happy if you have specifics. Please get that to me and I'll find out where the contract process is.

I just— I don't think it's any— it's not a staffing issue. It's maybe just the way that unfortunately our Contracting in VA and many other federal agencies is slow. Let me just very quickly identify the two contracts. Okay. This is a sharing agreement between VA PIH, VAFIX, and the Army to provide needed resources to both the veterans and service members who get care at Tripler.

So this is like a dual kind of a situation. Oh, is this— are you speaking of— and I apologize for interrupting, I didn't mean to, but is this DOW and us working together? On this. Apparently, well, look, I get this all the time. Believe me, there's an issue here.

Yeah, but we are committed to this. There's a problem, and I'm going to bring up something that you didn't ask for, but I'm going to bring it up anyway. DHA has an issue right now, the Defense Health Agency, and how they've restructured themselves, and they're actually having to depend on us for some of what they're having to do. We're working those things out. There's issues because there's also system-related issues on how we talk to each other.

But also on how reimbursement is made. We've made some great strides there and we're going to continue to do so. And I was there in Hawaii and talked about this issue in particular. That should have already been done. I appreciate you bringing it up.

I will find out why that hadn't been done. Okay. The second contract is relating to payments to the University of Hawaii for services to the Center for Pacific Islander Veterans Health. So those are the two contracts that we're having some difficulty in moving along. Thank you, Senator.

I'll be happy to. Thank you. Thank you, Senator Hirono. You and I agree on more than one thing. I also agree on this issue of freely associated states.

The Secretary was in my office in July of '25. He met with me and Senator Bozeman and Senator Risch, the three committees that have earned interest in jurisdiction, and he assured us that the VA understood they should implement the law. And we all need to put pressure to see this happens at state and elsewhere. So I look— we're happy to work with you to try to accomplish that.

Senator Bozeman. Thank you. And again, thank you, Senator Armaud, for bringing that up. You know that we're trying to accomplish the same thing, and I think we are making— we've had the opportunity to visit with the Secretary and really on several occasions recently. And I appreciate the fact that we're moving forward under your leadership.

Congratulations on your retirement and your service. Thank you, sir. We really appreciate that very, very much. I know that you've really expressed an interest in further accelerating EHRM rollout. Does the fiscal year '27 budget provide sufficient funding to further accelerate the program's rollout without sacrificing quality.

I want to help you. Yeah, it does. I want to let Richard address this because there is some needs from the Senate. We need this fully funded going forward because if not, we can't— there's no going back on EHRM. I mean, this is just— we're beyond that point.

So it's got to be done. So we are looking for fully funded. We've talked about that. Richard, you want to highlight that? Senator, before we talk about it publicly, While we're talking about it now.

Yeah, exactly. Senator, it does. $4.2 Billion budget request includes our ability to implement 26 additional sites. On average, it's about $65 million per site plus the cost of the program. So our schedule and the funding request in the president's budget allows us to do that.

If the funding changes, we could do more or less, but that's the ask. Very good. Thank you, Secretary Collins. The fiscal year '27 budget request and investing substantially in both direct and community care spending. As you know, community care serves as a vital complement to direct care, helping ensure that veterans receive timely access to services the VA cannot provide within appropriate time frame.

Can you tell us how community care investments support regional healthcare industries, particularly in our rural states? I think it's invaluable as far as not only just the investment in rural states and in the quality of healthcare, but also keeping communities intact with their— I think we serve a hand-in-glove effect with our local doctors, small communities, and working with that. But there's actually a real dollar effect here, and Richard can give you some real dollar effects for several states here if you want to see how that actually affects—. Senator, the tools that we've included in CCNNextGen, which we've talked about, allow us to measure and require quality, allow us to pay for value, not volume, allows us to use the programmatic tools to ensure the government is paying accurately, correctly, and timely. That allows us to act like a payer, which allows more providers to partner with us.

This is critically important in rural areas. On average, VA provides 5% of reimbursement for rural healthcare providers. So that's rural hospitals, doctors, nurses, home health agencies, mental health providers. These, these agencies often operate on margins of less than 1%, and at 5% of their revenue, VA reimbursement provides a critical role in sustaining infrastructure. 60% Of our veterans live in rural areas.

This is a partnership that benefits VA and our veterans. How much in Arkansas? And sir, just by way of one example, last year in Arkansas we invested $613 million in rural providers. Oh, that's excellent. Very good.

Thank you. Do you expect the new community care contract vehicle to better enable the department to enroll community care providers? Yes, sir, I do. Very good. That's it.

Thank you all very much. We appreciate all your hard work. Thank you, Chairman. It was good to be with you again a few weeks ago as well. Thank you for your help on the appropriations.

Senator Duckworth. Thank you, Mr. Chairman. Secretary Collins, you know that like a majority of veterans, I despise the idea of privatization of the VA. Privatization would devastate our growing population of veterans who return from war with unique, complex needs that require comprehensive, tailored care. And safeguarding our VA, investing in its capacity and building its strength and resiliency has never been more important than right now when we are at war.

Because despite promising the American people that he would stop wars, Donald Trump has illegally dragged the United States into a war against Iran, wasting billions of taxpayer dollars to get us stuck in a Middle East quagmire that threatens to become the exact type of forever war that he promised American people he would avoid. The Pentagon has officially reported that at least 406 members of the United States Armed Forces have been wounded in action in Trump's war of choice, and this number is likely to grow in the coming weeks, months, and potentially years. The VA must begin preparing to care for the next generation of combat veterans that Trump is unilaterally creating in Iran by seeking investments that enhance VA's direct care workforce and infrastructure. The veterans that I dedicate my life to serving earn their VA care. They certainly didn't.

Sacrifice for the right to be systematically handed off to corporate greed. Secretary Collins, you propose— your proposed budget seeks a massive 17% increase in funding for private sector community care but only asks for a meager 2.8% increase for direct VA medical services. When you account for rising inflation, that will likely translate into an effective cut for direct care. The Trump administration's bias for privatization is diametrically opposed through the DAV and the VFW's independent budget, which wisely recommends Congress increase funding for VA medical services by 19.4% and reduce community care spending by roughly 6.3%. And the divergence between the VSO's independent budget and your budget doesn't end there.

You also 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 prosthetics research. The independent budget recommends a 54% increase in prosthetics research. You propose a 37.8% cut to grants for state extended care facilities.

The independent budget calls for 118% increase in those facilities. The irony in your effort to shortchange the department you lead is that the VA's patient wait time performance often exceeds the department's goals while outperforming simultaneously the community care providers. Yet you propose to fund 12,500 fewer full-time equivalent employees than your department requests in fiscal year 2026. I have yet to see a meaningful cost analysis for your department's RISE initiative. And Assistant Secretary Topping, your denials of seeking privatization rings hollow with me because you promised me in February to provide me with your $2 trillion direct care investment plan, and you did that under oath, and then yet you appear today empty-handed.

Your homework assignment for me, which you gave me your word you would provide, is now 3 months state. Secretary Collins, you have repeatedly denied that Donald Trump wants to privatize VA to enrich his billionaire donors, but frankly, actions speak louder than words. And this Trump budget, while probably the most honest document we've received from VA during the second term because it clearly shows his abandonment of our veterans, is a clear privatization blitz. Your funding request for VA care would likely fail to keep up with inflation, yet you are simultaneously seeking billions to create a privatization slush fund that will force more and more veterans to seek private sector care. Even if they want to remain in the VA medical center home.

I want veterans who have access to outside care, but they need a robust direct care option first. It should not be a second or a third. They should not have to go to outside care and private care because there is no direct care option within the VA. Secretary Collins, why did you reject the independent budget's recommendation to increase investments in direct VA medical services by 19.4%? And instead, um, uh, reduce funding for— why did you— let me say that again. Let me— why did you reject the independent budget's recommendation to increase investments in direct VA medical services by 19.4% and modestly reduce funding for private sector community care by 6.3%?

Why did you do the opposite? Why did you increase private sector care and reduce VA direct care? Because I work within the budget that the VA has, and outside independent agencies are not responsible for any budget. They can put down numbers in any way they want to have it. They don't have to actually respond to a workforce development.

They don't actually have to respond to veteran care. And I reject vehemently— again, you're entitled to your own opinion, just not your own facts. And when you deal with it, when you, when you say that we're privatizing, that's just wrong. It's just flat out wrong. You're increasing your budget significantly for privatization while you're cutting VA direct care capabilities.

Senator, we pay double in direct— over twice as much in direct care than we do community care. We're following the law. Now, are you asking me to break the law? I am asking you to take care of veterans and stop enriching private companies. Do you not want me to follow the Mission Act?

Yes or no? I want you—. Yes or no—. To take care of our veterans. And that means you need to increase the number of direct care, not cut funding for direct care.

Well, what about veterans who— what about the veterans who are following the MISSION Act who actually want to have a community care doctor? Then they can— they go first to direct care and then they go into private care. That's my point. My point is that you're getting to a point that they don't even have the option to go to direct care first. The VA needs to be—.

The VA needs to be a medical center. That is not true. That is not true. You worked at the VA. You know better. Yes.

I did work with the VA, and I do know better. And I know what you do is—. What did you say? You just—. What I know is that you're in— you're ignoring the independent budget.

I am not ignoring anything. The independent budget recommendations demonstrate otherwise. Veterans want more care at VA facilities, but your department has made politically driven decisions to reject veterans' preferences. I strongly advise that you correct course, present real meaningful evidence, and actually consult Congress and the VSOs. And Mr. Tapper, where You promised me something and you still have not delivered it to me.

You did that under oath. Over. You're 3 months late. Thank you. What exactly did you ask for?

I want to know. All right, we're done. The political speech is over. Thank you, Mr. Chairman. Thank you, Mr. Secretary, for being here.

I just have to say on that, this most recent back and forth, I don't know any billionaires enriching themselves at the expensive veterans in North Dakota. So to the degree that you might be keeping a small community hospital open with 5 or 6 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's a little— enriching themselves a little bit rich for me. Excuse the pun. Um, so Mr. Secretary, I want to ask you about, um, in February, the VA implemented this new payment system for veterans receiving care at, at community nursing facilities.

And it makes pretty substantial changes in how the reimbursement works for veterans that reside in a facility for more than 100 days. I hope you're somewhat familiar with this. And while I appreciate the effort to modernize the system, which I think we badly need, I am concerned about a possible unintended consequence as it refers to, as it relates to access itself. So I just want to maybe, maybe a little clarification on that and then just ask you if you'd be willing to review that, those changes, and see if there's, if there is perhaps an unintended consequence and how we can avoid that. Senator, we'd be happy to.

I, I'm just going to be sitting here for just a second, if you would allow me a second. Yes, we're going to look into this, but the conversation I just had needs to be answered. You cannot go straight to community care as a veteran. That's just false. You can't just— I can't tomorrow just decide to go to community care.

And to have a senator actually say that is not very helpful to— I have veterans who won't come to VA because they hear about stuff like this, and it's a lie. And I'd be happy to have the continued conversation, but that's just not true. You can't go straight to community care from the street. You can't. We're not a third-party payer.

In that regard. Yeah, I'm just stunned. We're going to look at this on the healthcare. We appreciate your Medicare, the, you know, the PDMP, PM, I'm sorry, looking at from the Shanders. We're looking at right at this point, no VAMCs have reported a problem, but it could be a long-term issue that we're looking toward as we go forward.

So, I mean, I'm willing to look at how we can help better communicate because, look, long-term healthcare, whether it's with inside the, you know, our own facilities or with community, is something that this country has to look at. There's no question about it. There's no question about that. And I appreciate that. And that's why I appreciate the modernization effort of the system.

I just, I just see this as a possible challenge going forward. And if we look into it sooner rather than later, and if it needs to be tweaked, you know, I just appreciate looking at it. Also, you know, I know that President Trump recently reiterated his conviction about Made in America, uh, and as it relates to, to healthcare, but to include, of course, um, not just facilities, but, but equipment and, uh, and the, uh, the type of equipment that's available where we can get all the, the supply chain and whatnot here in the United States. Can you give me a sense of how the VA is prioritizing procurement for domestic, you know, produced products, particularly again, medical equipment? We are, we're following out on the, you know, from the White House direction, which has been through EOS to make sure that we're securing our supply chain, especially from the drug perspective, but also from equipment perspective as well.

That's just, it's going through the process of making sure. A lot of that had been not sourced here in the United States. Now we're looking at ways to have, ranging from gloves to equipment to ventilators to everything else. So we're committed to making that happen in the areas that we can. I'll be honest, with some of our problems that we have, and this is something that everybody up here would know about, is sometimes we are bound by set-asides and other things that keep us from actually accessing.

There is one set-aside in particular that dominates gloves and others, and they get all of their product from overseas, but yet we still have to go through them because that's the way the federal procurement system works. Yeah, well, there's no question there'll be a transition to this. I just— I appreciate his reiterating that. I do realize the challenge of you know, getting everything domestically. And if you can't, we're better off getting something than not getting anything because of it.

And so it is a transition at some point. And I appreciated our visit yesterday, frankly, in my office very, very much, and was encouraged by you bringing up the possibility of coming to North Dakota. We actually have a ventilator company that manufactures ventilators right in Fargo. So when we're there visiting the hospital Perhaps you can come see what's— Corvent Medical is what they call it. I appreciate that, Senator.

It's always good to visit with you, my former colleague in the House. And I'm open to anyone. I've had a great visit with Senator Hassett as well. Anybody want to invite me? Well, I'll be happy to come.

I've been to 71 so far. I'll come wherever you want me to come. Well, that's good. As we go forward. Thank you.

Thank you, Mr. Chairman. Senator King. Thank you, Mr. Chairman and Senator Cramer. I join you in the Made in America. I hope in the Armed Services Committee we can be sure that applies to warships.

As you know, there's a proposal kicking around to build ships somewhere else. Thank you. Mr. Secretary, thank you for joining us. As you know, I'm with you on the ologist pay issue, but I need a co-sponsor from across the dais. Could you see to that for me, please?

I'm an old Baptist preacher. Can I just say, do I see a hand? Yeah. Can I get a witness? Can I get a witness?

Well, what— the buses will wait. Okay, we'll go. Senator King, have you been rejected? Yes. Okay.

And it hurts. I hope it wasn't personal on any of our parts. No, but this is a bill that the Secretary and I agree— the issue that we're talking about is that we have a cap on salaries for physicians that is actually preventing the VA from hiring specialists across the board, whether it's cardiologists or rheumatologists or whatever. And it's a really serious issue. I heard what he said and it caught my attention.

It takes a legislative fix, and I've got the bill ready, Mr. Chairman. You can— we'll make the space for your name right there. Senator King, can I also— I don't want to interrupt, but can I say real quickly something? Because this gets brought up a lot when we talk about this. And in the Dole Act, there was $300 set aside to help this pay gap increase.

And this was in the Dole Act. I just have to say, I appreciate the Congress doing that, but that's 1.5% of my doctors. We were picking, you know, basically winners and losers and actually losing, running the risk. I had hospitals who didn't want to go through the process because they would lose doctors if they were paying more than others. So I look forward to continuing to work with you on it, and perhaps we can generate some additional support.

I appreciate it. Secondly, I want to compliment you. A press release just came out 2 days ago from the VA. VA hospitals earn record high quality ratings in 2026 CMS report. You've spent some time earlier talking about the quality of your VA employees. This is data that supports that premise that the VA hospitals are— actually, they score generally above hospitals in the, in the private sector.

4Th year in a row that the VA facilities have outperformed non-VA facilities. So that's the good news. Now, my concern is, and a little slightly different than my colleague Senator Duckworth, but yes, direct care is now twice of community care, but that's changing rapidly. And I've got a chart. This is, um, the orange line at the bottom are patients, patients in the VA.

The blue line is VA healthcare, and this is community care, and this is percentage increase year by year. Now, community care really started back in 2021, so of course you're going to see— but you see the rate of increase is a lot different, and that's what concerns concerns me about a subtle, perhaps not so subtle move toward community care. And here is the other thing that is bothering me. In 2025, 35,000 VHA employees were lost, including about 1,000 doctors, 4,500 nurses. This is— now, if the data is wrong, let me know, but this is the data I have from—.

I will explain it. February— in FY26, we've got another 15,000 VHA employees lost, including another 500 doctors. So what bothers me is you put these breadcrumbs together and it looks like you're reducing support on the VA side and drastically increasing as a percentage on the non-VA side. And right now, as you're right, it's about double But that's changing rapidly. In fact, in the '28 forward budget that you've submitted, there's a $17 billion increase for community care and a zero increase for VA care.

It's— there's— I think there's a slight increase, but adjusted for inflation, it's really a decrease. So you put all those things together, and I do see a trend toward what looks like an abandonment or a severe diminution of the role of VA direct care. I think this is something we need to discuss. Can you tell me for the record, point blank, there is no intention to gradually privatize VA health care coverage? There's no intention to gradually, there's no intention to accelerate, there's no intention to decelerate, there's no intention to privatize at all.

What can you tell me about those numbers though? You've cut of 40,000 people out of the VA health system, including over 1,500 doctors and 4,500 nurses, and you see the trend line of the money that you're allocating, somebody is predicting that in next year you're going to need $17 billion more for community care and no more for VA care. That certainly indicates to me you're expecting community care to gobble up the— the remainder, the lion's share eventually of the VA healthcare dollars. I'm going to take part of this and I'm going to answer quickly because I want you to hear from Richard on the numbers part of this. The part of the numbers as far as the employee part, I have to go back to this and numbers of employees do not equal success at the VA.

Number of people do not equal success at the VA. In fact, they don't waste time. We're not moving that—. Indicator, they're an indicator of something that's happening. Not really.

Well, they're an indicator of bad management for the last few years. They're an indicator of bad management and bad hiring. That's what they're the indicator of. Because the numbers, especially when— and by the way, we have people leave every day for no reason at all. They just leave, just like everybody else does.

The question is, do you replace them? Yes. Every business has attrition. Yes. We're hiring right now.

We are hiring with USAJOBS and all that. We're hiring every day at our facilities. And actually, in fact, we've actually remodeled our entire hiring process, which was lasting 100 to 150 days. We're now under our new model that we've just implemented in the last few months is down to get it back into the industry average of 30 to 45 days. It was taking 145 days to hire a doctor.

I just don't want to sit here at a future hearing and not have this press release that says the VA hospitals have a higher quality rating than the non-VA hospitals because of cuts to VA staff and losses in the—. In the VA. Just remember that that same press release takes into account last year when the discussion of this staffing issue is occurring. So we're maintaining our quality, maintaining what we need to do, maintaining our also responsibility to community care as we look forward to this. Richard, as far as the numbers go, Senator, just to be clear, we are investing in direct care and in community care. Roughly, it is a 2-to-1.

But the exact reason that you just brought up, the spending that you're showing community care, is one element. That is why we have asked for—. It's growing substantially and, and direct care is, is flat. It's one element. It is only the purchase care cost.

The administrative costs, the contract costs, are commingled with my direct care costs that are commingled with my national programs. The reason why we've asked to break these out into a community care account and into a direct care account is so we can give you an apples-to-apples, and we can tell you exactly what we're spending on community care, exactly what we're spending on direct care. I can't do that now. That I've derived from your prior reports, you're telling me don't include all the nuances that you're now discussing. And sir, what I'm saying is that the FY28 advance request includes an all-in cost of community care, which is currently commingled and cost shifted with other costs.

What we are asking to do is come to you and provide you the transparency predictability that you're asking for. What's the justification for significant $17 billion increase, whatever included in community care, whatever included in that definition, and essentially a flat or declining number for direct care? How does that square? Larger percentage of a smaller number. But what we have proposed in 28 is all in on the cost of purchased care.

So what we want to be able to show you is exactly what it costs— administrative cost, contract cost, and purchased care cost. Answering my question, you're increasing community care by $17 $1.5 billion and you're increasing direct care by zero. How is that not a direct incentive or an indication of a trend toward supporting community care as opposed— if you're not increasing direct care expenditures, that's going to diminish the quality and you're going to end up with people not wanting to go to the VA hospital. I mean, that's what— it's those two numbers that I can't reconcile. Senator, I think we just look at the numbers and we look at the quality and we look at the increase.

We've increased over 145,000 new veterans since the first of the year. We're increasing those that all come through our direct care as far as through their primary care doctor. There's no— this is just, I think, a concern that I'm not denying your concern. Okay. I'm not trying to deny it.

I'm not. But I think when the numbers you look at that Richard was talking about, some of this direct care cost and commingled costs with community care has just been a hidden cost that is not reflected in these numbers. And the year after and the year after. And we'll see. Yeah, I mean, we will.

But I think the bottom line is, is I concern myself with one thing and one metric only, and that is the veteran getting taken care of. That's the only metric that I look at. Thank you. Thank you, Mr. Chairman. Yes, Senator.

Senator, you—. Thank you, Mr. Chairman. Secretary Collins, I want to thank you first and foremost on behalf of every Hoosier veteran for prioritizing the new Indianapolis Medical Center and the Fisher's Outpatient Center in the VA's budget. You, you've visited, you've taken, uh, my request seriously since day one to make this a priority. Roudebush is 75 years old, and the staff there move mountains to take.

Care of our veterans, but the staff and most importantly our veterans deserve modern facilities, and I sincerely appreciate you working with me to deliver on that. The VA is taking a new approach in Indiana, replacing the big downtown hospital with a slightly smaller hospital as well as an outpatient center in the suburbs where most of the veterans live. How will that better meet veterans' needs and be more efficient? I think the biggest way there is, again, we're focusing on where we can get the veterans and where the veterans are located. People are not driving.

This is not 40 years ago where people enjoy driving downtown to go get their healthcare. They want to look at it just— look, and again, I can't separate out VA integrated healthcare system as a whole from the actual integrated healthcare system of the country. There's no hospitals in the world right now that are not building clinics or walk-in clinics or ambulatory clinics for their own systems. We have to sort of reflect that for our own folks. This is going to, I think, give us the better opportunity.

We're also putting what we call an all-in funding, which means we can fund it up front all the way instead of having the Louisvilles of the world, the Aurora, Colorado of the world, in which we have a 20-year project that cost us, you know, billions of dollars in overruns. We're able to actually— we're hoping— we started this last year with St. Louis. We're now actually looking to do it here in Indianapolis. We're also— one other thing that I think will help not only get the veteran care but also help us on on our cost control here is that we, VHA for some reason, decided that the national building standards were not good enough. So all of a sudden we took national building standards and on top of that, we saw this in Manchester actually, they just laid on top our own standards and it run up cost and run up everything else.

We're now stripping that out so that we can get basically better cost. And the example I always use is my hometown hospital and comparing it to, One we just built, $1.6 billion. We're getting ready to build in St. Louis. My hometown built a bigger facility with ERs, ORs, and everything else for $800 million. Did it in 24 months.

It's going to take us 5 years. I mean, it's just the craziness of how our construction goes right now needs to be addressed in the committee. On that point, can you talk about the advantages of, of this project becoming a chip-in type project? Very much so. Any, any project right now, I think chip-in is one of the greatest tools that we could use to advance our direct care system, to advance our hospitals, to get better in modernizing our facilities.

Tulsa right now is getting ready to move into a facility which Oklahoma State and our Muskogee VA have partnered in, and they're working hand in glove to cut costs for both but also improve care for both. We've seen this in Nebraska as well. I would love to see more CHIP-in projects approved because that's putting the community with the providers, making it better for our veterans, but also helping our communities by providing the expertise that the VA has as well. Including private contributions under the Chip In Act for the medical center in Indianapolis, the budget request covers full funding for both projects. What—.

Why is asking for full funding upfront important as opposed to incremental funding over several years? This is the way we've built in the VA forever. And it was, we'll come to appropriations, we'll come to the process and we'll say, okay, well, we got— and what I called it was making sure everybody was happy at Christmas. Okay. Everybody gets a little bit.

Okay. For Indianapolis, well, we're going to give you $200 million and you go buy the land and then maybe we'll come back next year and give you $200 million to clear it. And then maybe the next year we'll give you $500 million to do the next step. By the time you continue to do that over 5 to 10-year cost projections, your costs go from the original, say, $1 billion to $1.6 to $1.8 to $2 billion. Nobody bills that way.

We're— the federal government is the only one that bills this way. It's stupid. And but yet we do it all the time because all of us— I'm going to put my congressional— when I was back in Congress, we all want to bring something home for the district. We all want to have that we're working toward that. But construction can't work this way.

We've got to be able to build it at a single time. And again, I'm talking probably not like a secretary of a department should, in the sense of saying we've got to fix the system. It's not functioning for our veterans and it's not functioning for the taxpayer. Thank you. I yield back.

Senator Banks, thank you. One of the things, Senator King, that I learned from our committee staff is the— I thought we had done something about salaries and a cap. And we did in the Elizabeth Dole Act. We provided the department the authority to waive up to 300, to have up to 300 waivers for individuals who are— they're trying to hire. Yeah.

Can I comment on that, Mr. Chairman? Must have begun that process now to make that. Yeah. Could I comment on that, please, Mr. Chairman? We appreciate anything that's done to help this, but that was honestly like having 3 kids and saying we're going to give one kid the dessert tonight and not let the other 2.

This was actually what was intended for good became a problem in our facilities. Because let's just say, for instance, the 4 of us, the ranking member yourself and the 4 of us were all anesthesiologists. Well, Richard leaves and we have to bring in another anesthesiologist. We're having trouble recruiting them. Well, all of a sudden I'm going to pay this anesthesiologist new double what I'm paying the 3 of us.

Well, guess what? I'm going to say I'm out of here. I'm going to go somewhere else. No, I think, I think you have to pay them all the same. I would say, but that's what it was.

The 300 only gave us 1.5% of our doctors. So, and we got like 4,000 in that care. Mr. Chairman, I might just add, I have introduced a bill called the Honor Act that fully removes the physician pay cap. And I think that is an appropriate way to go. I hope there will be bipartisan support for it.

Yeah, I think, I think, look, there's, there's ways to go about this. There's, we're willing to work on this in any way possible. It's something I've needed to bring to attention. I appreciate the ranking member. I appreciate Senator King.

I appreciate Chairman looking at this. It's just something that, you know, even if we had it, you know, the top 6 positions, you know, whatever, because there is a financial cost to this. I'm not going to lie about that. There is a financial cost to it. But I think there's a bigger financial cost if we don't address this long term, like Senator King said, for how we then maintain doctors in our system.

Understand. Senator Hassen, I'm sorry, intruded on you into your—. In your long wait. No, thank you very much for the hearings. Secretary Collins, thank you so much for being here.

And I too enjoyed your visit up to Manchester. As you saw during your trip, our 75-year-old facility faces serious challenges. And just as an example, in recent years, failed plumbing has twice led to major flooding at the Manchester VA. As you know, I've been fighting for a new full-service VA hospital for years alongside our— the other members of our congressional delegation and other leaders throughout our state. We want our veterans to get the high level of care that Senator King was just referencing with the latest report on how the VA outpaces the civilian sector. Now, New Hampshire is the only state in the lower 48 without a full-service VA hospital.

And last week, the VA shared a plan to build a new medical center in the Granite State. And I'm delighted that we finally got that plan that we've been asking for. The plan includes many significant upgrades for New Hampshire veterans, though it does not propose what President Trump promised and what his executive order laid out, which which was to make sure that New Hampshire got a full-service VA hospital and was no longer the only state in the lower 48 without one. So I want to talk with you about the VA proposal for the new facility and how the VA came to select this approach. To start, can you please just, just describe the proposal for a new facility in New Hampshire?

I will be happy to let Richard— Richard has been here— as far as you get a much better answer, I want Richard to answer that for you. So thank you. Senator, as you know, this is near and dear to my heart. That is my father's VA. My sister received all of her care there as well too, and I was honored to work on this project, and I'm glad the president— president's budget honors his commitment in the EO. And so what we have proposed is a replacement medical center, a utility plant— as you mentioned, that's a huge issue— as well as community living center and the other infrastructure needed.

When we looked at utilization and requirements at Manchester, one of the things we looked at is the issue around inpatient beds, and the services that were needed. Because that is the Boston hospital market, relatively low demand for inpatient bed but high demand for ambulatory care, the proposal that we have, which is a $1.3 billion facility to serve veterans in that region, would meet the need that we demonstrated and is required. So let's just, in the interest of time, a couple things. I just want to be clear, the president's EO did not call for this. I went back and read it.

It said we were to get a full-service hospital, and that's what you guys were supposed to be working on. And his campaign promise has said the same thing. So let's just be clear now. If you're differing from the EO because of what you found and you want to discuss that, that's fine. But let's be clear and honest about what the executive order said.

It said that Manchester was to get a full-service hospital. So what services will be offered, including any new services that the proposed facility will have that are not currently available at the old facility? Senator, it'll be a full-service facility. It does not have inpatient beds, overnight beds. And that's because it's relatively low utilization in that area.

It's only about $12 million in total inpatient cost per year for that facility, but it would include all other services. Okay. So I think you just explained the difference between the facility you're proposing and what I would consider, and I think most people hearing the term would consider, a full-service.

Hospital, and you've explained why the VA opted for that path. I want to continue the conversation though, 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. Part of my concern is that, as I understand the plan, as I've read it and what you've been saying to us about utilization, is a reliance on a civilian healthcare system that is facing great stress in New Hampshire, in no small part because of $2.3 billion in Medicaid cuts to our state in the next 10 years. I've got 4 rural hospitals that are on the brink of closing, hospitals that— Littleton, Laconia, Keene, and Woodsville— that have— that would be service areas for a number of veterans. So I'm really concerned that you're not taking the full healthcare picture in New Hampshire into account.

Um, and, um, I also just want to continue that conversation with you. What opportunities, in addition to our conversation, will Granite Staters have to review the plan and provide feedback? I, I think the biggest thing is we'll continue to, uh, take the plan that we have and continue to, uh, communicate with the, uh, folks in that area and continue this process as we move forward. Well, I hope we can develop a real drill down on a plan where veterans throughout the state, rural areas, more urban areas, will have a real chance to look at this plan. If this plan were to move forward, what's the timeline?

When would the VA break ground? Senator, depending on the budget and assuming we've got the budget, we'll begin on the budget in FY '27. And I want to go back to one point that you made too around choice, stressed rural providers in New Hampshire too. Part of the $200 million investment in community care that we've made in your state last year includes inpatient beds. If we did put beds in this facility, veterans would no longer have the choice.

They would have to meet the access standards in order to access healthcare outside VA. Right. So, so part of this was balancing veterans' needs and how to best meet those in a way that also took into account the local healthcare infrastructure. And, and I do, look, I do understand that balancing. There are people in my state, veterans who like the community care they're getting and they don't wanna lose it.

Uh, that's also something we could address legislatively. Um, but I also think it's really important— you all are investing in some inpatient beds in New Hampshire, but there's a real possibility that there won't be facilities for you to invest in, in places where you need them to be because of these Medicaid cuts that are really devastating our state. How will the VA ensure that high-quality interim medical care is available for New Hampshire veterans during any demolition or construction process?

Again, Senator, so our veterans will have access to— will have access, A, to both VA facilities. We've got the Boston VA facility also in that region, plus nobody in New Hampshire wants to drive to that Boston facility, including my family. Senator, I'm aware of that. Yeah, but at the same time, the veterans that currently have choice and access and can choose between VA and New Hampshire community providers will will be able to continue to do so. We'll continue to fund that care.

That's part of the NextGen contract and our commitment both to rural and urban providers. We've got that commitment to our veterans in that area. I appreciate that. Thank you, Mr. Chair.

I yield back, and thanks for the indulgence. Senator Gago.

Senator Collins, you've spoken positively about innovative therapies for PTSD, including— It is on. I think it may not be working, though. Hello? Hello? I done thought my veteran hearing had already gone.

Try this one, then, Senator. Let's try this one. There we go. That one's not working. Okay.

Sir Collins, you've spoken positively about innovative therapies for PTSD, including psychedelic-assisted therapies. Yet we are seeing funding cuts for the research. Veterans facing PTSD, TBI, and treatment-resistant depression are looking into VA to move faster in evaluating and supporting therapies that are showing promising results, especially for veterans who have exhausted your traditional treatment options. My legislation with Senator Sheehy, the V— the VHA Novel Therapeutics Act, is an important step toward ensuring VA is fully equipped to evaluate and responsibly deliver emerging therapies, offering real hope to veterans. Can you discuss how the VA is currently approaching innovative therapies, including psychedelic-assisted therapies for PTSD, and what investments VA is making research, provider training, and patient access in regards to that type of therapy.

Yes, Senator, thank you for that, because I know you and I have talked about this before. I've been outspoken on this, saying if it helps a veteran, we're going to, you know, look into it. I appreciate the president stepping forward on that. This is a combined effort between HHS and FDA. And of course, CMS has got to be a part of this, plus us in how we develop it.

We're developing the standards right now on how we're going to be implementing this. Our budget— and Richard can speak to the budget side— is going to facilitate that, is getting us forward. The big issues that we have right now is making sure that we have the proper protocols, the proper rims in place to use these, uh, uh, different psychedelic treatments. One of the things of which, by the way, we just started, I think this week or this month, we have just started another MDMA treatment. It was already a veteran, veteran facility that we've already started.

So we're already starting ahead of the schedule, getting this done. The big one, and I'm just going to be very blunt and honest about this, ibogaine is our next probably big one. It's going to take a little time to get that because we don't have that. That's got to come through FDA first. We'll be prepared for that.

We also have to have a federal source of sourcing the ibogaine, which we don't have a costing on at this point, so we'll look forward to doing that as we go on forward. I think what our current— the president's budget also supports anything we need to do to support that EO. Well, I would really love a commitment for you to work with Congress on closing the gap between our research of these promising innovative therapies and veterans' access to these treatments, because that's usually the kind of the gap that does exist. Yeah, that's going to be— and that's one of the things I want everybody just to be coming to with open mind and hearts on because even in the, you know, whether it's private sector or, you know, VA sector, any of this, the, the trained physician, these are very clinically intensive treatments. MDMA requires almost 120 hours per patient with 2 psychiatrists going through this.

So we're working to work up to speed on that. And so far our research is doing it. We have a— I have an individual that's committed simply to doing that right now for us. But it does save on the other end because then you have less of a therapy. I apologize.

It saves on the other end because with good MDMA therapy, I agree. On traditional side of—. Where it works is it works out beautifully, and I'm agreeing with you. So the other thing, when I asked in January last time we were here about the new Yuma VA facility, I was concerned they would not have the staffing need to deliver care. 30,000-Square-foot facility in Yuma is set to open next summer and provide great comprehensive care.

As you know, staffing caps as put forth by our— by your departments of organization require this facility to acquire staff by pulling providers from other VA facilities, facilities that also are understaffed. And I've yet to receive an answer from you how this will work. I'm asking you again because again, in this, this community, a rural community in Arizona, has been waiting for this to open. Can you commit today the new Yuma VA outpatient facility will open by the summer of 2027 and will be fully staffed to serve our rural Arizona veterans? The sort of last question, any facility we open will be staffed to facilitate the veterans in that area, and we will be hiring those that need to be working in that facility.

There's not a— there's no cap on it that keeps us from hiring doctors to open our new facilities. That's it. That's just the— again, I go back to what you and I both know from the military. There's unit manning documents where you know how many people you have, and what we don't want to have is a facility for now we can actually know that we need more people here. We need more doctors here.

We need more clinics, and that's what we're going to be looking at. Well, look, it would make me feel a lot better, obviously, since I've been asking about this every time you come through, if you could come, you know, not you, but someone within your staff could come with us and talk to us about what the plan is, what the staffing plan is, what the recruitment plan is, because That'd be very, very helpful because, again, this area of Arizona has been waiting for a long time for this, and I think they would really appreciate it and make me— make it be easier for me to communicate with them that this is going to be a fully functional facility from day one. Well, Senator, I look forward to that. I look forward to seeing you when I'm out there again in Arizona as we go through. But I think your commitment there is my commitment, and that's to making sure that we get, especially in our rural areas, is that, you know, blending together and looking at that.

So I appreciate your concern. Thank you. Senator Gallego, thank you.

Senator Sanders. Thank you very much, Mr. Chairman. Thank you, Mr. Secretary. A few questions regarding Vermont. We have been on a list for eternity regarding the construction of two CBUX, one in Burlington, Vermont, and one in the southern part of the state, maybe in the Brattleboro area or in, uh, the Keene, New Hampshire area.

I am told that, uh, the re— these clinics will open up in 2029, May 2029. I suspect you don't have that information in front of you, but I would— could you get back to me on that? Yeah, I will, I will definitely. I know the Brattleboro is, uh, scheduled to open, and we've been working very hard with you and your staff on the Brattleboro getting open by September on that, and we will continue to help you on that. That one is damaged, it has some— yeah, it was damaged We're trying our best, but we're talking about— I think we're in line for 2 new CBOCs.

Okay. Okay. And really, the bureaucracy has been horrendous before you came into office and since. Let's see if we can speed that up. Is that possible?

Senator, I'm more than willing to get rid of bureaucracy to help the veteran. Okay, let's do that. Second of all, will you get back to me on the status of those and maybe we can chat about how we can move that along? We will. I have long believed, as I think.

Most Americans do, that dental care is a part of healthcare, correct? It always has been, yes. Yeah, and right now, um, and I think all of the service organizations, the American Legion, the VA, the, uh, VFW, etc., believe that dental care should be a part of VA healthcare. Right now it just applies to service-connected folks, uh, Any thoughts about how we can move forward and make dental care part of VA healthcare? I think that's, you know, as we look at expansion of services, of course, in the purview of Congress and how we actually expand that, I mean, we're gonna do what is directed to us from there.

We're using resources we have now under the current statutory limitations to make it available to as many people as we have. That is a good balance between our direct care and our community care in dental. I'm committed to working with you if, you know, if it be the will of the Congress to move forward however you see fit. What do you think? Is that something you would support?

I think there's— I think there's a need there. I think there's a— I think we need to determine what the need is and how we can actually afford it. There is a balance of giving something and also being able to afford it. So I think that's something we have to look at. My feeling is there's a real need out there.

I think if you talk to veterans, they will tell you that. All right. That's about it, Mr. Chairman. Thank you. Thanks.

Thanks for joining us. We're going to wrap this up with the exception of apparently Senator King now and Senator Blumenthal, who have something to follow up with. I don't have a question. I just— there's been a lot of talk about CBOCs and facilities. I want to tell you the CBOCs in Maine are fabulous.

Thank you. We've got a beautiful new one in Portland, and then we've got two new ones in the small towns of Rumford and Presque Isle. The veterans are very enthusiastic, and again, I want to compliment— I want to send my compliments and thanks to those wonderful people who are staffing those facilities, including, of course, Togus, our oldest in the country, oldest one, veterans hospital. Now, thank you, Senator. We appreciate that.

I think that's been something that has been, you know, we've opened 35 new ones just in the last year and a half. We got more plans to open those. It puts the care where it needs to be, and they're great facilities. Thank you, Senator King. Thank you, Senator Blumenthal.

Thank you. Just a few, a few more questions, Mr. Secretary. Talking about local facilities, the West Haven facility, Mm-hmm. Is under construction. Is the timeline meeting the projections as to when it's going to be done?

As far as I know, it is, Senator. I'll check into it, make sure our staff gets back to you. I don't have that right in front of me, but I'll check. If you could get back— No problem. —About the details there.

Not a problem. It's an enormously important facility to all of Connecticut, and I would appreciate more information. Definitely. We worked very hard. For many years to make it possible and appreciate your cooperation.

Um, I want to talk about National Cemetery Administration staffing as we go into Memorial Day. A lot of folks are going to be out at cemeteries celebrating the service of the fallen, and, um, my understanding is that The FY27 budget request calls for 2,305 full-time equivalents at the National Cemetery. This is slightly less than previous years. If again, we can compare numbers despite the continued growth at VA National Cemeteries across the country. At the same time, the most recent VA Workforce Dashboard reports only 2,094 FT on board at the National Cemetery Administration.

My calculation is that the National Cemetery Administration is missing about 10% of the workforce Congress has funded. I hope I'm wrong, but that's what we've seen. Assistant Secretary Engelbaum recently briefed the committee that an additional 130 cemetery caretaker vacancies were cut. So 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? I admire Undersecretary Brown for the service he's providing to this nation in a critical area.

We're not focusing on it with the same depth and passion that I think it deserves— I agree— for all 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 of concern. Yeah, Senator, you and I have the same concern here, and we're working with Sam. There were some issues, uh, that have developed over the last previous, you know, a few years in the budget dealing with NCAA. We're working with Sam. Richard is working.

Now that we have consolidated financial management so we can look at this, we are looking at that. Sam and I talk regularly. I cannot also just say there— can I, if you don't mind, Senator, I want to say something. Sam, I agree with you about Sam Undersecretary. I don't think there could be a better fit for that role than a man who has the heart that Sam Brown does for that.

And as we go forward, I'm looking forward to working with him. I also have to say for Margarita Devlin, who is running our VBA operations, and we all have differences on how we look at our disability payments and how we're getting them there as far as timelines and stuff. I got to say that the challenges that they have faced and to overcome things has been incredible. And I just had to point them out. And of course, you know, Bartram, John Bartram running VHA, that we've got some people who are dedicated to doing that.

And I appreciate your concern on the NCA side as well. Well, I hope to get more numbers from you about the whole appeals process. Again, I want to clarify that the information I have is that the request for 2026 anticipated 92,000 appeals and the actual number has proved to be much higher. Well, I look forward to getting with this. This— the board issue is one that, frankly, sir, is, is you deal with the problems that we face in trying to get everything squared away.

The board has been one that we've been dealing with, but honestly have been sort of saying, okay, how do we get it fixed? Because there's been a lot of discussion about that. I'm willing to work with your staff, and I know our folks are as well, and also to get the number and information, because trying to determine which slot they're going in for appeals is also an issue that I deal with almost every week, uh, in looking at that. Um, you committed, I think, at some point, uh, or we have asked for a comprehensive list of canceled contracts. Including contracts for veterans services like mental health, radiology, research, patient safety, infrastructure.

Uh, you provided a list of 620 contracts in March. It seemed to be incomplete. Again, without going into the details here, I'd like your commitment to provide those additional, uh, contracts. If you can point to the contracts you feel like you're missing, we'll be happy to, because at this point, my understanding, my, my direction was just to release everything that we have. So I'm— if you have something that you think you're missing, let us know.

Uh, I want to ask you about a very important veterans housing program. Um, in May of 2025, without any consultation or oversight, you ended the Veterans Affairs Servicing Purchase Program known as VASP, which was a kind of last resort tool for a lot of veterans to prevent foreclosure. There was no program in place to provide that same service. As you know about this program, it steps into situations where a veteran is about to lose their home and Unfortunately, now the VA is taking much longer than expected to implement the partial— the bipartisan partial claim program. Uh, recent data indicates that more than 15,000 veterans lost their homes since FASTP was ended, and another 90,000 veterans are at risk of losing their homes because they're in the process either of foreclosure or evictions.

Uh, will you commit to, to work with us in helping veterans who've lost their homes, especially those eligible for VASP or partial claim programs, to, to stay in their homes? Well, first and foremost, the, uh, VASP program was something the VA should never have been in to start with. It was not statutory. It was something that they basically came up with in the previous administration. It was causing issues with backlog of assets and stuff that we had no idea how to deal with.

We were not in the real estate business, should not have been there to start with. And on the advice of members of Congress, including chairman in the House and other people, we got out of a program we should have never been in to start with. Partial claims— I was never asked. I appreciate that, Senator. But there was no consultation with ever starting it either.

So, I mean, I think that's the problem that we have sometimes at the VA is that there should be better communication. But also, I will say this. I take a firm disagreement on partial claims. We were told that we would have that within 9 to 12 months. Guess what?

It's going to be in place by June 15th. We're going to be ahead of schedule of what we were promised this body that we would do. Right now, also, remember, the VA is about putting people in homes. We don't take people out of homes. Those are the mortgage bankers that take them out.

We don't take anybody out of homes. I understand that. But let me also say what we do. Let me also say what we do. And I appreciate your concern.

We have the same concern. But do you also—. People making.

They have to make payments on houses, many of which they're dealing with, but we also offer loss mitigation offers. We offer special forbearance. We offer repayment plans. We offer loan modifications. We do servicer incentives.

We do all of these things well before the time the foreclosure occurs. We do everything we possibly can to keep them from that end. If the mortgage company decides to foreclose, it's not because we have not done everything we possibly can. VASP was a program that should not have been started in the way it was and was adding to our outline, basically liability areas that we should have never been in. So I, I want to work with you to find a viable solution.

I think partial claims does that. We're supporting that. We're doing it ahead of schedule, and we're going to hopefully help these that, that are in need. Well, I take from what you've just said that, uh, the program, partial claim program, will be in place operating this coming month, correct? That is what— that is the indication I've gotten.

June 15th, and that is ahead of schedule. 15Th, okay. And that is ahead of schedule. Well, that's a commitment, and we will hold you to it. No problem.

Let me ask about VA research.

Why are you asking us to cut $20 million from the research budget? Richard will— Richard's here to discuss those very issues in the budget. Uh, Senator, as you know, our budget ask is $2.4 billion in budget authority, $979 million in VA direct funding for research projects. As you know, last year at the House Appropriations budget hearing, Secretary was pushed on $550 million in known waste in that program. As you know, we've struggled to have control over that portfolio.

While we've funded amazing breakthroughs that have benefited veterans, we've also done some things that probably we shouldn't have funded. For example, animal research. And after we told you we weren't doing it, we didn't think we were doing it, we were doing it. You passed a law telling us to get a hold of it. And last year, legislation was proposed that would have required us to track research spending and outcomes.

Um, that's where we were. Where we are, we have 4,377 research projects. We are tracking those projects. We can tell you where we're at. We can tell you what the outcomes are and how those benefit veterans.

We've got 17,282 overall research that we're supporting. Our budget request supports that, is responsive to your demands that we understand, manage, and be accountable for the outcomes of this program. And the budget request is there. I don't understand what you just said to me. We'll be happy to—.

Why? Why? You're doing great work and now you're cutting it. I know you've just given me a lot of numbers, sir, but—. Well, I am the CFO, Senator.

—To the why question there. The VA has been a world leader in research. Why are you cutting? We absolutely have. And we are accountable for the funding you're giving us.

We're accountable for the research that we're managing and we're accountable for the outcomes. We've done that. Our budget request reflects that. The budget request is $43 million, uh, difference of 1.5%. You're saying people are not asking you to— for research?

We're saying the president's budget request to fully fund our research portfolio. That's what we're asking you to do. That's our request. I, 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 well know, the VA has provided enormously important groundbreaking advances in medicine that have benefited Many people outside the veterans community. Senator, there is no change in our research portfolio.

There's no change in our research. What there is change is we are accountable for the program. We're managing it, and our budget request reflects. Okay, well, we can continue this conversation at a, at an earlier time in the, in the day on another day. But I have one last— I'm going to say this is a friendly suggestion, Mr. Secretary.

But since you raised the topic, I'm going to follow up. Travel. I have no doubt that you've traveled. You made reference to my traveling. I've never been invited to travel with you.

And more to the point, you have visited a lot of states where you haven't invited any of my colleagues. To be with you. So far as I am told, Arizona, Wisconsin, Colorado, Pennsylvania, North Dakota— I'm sorry, New York— Republicans have been invited, but no Democrats. And I have, and I'd like to make them part of the record, Mr. Chairman, posts from your account and members of Congress reflecting your visits. I'm not saying we have a scientific study here, but just that if you're going to talk about traveling and you visit states, I would respectfully suggest that, again, friendly suggestion, you invite Democrats as well as Republicans.

Well, I was just in Colorado with Democrats. I've been with Senator Hassan. And by the way, I don't— you don't need me to travel with you. You can go to your own facilities in your own state. I go all the time.

Not since January of last year. I'm sorry. Of last year. We have no record. Well, you may not have a record of every visit I have made to facilities.

I understand, Senator. We're good. Well, like I said, we'll go anywhere we need to go, but I'm out there working hard. But any implication that I don't understand what veterans and veteran employees are saying, I'm not going to talk. I'm not going to accept the premise of that question because it's all I do.

Thank you, Mr. Chairman. Um, on contract cancellations, Mr. Secretary, the VA has not yet briefed us. I know there was a bipartisan ask on this. Am I missing something?

At least my staff tells me that hasn't occurred. Help. I apologize. I, I maybe said something I didn't understand. Contract cancellation or cancellation?

You and Senator Guy Ager. Well, we come from the same— we were in the House together, you know, before you left us, we went, you know, to the House. After that, we don't hear as well anymore. I'm only pointing out Senator Blumenthal raised the topic of contract cancellations. And what I'm pointing out is there is a bipartisan request for us to be briefed, which we— I'm told has not yet happened.

Mr. Chairman, I believe we've provided that. And so we provided the review of 76,000 contracts. We identified the 620 contracts we terminated, the 103 we de-scoped, and the 842 we did not exercise options on. We provide the $61.7 million total, uh, and then the $5 billion in cost avoidance. So a total of 1,565 contracts.

I believe we provided that to—. Let me see what the folks behind me have to say. What you're asking for is this meeting—. It's a briefing request, not the numbers. Yeah, we got the numbers, but what I'm reminded of is that you're working to schedule a meeting with my staff, with our staff.

Oh, so you want more than just the information? You're correct. Talking. We want a briefing. We're good.

We're good. Y'all want to have a meeting? That's great. No, we're good. We gave you the information.

We thought that might be good. So we'll have the staff set up. Thank y'all for getting it set up. We'll have one. I think it's in the works.

Appreciate it. Um, my script says if there are no more questions, and I'm going to say there are no more questions, uh, I again thank you for your presence here 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. Uh, ask our witnesses to respond any questions for the record received, received in the following today's hearing in a timely manner. And the hearing is adjourned.