(Senate - May 22, 2018)

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[Congressional Record Volume 164, Number 84 (Tuesday, May 22, 2018)]
[Pages S2815-S2827]
From the Congressional Record Online through the Government Publishing Office []


  The PRESIDING OFFICER. Cloture having been invoked, the clerk will 
report the House message to accompany S. 2372.
  The senior assistant legislative clerk read as follows:

       House message to accompany S. 2372, a bill to amend title 
     38, United States Code, to provide outer burial receptacles 
     for remains buried in National Parks, and for other purposes.


       McConnell motion to concur in the amendment of the House to 
     the bill.
       McConnell motion to concur in the amendment of the House to 
     the bill, with McConnell amendment No. 2246 (to the House 
     amendment to the bill), to change the enactment date.
       McConnell amendment No. 2247 (to amendment No. 2246), of a 
     perfecting nature.
       McConnell motion to refer the message of the House on the 
     bill to the Committee on Veterans Affairs', with 
     instructions, McConnell amendment No. 2248, to change the 
     enactment date.
       McConnell amendment No. 2249 (to (the instructions) 
     amendment No. 2248), of a perfecting nature.

[[Page S2816]]

       McConnell amendment No. 2250 (to amendment No. 2249), of a 
     perfecting nature.

  The PRESIDING OFFICER. The Senator from Montana.
  Mr. DAINES. Mr. President, we have all seen the headlines across the 
Nation about the VA Choice Program and how it has failed our veterans. 
I wish to share some of those headlines from my home State of Montana.
  From Montana Public Radio, the headline was: ``Montana Hospitals: New 
VA Program Fails To Pay.''
  From NBC Montana, the headline was: ``New problems for Veterans 
Choice in Montana.''
  From the Billings Gazette, the headline read: ``Painful truth about 
Montana VA.''
  As I travel around the State, as I hear from veterans who come back 
to Washington, DC, I personally have heard from them, from countless 
healthcare professionals, from our hospitals regarding payment delays, 
long waiting times, and elusive runaround on the most basic services.
  Under the Choice Program, our veterans did not receive the healthcare 
they deserved. However, the bipartisan MISSION Act will follow through 
on the promises that were made to our veterans. Rural veterans will get 
greater, easier, quicker access to the care they need. Whether a 
veteran lives 20, 30, or 40 miles from a VA clinic, they can go 
elsewhere if the VA does provide them with the services they need. It 
brings VA care into the 21st century by encouraging telemedicine and 
strengthens oversight of opioid prescriptions. Veterans will have more 
access to doctors because there will be measures holding companies 
accountable--companies like Health Net--for how they manage the new 
program. It provides scholarships to encourage medical and dental 
students to serve in the VA, and it creates a new loan repayment 
program for medical students who are training in specialties that are 
currently lacking in the VA.
  This is one of the big problems we have. We can't fill the slots with 
medical professionals in the VA. It is about time we take meaningful 
steps toward fully delivering on the promises we have made to our 
  On this Memorial Day week, I wish to share that we have passed my 
bill to name VA clinics in Missoula and Billings after Montana veterans 
David Thatcher, Dr. Joseph Medicine Crow, and Benjamin Steele. My bill 
has been sent to President Trump's desk for his signature. With the 
passage of the MISSION Act, these three clinics will be delivering new 
and improved care and will also display the names of three Montana 
World War II heroes. I urge my colleagues in the Senate to join me in 
supporting the VA MISSION Act.
  I yield back my time.
  The PRESIDING OFFICER. The Senator from Washington.
  Mrs. MURRAY. Mr. President, I come to the floor today to bring 
attention to a particular provision of the bill now before the Senate--
a provision that would do so much to help our country fulfill its 
promise to our veterans--and that is to expand and strengthen the VA's 
caregiver program.
  This program may not be well known outside of military family 
circles, but, make no mistake, the caregiver program could be a game 
changer for the estimated 5.5 million people across this country who 
put their lives on hold to care for a loved one who returned from 
service with illness or injury.
  I met one of those caregivers not too long ago in my home State of 
Washington. Tiffany Smiley wears many hats. She is a mother, a wife, a 
nurse, and a veteran caregiver. She and her husband Scotty first met 
back in junior high, and years later they were married. He signed up to 
serve our country and Tiffany became a military spouse. Then, in 2005, 
she got the call every military family fears. Scotty had been severely 
injured in a suicide bombing in Iraq. He was alive, but he lost his 
eyesight permanently.
  As Tiffany describes it, her world was shaken to its core, and their 
lives were never the same again. But Tiffany, like so many other 
military spouses, didn't think twice about whether she would care for 
her husband and their growing family. It was just a matter of how she 
could do it. To this day, Tiffany is an amazing advocate for the 
caregiver program and what it has meant to her and to her family.
  She describes both the good days and the bad days, so those of us not 
in her shoes can understand some of the challenges they face. She does 
it because she knows she is not alone. She knows that sharing her 
experience is making a difference to educate the rest of the country 
about what it means to be a veteran's caregiver.
  It is so true. I heard from countless people who, when their loved 
one came home from service with an injury or illness, made big life 
changes by quitting a job, scaling back their hours, or taking leave 
from college. They put big purchases, retirements, and dream vacations 
on hold or they took on more parenting responsibilities. You name it. 
They sprang into action and did what they needed to do, because that is 
just what you do when it is someone you love.
  We know that the care military caregivers provide comes at a cost. 
Several years ago, the Dole Foundation commissioned the largest ever 
study of its kind to examine the sacrifice of military caregivers. It 
showed that some caregivers spend more than 40 hours a week caring for 
veterans. That is the equivalent of a full-time job, and that takes a 
toll. The study showed that caregivers have significantly worse health 
than noncaregivers. They run a higher risk of depression because they 
put their own physical and mental well-being on hold. The stress of 
providing care can strain relationships and increase divorce rates. So 
caregivers--or, as they are often called, our hidden heroes--don't 
necessarily wear a uniform or go overseas, but they sacrifice a whole 
lot and they serve our country in ways most people find unimaginable.
  That is why expanding the caregiver program to veterans of all eras 
is so important, because the program provides resources and support, 
including training and counseling, a stipend, access to healthcare, 
respite, and more.
  This bill expands the support services for caregivers to address 
their still unmet needs. That includes offering financial and legal 
advice to deal with the many complex and difficult challenges that 
arise that are unique to being a caregiver.
  Not only does the caregiver program recognize the sacrifice of 
caregivers, but it also puts decisions about care into the hands of the 
veterans and their loved ones. They can decide to be at home with 
onsite care or on their own terms and as independent as possible. That 
is really important. The fact that we are so close to getting this 
program expansion across the finish line goes to show how far we have 
moved this conversation. That is also why we have to keep pushing it 
forward--so veterans and military caregivers never feel like they have 
to face these problems alone, because the reality is that if a 
servicemember is hurt while fighting for our country, the 
responsibility of care should never fall to only one family. It is the 
responsibility and the duty of our entire Nation to have their backs 
and give them what they need.
  We can't stop until we get this done. We can't stop until every 
veteran and military caregiver knows that their country is there for 
them on their terms, no matter what. I am so proud that the caregivers 
program expansion is front and center in the VA MISSION Act now before 
the Senate. On behalf of Tiffany and Scotty and all of the other 
military families out there, I urge my colleagues to express their 
support for this critically important program.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SULLIVAN. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Cloture having been invoked, the motion to refer and the amendments 
pending thereto fall.
  The PRESIDING OFFICER (Mr. Hoeven). The Senator from Alaska.

                         Tribute to Rich Owens

  Mr. SULLIVAN. Mr. President, as my colleagues know, one of the best 
times of the week for me is when I get to come down to the floor and 
talk about some of my great constituents back home in Alaska, somebody 
or a group of Alaskans I refer to as the ``Alaskan of the Week.''

[[Page S2817]]

  We all think we come from great States, but what I really enjoy about 
talking about the Alaskan of the week is not just talking about Alaska 
and how beautiful and big and majestic it is but also about the people 
who make it such a great place. In this ``Alaskan of the Week'' 
presentation, I want to talk about not just Rich Owens, whom I am going 
to talk a lot about this afternoon, but also small businesses in 
Alaska--in this case, in Anchorage, my hometown. As you know, the 
owners of these businesses really make a positive impact on communities 
like Anchorage or States like Alaska or really the whole country.
  When you think of Alaska, you think of food. Particularly right now, 
as spring is in full swing, you think of our delicious salmon. I have 
good news for all the salmon lovers out there: Copper River salmon 
season opened last week. It is some of the best wild salmon on the 
planet. You might also think about our halibut and black cod, king 
crab, shrimp, and oysters. We actually serve that to our fellow 
Senators here when we have lunch. I know the Presiding Officer loves 
Alaskan seafood.
  I want people to actually realize that some of our food is ice cream. 
I know that sounds strange--ice cream in Alaska. In fact, it is said 
that Alaskans consume more ice cream per capita than any other State in 
the country. Go figure on that one. That doesn't surprise Rich Owens, 
our Alaskan of the week, who is the owner of the bustling Tastee Freez 
on the corner of Jewel Lake and Raspberry Road in Anchorage. That 
Tastee Freez, which opened in Anchorage at a slightly different 
location 60 years ago, is one of the oldest Tastee Freezes in the 
country, and it sells more ice cream than any other Tastee Freez in 
America. That is remarkable. Rich also claims the largest menu of any 
Tastee Freez in the United States.
  Like so many of our great small businesses, it is much more than just 
an ice cream store. To those who live in Anchorage and many who live 
across the State, Rich's Tastee Freez is an institution. It is a 
bulwark for the community, thanks largely to Rich's ownership. Since he 
bought the business in 1994, he has made giving back to his community 
his top priority in so many different ways beyond running that great 
small business.
  Rich was raised in a small town in Montana. His father was a 
pharmacist, and his parents owned a drugstore. Giving back to the 
community was something he saw his parents do every single day. ``It 
was not the exception,'' Rich said, ``it was the rule.''
  Rich came to Alaska in the 1980s to work at what is now the 
Millennium Hotel--another great business in Alaska. In 1994, he bought 
the Tastee Freez. Since that time, Rich has donated his time and energy 
and, importantly, his philanthropy to our great State and our 
community. Let me provide a few examples.
  Rich is a huge champion for our schools. That can mean delivering up 
to 400 sundaes to elementary schools when they have a family reading or 
math night. He helps fund school trips for students who need help. 
Every year, each elementary school that he works with stages a Tastee 
Freez takeover. School staff members work shifts behind the counter, 
and Tastee Freez employees wear school T-shirts. Those takeovers are 
widely advertised and popular, and Tastee Freez donates a portion of 
that day's take to the school. He is very focused on community.
  Rich has also formed a work-study partnership with high schools. He 
guesses that the average age of his 28 employees is 17 years old--about 
the age of our pages right here listening so intently. For so many 
Alaskans, it was their first and some say their best job ever, working 
in that Tastee Freez Rich owns. He has donated his time, energy, and 
talents to successful summer camps that teach young Alaskans about the 
outdoors and important values. One of his assistant managers began to 
work at the shop when she was 15 years old. She is 31 years old, and 
she met her husband at the shop. This is a great community small 
  Rich is also a huge supporter of our military, our veterans, and the 
National Guard. As we are approaching Memorial Day weekend and as we 
are literally debating a very important Veterans Affairs' bill on the 
Senate floor right now, it is important to remember the thousands of 
Alaskans and the literally millions of Americans who are veterans and 
those like Rich, who are supporting our veterans day in and day out.
  For example, Rich has been part of the Alaska National Guard's 
Operation Santa Claus each Christmas holiday, which flies Santa Claus 
and a bag of presents, toys, school supplies, and fresh fruit to some 
of the most remote, far-flung Alaska villages each year during the 
holidays. These kids and these communities love it. Of course, Santa 
and his helpers also bring Rich's ice cream. Thanks to Rich, the kids 
get ice cream in the winter. Every year, he serves thousands of 5-ounce 
sundaes to these young kids in our villages--some who have never seen 
sprinkles or caramel toppings on their ice cream. For his efforts, Rich 
is known in my State as the commander of the Alaska National Guard Ice 
Cream Support Squadron.
  Just a few weeks ago, the Tastee Freez in Anchorage--Rich's great 
small business--celebrated 60 years of service to the community. In 
case you want to know whether this is a popular small business in our 
community, over 1,000 people showed up at this celebration. They served 
1,644 small ice cream cones, not including the dipped cones and sundaes 
that day--all free of charge.
  I was there for that great celebration. Senator Murkowski was there. 
Congressman Young was there. Our Governor was there. Tastee Freez 
corporate officers from the lower 48 flew up to Alaska for this big 
event. They had never seen anything like it. This is the No. 1 Tastee 
Freez in the country. But what most excited Rich that day was all the 
people there he had served throughout the years, including the hundreds 
of people who used to work at the shop, who met their spouses at Tastee 
Freez and then had children, and those children now go there, and some 
even work there.
  That is what a small business with heart can do for a community. It 
can provide young people with their first real job. It can bring us 
together. It can provide a sense of community. It can serve the 
community. And, of course, it can be a delicious place of memories for 
families. That is what the Tastee Freez in Anchorage has done, and that 
is why we want to congratulate Rich on being our Alaskan of the week 
and thank him again for all the great things he has done for our State 
and community.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. MORAN. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MORAN. Mr. President, I am pleased to be back on the Senate floor 
this afternoon in support of the VA MISSION Act. I was here last 
Thursday, and, in part, I paid tribute to Senator McCain. We greatly 
miss him here on the Senate floor. I personally--and I know my 
colleagues also--wish he were here to help us determine a path forward 
and to find the solutions to problems. Senator McCain is an expert in 
caring for those who have served us in the military and taking care of 
our military retirees and our veterans. So, again, I use this moment on 
the Senate floor to pay tribute to my colleague Senator McCain and to 
thank him for his service to our Nation and his willingness to work 
side by side with me as we develop legislation that deals with the 
issue of community care for veterans across the country.
  I highlighted last Thursday that challenges at the VA have caused 
Congress to respond, and that response involves Choice, legislation 
that now exists in which, under certain circumstances, veterans have 
the ability to find and be provided care within their communities. They 
can see their hometown physician and be admitted to their hometown 
hospital under certain circumstances.
  The Choice Program has worked well for many veterans, just as the VA 
itself internally works well for many veterans. But I know from my own 
experience as a Member of the U.S. Senate

[[Page S2818]]

that Kansans have experienced significant challenges with VA programs, 
especially with the Choice Program, in which the bureaucracy seems to 
inhibit the ability of the VA to provide the care that veterans across 
Kansas are seeking.
  I indicated last week that currently within our office, we have 80 
cases in which we are dealing with veterans who are facing challenges 
from something they need from the VA and are not receiving. I looked at 
the numbers prior to that since I have been a Member of the U.S. 
Senate. There have been 2,650 occasions in which a veteran sought help 
from their U.S. Senator for something we would expect them to be 
entitled to based upon their service to our Nation. We are grateful to 
those veterans, and we want to make sure they are honored and esteemed. 
At the same time, we want to make sure the promises that were made to 
those who have served our Nation are kept.
  The legislation before us that has been approved by the House of 
Representatives and is now in front of the Senate has been entitled the 
VA MISSION Act. We were actually successful in honoring Senator McCain 
by including his name in the title. Again, I appreciate his willingness 
to help create the Choice Program and now to reform and extend it.
  One of the challenges I have taken upon myself is to make certain we 
don't simply--nothing is simple around here--just extend the current 
Choice Program. We have worked to reform it and improve it and make it 
more likely that the challenges of those 80 veterans who are seeking 
help from my staff or those 2,650 who have sought help from my staff 
are a lot less.
  So I judge the efforts in this legislation with this challenge: What 
are we doing to reduce the problems veterans encounter in seeking the 
help they are entitled to? In a conversation with my staff, I asked 
them to give me the top 10 reasons why this legislation is a good 
thing; tell me what are the top 10 reasons a Member of the U.S. Senate 
should vote for this legislation.
  Incidentally, when we pass it, it will be forwarded to the President. 
President Trump has indicated his strong support for this legislation, 
so there is every indication the President will, of course, since he 
supports the legislation, sign it into law and will do so prior to 
Memorial Day, a time in which we again pay respect to those who have 
served our Nation.
  My top 10 list became 12, and I would guess that if given more time 
and greater ability to spend time on the floor, that list of 12 could 
be expanded to a much longer list, but let me share with my colleagues 
reasons that I think it is important for this legislation to be 
approved and to be sent to the President.
  Again, I was a skeptic early on. I wanted to make certain that we did 
something significant and not just extend the Choice Program into the 
future but make significant changes. The challenge has been trying to 
make certain the VA does things we want them to do, that they follow 
the letter of the law of legislation we pass, and they follow the 
intent of Members of Congress. In regard to the Choice Act that passed 
now 3 years or so ago, it was hard sometimes to see that the VA was 
implementing that legislation the way it was written or the way it was 
  No. 1 of the top 12 reasons this legislation should be approved is 
that this legislation makes certain the VA executes the law consistent 
with the intent of Congress. It mandates coordination with Congress as 
it develops rules and regulations under this new legislation.
  The goal I expect to be successful in achieving is to prevent the 
VA's ability to narrow or limit the program's opportunity to serve 
veterans as was intended by this law and, more importantly, as they 
  No. 2, this legislation consolidates community care programs. There 
are seven different community care programs within the VA in which a 
veteran can access care away from the hospital--the big brick buildings 
that most of us have in our States; usually in the most populated areas 
of our States--and those seven community care programs are consolidated 
into one community care. That will reduce the bureaucracy at the VA but 
will also make it more understandable for our veterans and for the 
providers, including doctors, hospitals, and others who provide care to 
veterans today, in those community care programs--one program, not 
  No. 3, we want to improve care coordination. By that we mean the 
quality of the relationship that a veteran has with the VA and what 
that relationship means in terms of them accessing care today and 
tomorrow and care related to their circumstances. This legislation 
requires the VA to provide a coordinator of care for veterans utilizing 
care in the community to ensure continuity of care and service in a 
timely manner. This will make it an easier task for a veteran to 
receive what they need, and it ensures it is done in a timely way. It 
also prevents lapses in care by increasing the communications between 
the veteran and the VA community provider.
  No. 4, the legislation reforms eligibility. This is an important one. 
They are all important, but this one is especially important to me.
  Under the Choice Act under which we operate today, the VA was 
instructed to allow a veteran who lives more than 40 miles from a VA 
facility or it takes more than 30 days for that veteran to receive his 
or her care at the VA--to provide, under Veterans Choice, that care in 
a community setting. Eligibility was defined by a narrow circumstance. 
However, having said that, it was never clear whether a veteran would 
  That 30-day, 40-mile criteria empowered the VA to make decisions that 
often left a veteran who seemingly should be eligible, ineligible for 
care in the community. This legislation removes the 30-day, 40-mile 
requirement and replaces it with the criteria of what is in the best 
interest of the veteran. That is pretty important and pretty basic. One 
would expect that always to be the circumstance, but the criteria is 
changed now to what is in the best interest of the veteran, and the VA 
must meet clearly defined, routinely reviewed criteria as to whether 
that veteran is eligible to have community care if he or she desires 
it. So we are reducing the discretion. The decision is still made 
between the veteran and the VA, but we have narrowed the amount of 
discretion the Department of Veterans Affairs has and left the 
opportunity for the veteran, when it is in his or her best interest, 
access to care in the community.
  So it is clearly defined, and the criteria is routinely reviewed to 
make sure access is available and that quality standards are met.
  No. 5, if it turns out that the veteran disagrees with the decision 
made by the Department of Veterans Affairs as to whether he or she is 
eligible for care in the community--whether or not it is in his or her 
best interest--then there is an appeal to the hospital director in that 
person's area. In Kansas, this would be an appeal to the hospital 
director at the Colmery-O'Neil Hospital, at the Dwight Eisenhower 
Hospital in Leavenworth, or the Dole VA Hospital in Wichita.
  Today, when a veteran is denied access to care in a community, their 
only recourse is to call their Congressman or to call their U.S. 
Senator to complain and have us go to bat. While we are all willing and 
we welcome the opportunity to serve those who have served us, the 
reality is, no one--and certainly no veteran--should have to call their 
U.S. Senator in order to get the VA to provide care that is in their 
best interests.
  So this now gives a different route and hopefully a much more 
convenient route for veterans. We wouldn't have had the 2,650 cases if 
we had this provision. The veteran could have the opportunity to have 
their decision about their care--what is in their best interests--
determined by the VA at home. So there is recourse for a veteran who is 
dissatisfied with the outcome.
  No. 6, this provides full access for episodes of care. What our 
veterans have faced in using the Choice Act to date is, they will get a 
referral to a physician, but then the physician decides the veteran 
needs lab work or an x-ray. Unfortunately, that meant the veteran had 
to return to the VA to seek additional approval for the lab work and 
additional approval for the x-ray.
  So we have redefined what it is the referral involves, which is they 
are referred for an episode of care. That means the lab work and the 
entire episode of care is treated in completion in

[[Page S2819]]

the community. No longer is the veteran required to re-call, re-request 
the VA to give them additional reauthorization.
  No. 7, the legislation also mandates regular market assessments to 
determine what care is available in the community and where the 
Department of Veterans Affairs excels. We know the Department of 
Veterans Affairs has many medical programs, care, and treatments that 
veterans want and need, in which they excel. This gives us a better 
understanding--the veteran, the Department of Veterans Affairs, and us 
as Members of Congress in our oversight responsibilities--to know what 
is available within the VA and what is available in the community, and 
that lends itself to the determination of what is in the best interests 
of the veteran.
  No. 8 of the list of 12 is something that is important to us as 
Members of Congress who have veterans who come from rural areas. We 
have 127 hospitals in Kansas; 88 of them are designed as critical 
access hospitals. It is a designation under Medicare, and it provides a 
cost-based reimbursement for that healthcare provider. It means our 
smallest hospitals in our smallest communities have a Medicare 
reimbursement rate that is designed to keep them in business, to keep 
their doors open.
  Unfortunately, the Choice Act, in its current form, only requires the 
VA to reimburse at Medicare rates. That Medicare rate was never 
interpreted by the VA to be the rate that hospital received for 
Medicare patients, only a more standard Medicare rate. This legislation 
requires that the care be paid for at that critical access hospital 
designation rate. The same, I hope, is true for our rural health 
clinics, so physicians and hospitals receive the amount of money they 
would receive if they were treating a Medicare patient.
  Why is this important? It is important because it encourages our 
hospitals to accept veterans into the community care program. The 
amount of reimbursement they would receive would be the same or similar 
to what they receive in caring for a Medicare patient, and our 
hospitals, in that circumstance, are hanging on financially by a thread 
anyway. It is a challenge to keep hospital doors open in our smallest 
communities. This gives them a reimbursement rate that increases the 
chance that the revenue is sufficient to cover the cost. It will 
encourage more hospitals to accept Choice community care patients, and 
it will increase the chance of those patients being alive and well into 
the future.
  No. 9, this bill allows for access to walk-in care. Something that is 
changing in our delivery healthcare system is the ability to go to a 
pharmacy and have your blood pressure taken or get an inoculation, a 
vaccine. So access to walk-in care is becoming more common across our 
State and around the country. This allows our veterans to receive, 
under this community care program, care from local walk-in clinics, 
convenient care clinics, and federally funded health centers, giving 
veterans the same access to nonemergent convenience care that people 
other than veterans now receive.
  Allowing walk-in care at your local clinic is a much more convenient 
and a much more cost-effective way of addressing the issue of access to 
care across the State of Kansas and around the country.
  No. 10, this legislation provides additional funds to maintain the 
Veterans Choice Program during its development and implementation. One 
of the challenges we faced is the inability of the Department of 
Veterans Affairs to determine actually how much money is required to 
keep the Choice Program going. This legislation keeps the program in 
place while we transition.
  I serve as a member of the Appropriations Committee, and I have 
chaired the subcommittee that funds the Department of Veterans Affairs. 
We have been worried that every time there is a shortfall in the money 
available for Choice, we will see the VA reduce the number of veterans 
who qualify for care and therefore starve the program, and the networks 
that have been built up with healthcare providers in the community will 
disappear. So this is stabilizing. It is a process issue, but it is 
important because it allows for care to continue during the interim as 
we move to this new legislation.

  No. 11, it increases access to telemedicine. The VA is known as a 
high-quality provider of telemedicine, but this is an opportunity to 
expand that, especially for rural veterans or specialty care, where it 
is expensive for that care to be provided--and we don't have providers 
in every VA setting--or if where a veteran lives is so remote that 
getting to the Department of Veterans Affairs hospital is a challenge. 
The State of Kansas has lots of rural communities and long distances--
it can be a 4- or 5-hour drive.
  I have been joined on the floor by the Senator from Montana, the 
ranking member on the Veterans' Affairs Committee on which I serve. The 
Senator from Montana understands very well the challenges rural 
veterans face in getting access to care when it is a distance away.
  Finally, No. 12, we are going to work hard to foster innovation 
within the Department of Veterans Affairs. This legislation creates the 
VA Center for Innovation for Care and Payment, allowing the VA to more 
efficiently develop and carry out pilot programs to test and check out 
innovative solutions and approaches to improving the care for veterans, 
improving access to care, improving the cost associated with that care, 
and trying to find ways we can better assist our veterans in a more 
cost-effective way.
  I again reiterate my support for the VA MISSION Act and honor Senator 
McCain, for whom this legislation is named. I look forward to its 
passage. I am encouraged by the vote that occurred as we moved forward 
with this bill. I think there were 94 Senators who voted in favor of 
it. It has broad support.
  It was my pleasure to work with my colleagues on the Veterans' 
Affairs Committee.
  I now yield the floor to the Senator from Montana, Mr. Tester.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. TESTER. Mr. President, I thank Senator Moran for his kind 
  I want to begin my comments by acknowledging the chairman of the 
Senate Veterans' Affairs Committee. We would not be here today taking 
up the VA MISSION Act without the leadership of Senator Johnny Isakson 
of the majority. He is a fierce advocate for veterans, and he has been 
an incredible pleasure for me to work with. The bipartisanship and 
collaboration on our Senate Veterans' Affairs Committee happens because 
we leave politics at the door. That is possible because of Johnny's 
personality and leadership style, as well as his commitment to the 
veterans of this Nation.
  I would also like to thank the many veterans service organizations 
that have weighed in and provided positive feedback on the VA MISSION 
Act. Thirty-eight veterans organizations representing millions of 
veterans and service men and women nationwide support the VA MISSION 
Act. They have been asking for Choice reform and responsible investment 
in the VA, and this bill gets it done.
  I also thank the House Veterans' Affairs Committee for working with 
us in getting a bill drafted that we can all be proud of.
  At the beginning of this Congress, we set out to draft a bill that 
reforms community care and also strengthens the VA. As Senator Moran 
pointed out, coming from a State like Montana--a rural State, 147,000 
square miles--I know we cannot have a VA clinic in every community, but 
veterans cannot always drive 2 hours to the nearest VA clinic, and they 
certainly can't afford to wait months for an appointment. That is why 
we need private healthcare to fill in the gaps when the VA cannot 
deliver that healthcare.
  I also know how much veterans need the services they get from a VA 
clinic. In my dozens and dozens of face-to-face listening sessions with 
veterans, they have told me that the kind of care they get from the VA 
is important. They are surrounded by their peers, many of whom have 
experienced the mental and physical implications of being in combat. VA 
doctors and nurses know how to treat PTSD, toxic exposure, and other 
wounds unique to their service.
  The best defense against any effort to privatize the VA or send 
veterans wholesale to the private sector is to make sure the VA is 
living up to our promise to veterans. The VA MISSION Act recognizes 
that there is a balance

[[Page S2820]]

between VA care and community care and invests in medical and clinical 
staff to serve veterans at the VA. It builds capacity within the VA, 
and it uses the private sector to fill in the gaps where the VA falls 
  It takes the bill that Johnny and I wrote, the Caring for Our 
Veterans Act, and adds a few things, but the foundation of this 
legislation is something Senator Isakson and I have written over the 
course of the last year with veterans groups. So I am incredibly proud 
to be standing here today to hopefully push this bill to the 
President's desk.
  The Choice Program was created with an important mission: to make it 
easier and faster for veterans to get healthcare. It hasn't worked like 
that for many veterans--veterans like Tom, a retired U.S. Navy 
commander of the Vietnam war, a Montanan. In his 24 years as a Navy 
pilot, Tom spent a lot of time yelling to be heard over the roar of an 
engine. That took a toll on his ability to hear. Three years ago, he 
began the process of getting hearing aids from the VA. He got his 
hearing test done, but when it came time to order the hearing aids, Tom 
was told that he wasn't authorized.
  The nearest VA facility to Tom was almost 3 hours away, so he and his 
wife decided to drive to the closest civilian clinic, which was about 
45 miles away in Sandpoint, ID, just across the line from his home in 
Noxon, MT. There, he hit another snag. After weeks of back-and-forth 
visits, the authorization was again denied because he was not a 
resident of Idaho. So he returned to square one. He drove 5 hours to 
Fort Harrison in Helena, 250 miles away.
  With assistance from my office, he got the authorization for those 
hearing aids. Tom had to drive two 5-hour roundtrips to a Choice 
provider in Kalispell, but a few months later, he finally received his 
hearing aids.
  All in all, Tom drove nearly 20 hours to get those hearing aids, and 
I am here to tell you that it shouldn't be that hard for a veteran to 
get the healthcare they have earned from the VA. Do you know what the 
worst part is? There was an audiologist in Tom's hometown the entire 
time who could have helped him if the VA had just realized how 
important it was to access that audiologist instead of driving 20 hours 
down the road.
  Unfortunately, Tom is not the only veteran with a story like this. I 
could tell you about a veteran in Lake County who had several 
appointments scheduled through the Choice Program, and then he was told 
he wasn't eligible for Choice at all--after his appointment. When he 
caught pneumonia, my office stepped in and got him the care he needed 
through the Choice Program. I could tell you about Bruce, a veteran in 
Billings who couldn't get a followup appointment through the Choice 
Program after his hip surgery. He was told he wouldn't wait more than 5 
days, and then he couldn't get anybody on the phone. We were able to 
help him get the followup care he needed. Terry, in Butte, got a 
procedure done through the Choice Program. It was approved, completed, 
and then he was told he didn't qualify for the Choice Program. Again, 
this U.S. Senator had to step in so Terry didn't have to foot the bill 
for his healthcare.
  I could go on and on. Veterans across the State of Montana have 
called my office for help since the Choice Program was started. Their 
frustrations over issues like scheduling, reimbursements, or traveling 
long distances for care are a sorry way to say thank you to those folks 
who have served this country.
  It shouldn't take a Senate office stepping in to make sure the 
government lives up to its promises to America's veterans, so Chairman 
Isakson and I wrote a bill that reforms the entire system. We 
negotiated with the House, the White House, veterans, and advocates to 
move our bill forward.
  The Caring for Our Veterans Act was a giant step forward. Thanks to 
the leadership of the House Veterans Affairs Committee and our effort, 
the Caring for Our Veterans Act is included in the VA MISSION Act.
  Our bill gets rid of seven different community care programs, 
including Choice, and replaces them with one community healthcare 
system with a streamlined set of rules for veterans, local providers, 
and VA staff. It will be much easier to understand.
  Under the MISSION Act, if a veteran wants to get care in their 
community, they can have a discussion with their doctor and decide what 
is best. VA doctors and nurses won't have to spend time figuring out 
which program to refer a veteran to.
  Local providers who see veterans won't be waiting months for payments 
from the VA. A new, streamlined payment system will make sure they are 
getting paid in a timely manner.
  Our bill holds the VA accountable and requires them to create a 
business plan to tell us exactly how the agency will spend taxpayer 
dollars if and when they ask for additional funding.
  Our bill brings more providers to work at the VA, especially in rural 
and Tribal areas and vet centers.
  The bill breaks down barriers along State lines that prevent veterans 
from accessing mental health care closer to home.
  The bill expands the VA Caregiver Support Program to veterans of all 
eras and their caregivers. This was a provision Senator Murray worked 
on very hard. It was the right thing to do, and Senator Isakson made it 
a priority of his.
  The VA and community care are equally important parts of the VA 
healthcare system. It will either starve the VA to death and empower 
rural community hospitals or, as this bill does, strike a balance--the 
right balance--between investing in the VA's ability to provide care 
for our veterans and cutting the bureaucracy when it makes sense for a 
veteran to go to a local doctor.
  The VA MISSION Act is a bold, bipartisan product of working together 
that puts healthcare decisions in the hands of veterans and breaks down 
barriers to healthcare wherever it makes the most sense for a veteran 
to get the care they need.
  This Nation owes our veterans much more than a thank-you. Veterans 
deserve a healthcare system that works for them regardless of where 
they live, what medical condition they are struggling with, or their 
means. Our bill gets rid of a one-size-fits-all system and creates a 
more efficient and easier to navigate system for veterans.
  I urge the Senate to pass the VA MISSION Act to send the message that 
saying thank you isn't enough for those who put their lives on the line 
for our Nation. We are going to deliver them a healthcare system that 
is worthy of their service.
  Mr. President, I turn the floor over to Senator Johnny Isakson, 
chairman of the Senate Veterans' Affairs Committee.
  The PRESIDING OFFICER. The Senator from Georgia.
  Mr. ISAKSON. Mr. President, before the Senator from Montana leaves, I 
wish to thank him for 3 years of dedicated service and the last 2 in 
particular as we put together the pieces of shrapnel--which was the 
original attempt to make Choice work--to be a streamlined program that 
is going to work for all of our veterans.
  Jon Tester has been a magnificent ranking member and a magnificent 
leader. I appreciate very much the kind things he had to say about me, 
and I say ditto to you.
  I also thank Chairman Phil Roe, of Tennessee, in the House of 
Representatives. He has been a stalwart.
  The reason we are able to act today and tomorrow--as the House did 
last week--and pass a bill before Memorial Day is because both bodies 
have worked together, and the votes have been overwhelming. Our motion 
to invoke cloture this morning was 91 to 4. The House passed this 3 to 
1 when they passed it in final passage. So obviously there was a lot of 
unanimity, but that should not be a disguise for the effort it took. It 
took a lot of effort to get to where we are and a lot of people doing 
that effort--a lot of Republicans, a lot of Democrats, a lot of staff. 
There was a tremendous amount of staff time. We went from doing the art 
of the impossible to making the art of the possible, with everybody 
working together, leaving our political weapons at the door, and 
putting our good heads together to make the Veterans' Administration 
system better for our veterans.
  My speech is not going to be long because Senator Moran and Senator 
Tester have covered the types of examples the new Choice Program brings 
for all our veterans--a real choice, a real opportunity to make the 

[[Page S2821]]

sector a force multiplier for access to healthcare for our veterans but 
also make our healthcare system for our veterans accountable--
accountable to the most important people of all, and that is our 
  It does a few other things too. It creates a caregiver program for 
the Vietnam-era veterans. That hasn't been talked about much on the 
floor, but Patty Murray on our committee and Susan Collins from the 
Republican caucus in the Senate have for years tried to get caregiver 
benefits for Vietnam-era veterans and veterans of other wars which were 
not covered previously. With the passage of this bill, they will be 
covered for those basic essentials of life and necessities. They will 
have that covered for them, and we will get it done.
  Those veterans who came home from a terrible war in Vietnam with many 
injuries we had never seen people survive before also need care we 
never thought we would have to pay for before, but we are doing it now 
with caregivers for that generation, which is my generation. I am proud 
to say that we are finally looking after them and are seeing to it that 
they are included and are working hard on doing so.
  We have also made Choice accountable to the veterans, working for our 
veterans and making our VA better at a lower cost to the taxpayers than 
it would have been otherwise, were we providing that service solely by 
the VA. You get choices, you get quality, you get better service, and 
you get a better VA for our veterans.
  There have been a lot of people who have made this happen. Senator 
John McCain originally introduced the idea of Choice 4 years ago. He 
founded it, and that is why his name is a part of the title of this 
bill. We could not have done this without John. He is a great American 
hero, a great colleague, and through our prayers and our blessings, we 
wish for him to recover as he is in Arizona.
  I want to thank Joan Carr, my chief of staff; Trey Kilpatrick, my 
deputy chief; Jay Sulzman; Amanda Maddox; Ryan Evans; Sal Ortega; and 
Kristine Nichols. My staff has been phenomenal. They have done a great 
job. They put up with a lot. They have worked hard, and we got here 
because of them.
  Also, I thank the other unsung heroes of the Committee on Veterans' 
Affairs who have helped Jon Tester and me and all our members to see to 
it that we covered every item, dotted every i, and crossed every t: Bob 
Henke, our staff director; Adam Reece, who deserves a special shout-out 
and who, the last couple of weeks, has done double duty and done a 
great job to get us to where we are today; Leslie Campbell; Maureen 
O'Neill; Jillian Workman; David Shearman; Camlin Moore; Thomas Coleman; 
John Ashley; Mitchell Sylvest; Heather Vachon; and Pauline Schmitt. We 
could not have done our job as elected officials were it not for those 
people who tirelessly worked long hours to see to it that we got it 
  Here we are in the U.S. Senate. I am speaking with my First Amendment 
rights. You are gathered in the Gallery today and watching this at home 
on C-SPAN because of the First Amendment, gathering because of the 
amendment that allows us to freely assemble without fear of retribution 
by the government. Our Bill of Rights are the rights we operate under, 
and we wouldn't have them at all were it not for our veterans.
  Next Monday we will celebrate Memorial Day. We will give thanks for 
every veteran who sacrificed their life and gave the ultimate sacrifice 
for you and for me. It is not unreasonable to think back and say: You 
know, had our soldiers not done what they did in World War I and World 
War II, we might be speaking German or Japanese today rather than 
English. Because they fought for us in the two great World Wars, they 
secured and preserved our liberty and freedom, and we speak today as 
free Americans, and we enjoy the freedom that only democracy could 
give. That is what we owe our veterans. We owe them everything. Without 
them, we wouldn't have the protections we have today.
  As Memorial Day approaches, I love to tell my favorite story about 
the great reminder I have of what Memorial Day is all about. It is all 
about a veteran, Roy C. Irwin, from the State of New Jersey. I have 
never met Roy; I never knew him. When I was in Margraten in the 
Netherlands at the U.S. cemetery where over 8,000 Americans are buried 
from the Battle of the Bulge, my wife and I spent an afternoon paying 
tribute and respect at the graves of our veterans and our soldiers. We 
walked down the road to look at the Stars of David and the crosses, 
paused for a minute at each headstone, and gave a prayer of thanks for 
the veterans who had sacrificed everything so that we could be there.
  Then something happened to me that I have never forgotten, and it 
could happen to any one of you if you ever go to one of those 
cemeteries and visit. I came upon a headstone, a cross, and I stopped 
and read it. It said: Roy C. Irwin, New Jersey, private, died, killed 
in action 12/28/44. I froze in place; 12/28/44 was not just the day 
that Roy C. Irwin died in the Battle of the Bulge fighting for us. It 
was the day I was given birth by my mother in Piedmont Atlanta Hospital 
in GA.
  There I was, standing at the foot of someone who had died on the day 
I was born. He gave his life so that I could enjoy mine.
  Since that time, I have had 73\1/2\ years in which I have been able 
to be a free citizen of the United States of America, all because of 
lots of things but nothing more important than Roy C. Irwin and 
thousands like him who volunteered to fight for our country, to call on 
the forces of evil wherever they might be. They won our freedom, 
maintained our independence, and saw to it that you and I could be here 
today. I have always stopped to give thanks every Memorial Day for all 
of those who pledged and gave the ultimate sacrifice so that I could be 
here to make a sacrifice for you.
  I look at our pages in the room today, and I think about my children 
and my grandchildren. I am so happy they had the opportunity to grow up 
in the United States of America and so happy you have the ability to 
serve here today in the United States of America. Remember this: You 
and I are both here because of one thing. This is a country full of 
brave volunteers who, when the bell tolls, answer the bell and go fight 
for America, fight for our freedom, fight for our peace, and fight for 
our liberty.
  So strike one for liberty when we vote on the final passage of the VA 
MISSION Act. Vote for better healthcare for our veterans, the choices 
of our veterans, caregivers for our veterans who haven't had them in 
the past. Give thanks. And with your vote for that bill here, we will 
have to continue to pay our debt to those who sacrificed or offered to 
sacrifice the maximum sacrifice for us.
  This is a great country for lots of reasons. You will never find 
anyone trying to break out of the United States of America. You always 
find them trying to break in. There is one big difference over any 
other; that is, those who have fought and died so that we could be free 
and American citizens forever.
  May God bless our soldiers, may God bless our country, and may God 
bless the United States of America.
  I yield back my time.
  The PRESIDING OFFICER (Mr. Flake). The Senator from Connecticut.

                              Gun Violence

  Mr. MURPHY. Mr. President, 2 days before the tragic shooting in Santa 
Fe, which has rightly dominated the news for the last several days, 
Texas experienced another mass shooting when a man killed his three 
children, his ex-wife's boyfriend, and himself. Mass shootings are 
generally characterized as incidents where four or more people are shot 
at one time. It is a catastrophic event for a community to have four 
people shot in one instance. That shooting 2 days before the Santa Fe 
school shooting was the 100th mass shooting in the United States of 
America in 2018. We average about a mass shooting every single day in 
this country.
  In the 3 days following the Santa Fe High School shooting, there were 
around 88 gun deaths and 222 gun injuries in this country. That is a 
big number. It is the most in any 72-hour span so far in 2018.
  Rightly, our attention has been directed toward the community of 
Santa Fe as they try to recover from the unrecoverable--another 
targeting of children in a school in this country. It is important to 
remind ourselves that no

[[Page S2822]]

matter whether the shooting happens on a street corner, in a school, in 
a movie theater, or in one's home, the devastation for those who lose 
their brother or their sister or their husband or their wife is no less 
or no greater, whatever the circumstances may be.
  In the 3 days after Santa Fe, as the country could have been deluded 
into thinking that was the only shooting of any consequence in the 
country, 88 people lost their lives from guns, and 222 others were shot 
and survived--part of the 33,000 a year, 2,800 a month, and 93 on 
average a day who are killed by guns in this country. It is a mix of 
suicides and accidental shootings, domestic violence incidents, mass 
shootings, and homicides, but there is no other country in the world in 
which the number is this big.
  There have been 5,531 deaths from gun violence in 2018 alone. That is 
according to Gun Violence Archive. Twelve hundred kids have been killed 
or injured, and we are not even halfway through the year.
  Our rate of gun violence in this country is 20 times higher than that 
of all our other competitor OECD nations. It is not because our schools 
are less safe. It is not because we have more instances of mental 
illness. It is not because we have more troubled young men. It is not 
because we spend less money on law enforcement. You control all of the 
other factors that people claim to be the reason for these crimes, and 
it cannot--it does not--explain why this epidemic is happening here and 
nowhere else.
  What is different about the United States is that we have the 
loosest, laxest gun laws of the OECD nations. What is different about 
the United States is that in shooting after shooting, killing after 
killing, we do nothing. We do nothing of substance or significance to 
condemn or change this trajectory of violence.
  I argue to you that would-be shooters who are contemplating acts of 
mass violence--who clearly have had something go wrong in their mind to 
consider such a thing--see our silence as a green light. Of course, we 
don't mean it that way, but when we refuse to do anything other than 
make minor tweaks to Federal gun laws year after year, young men who 
are contemplating doing something like this, seeing no substantial 
condemnation or change in law, pervert that silence into permission.
  I think that is what is happening today. That is why I argue that we 
have become complicit in these murders, whether we think we are or not. 
We are grieving hard for Santa Fe, but we are grieving hard for all of 
the other victims.
  I sat with the President at the White House a few months ago as he 
told us he was going to fix this problem. He was lying. He wasn't 
telling the truth. He had no intention of fixing the problem. The 
President had the gun lobby in the next day, and all of a sudden the 
discussion evaporated. He talked a lot in that meeting about school 
safety and arming teachers, but it is important to note that Santa Fe 
High had adopted really aggressive measures to prevent a school 
shooting. They had resource officers who were armed, two of them. They 
had approved a plan to arm teachers, though they had not started to do 
so. They had gone through a very successful lockdown. They had won an 
award for that response. In this school they thought they were ready, 
and they weren't.
  This has to be about a conversation rooted in data. The data will 
tell you that more guns will not solve this problem and that for every 
time a gun you own is used in self-defense, there are four times that a 
privately owned gun is used in an unintentional shooting, seven times 
that a privately owned gun is used in an assault or murder, and 11 
times that a gun is used in a suicide. The data doesn't back up the 
fact that more guns are going to solve this problem.
  Beyond the data, there are these faces, there are these people, there 
are these lives that were cut short. I want to spend the remaining few 
minutes telling you a few of their stories. I have tried to do that 
over the years--to come and put a hole in the data and let you know who 
these people are whom we have lost.
  On average, psychiatrists and mental health professionals tell us 
that when one person is killed by a gun, there are 20 other people who 
experience trauma or some level of trauma.
  In Santa Fe, we think a lot today about Cynthia Tisdale. She was 63. 
She was a substitute teacher for children with special needs. She got 
married when she was 17 years old, and she took care of her ailing 
husband. He was very sick for 47 years. He said:

       She was a good woman. She watched out for me.

  Her son said:

       She loved to help children. She didn't have to do it. She 
     did it because she loved it.

  Cynthia Tisdale is gone at 63.
  Sabika Sheikh was 17 years old. Unlike the others who were killed in 
that school, she didn't have any family in the United States. Santa Fe 
was her adopted community. She was staying with a family. The family 
she left behind, her adoptive family in Texas, said: ``We loved her and 
she loved us,'' adding that the ``root of our issues is love because 
when people love each other, these kinds of things don't 
happen.'' Sabika dreamed one day of being a diplomat and working to 
empower women. She died at age 17.

  Christopher Jake Stone was 17 as well. He was the youngest of three 
siblings in Santa Fe. He and his siblings were known as the ``three 
Stones.'' His sister said:

       Being a brother was his best job. He was always there if 
     someone needed someone to listen to or some cheering up. 
     Definitely the life of the party, and one of the most 
     understanding, open-minded kids I know.

  She said in a Facebook message: ``He had a lot of heart.''
  Two days later, to give you a sense of the scope of this, Kimberly 
Phillips was in a parking lot at a Shell gas station in Chattanooga, 
TN, when her ex-husband found her, shot her, and then killed himself 
afterward. It was a murder-suicide, one of the thousands partner-on-
partner incidents of domestic violence that happen in this country.
  One of her coworkers at the senior living community where she worked 

       Today I lost one of the most caring, loving caregivers I 
     have ever had on my team. . . . She loved her residents and 
     took their care very seriously.

  She was 48 years old.
  The day before that, Sherrell Wheatley was walking home from feeding 
one of her neighbor's dogs in Dayton, OH. Her neighbor said that she 
did this all the time. She cooked a lot, and she would cook all the 
scraps and take them to feed the neighbor's dog. She was walking home, 
and she was shot as a bystander in a driveby shooting. She was a mom, 
grandma, aunt, an active member of her local community, a volunteer in 
the local elementary school, and a pillar of kindness.
  Her son, a quadriplegic who relied on her care, said:

       That was my mom--

  She was helping people, even at the moment she died.

       I loved her. She was my angel, she was my everything, and 
     somebody snatched that away from me.

  Those are just 5 of the victims who died over a 2- or 3-day period of 
time--32,000 a year, 2,200 a month, 93 a day--and we are doing nothing.
  I appreciate some of my colleagues working on a minor adjustment to 
our background check laws earlier this year. I am not saying that is 
totally inconsequential, but it doesn't match up to the moment.
  What is wild is, we are the only ones who don't think we should do 
anything. Americans have woken up to what is happening, and they are 
desperate for us to change the laws. In fact, 97 percent of Americans 
think we should pass universal background checks. By a 2-to-1 margin, 
people think we should get these assault weapons and military-style 
killing machines off the streets. People support things like what we 
did in Connecticut, requiring people to get local police permits for 
carrying a handgun. These are not controversial outside of the U.S. 
  Increasingly, Americans have come to realize that no one is safe. In 
that heartbreaking video, a young woman, I think just hours after the 
shooting, was asked by a newscaster whether she found it hard to fathom 
that the school shooting had happened at her school. To paraphrase her 
answer, she said: No, I wasn't surprised. It happens everywhere, and I 
just figured it was a matter of time before it happened here.
  Nicole Hockley, who lost her son at Sandy Hook, says all the time 
that she

[[Page S2823]]

never, ever expected to be one of these parents grieving the loss of a 
child. She reminds everyone she talks to that you don't imagine you 
will be in that situation either, but if you don't do something about 
it, if you don't stand up and speak truth to power, it might be you 
  I will continue to come to the floor and tell these stories--these 
voices of the victims who have been silenced through gun violence. 
Hopefully, at some point, we will wake up to the need for change.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. THUNE. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Mrs. Hyde-Smith). Without objection, it is so 

                               Tax Reform

  Mr. THUNE. Madam President, tax reform is working. The results of two 
surveys released last week show that tax reform is doing exactly what 
it is supposed to be doing for American workers.
  Our goal with tax reform was simple: make life better for American 
workers. So we took action to put more money into Americans' pockets 
right away. We cut tax rates across the board, nearly doubled the 
standard deduction, and doubled the child tax credit. Americans are 
already seeing this relief in their paychecks.
  We knew that tax cuts, as essential as they were, were not enough. In 
order to make life better for American workers, we also needed to make 
sure Americans had access to good jobs, good wages, and good 
opportunities, the kinds of jobs and opportunities that would set them 
up for security and prosperity in the long term. Since jobs and 
opportunities are created by businesses, that meant reforming our Tax 
Code to improve the playing field for businesses so that they could 
improve the playing field for workers, and that is what we did.
  I am proud to report that it is working. Last week, the National 
Association of Manufacturers released the results of its recent tax 
reform survey, and here is what the survey showed: 77 percent of 
manufacturers planned increased hiring as a result of tax reform, 72 
percent planned to increase wages or benefits, and 86 percent report 
they plan to increase investments, which means new jobs and 
opportunities for workers. These are tremendous results, and they are 
exactly what we were looking for with tax reform.
  Government can make sure it isn't taking too much out of Americans' 
pockets, but it can't create the jobs and opportunities Americans need 
for long-term economic security and prosperity. Only businesses can do 
that. But government can make sure that businesses are free to create 
jobs by making sure they are not weighed down with burdensome taxes and 
regulations, and that is exactly what we set out to do with tax reform.
  Before the Tax Cuts and Jobs Act, the government was not helping 
businesses to create jobs. In fact, it was doing the opposite. That had 
real consequences for American workers. A small business owner 
struggling to afford the hefty annual tax bill for her business was 
highly unlikely to be able to hire a new worker or to raise wages. A 
larger business struggling to stay competitive in the global 
marketplace while paying a substantially higher tax rate than its 
foreign competitors too often had limited funds to expand or increase 
investment in the United States.
  When it came time for tax reform, we set out to improve the playing 
field for American workers by improving the playing field for 
businesses as well. To accomplish that, we lowered tax rates across the 
board for owners of small and medium-sized businesses, farms, and 
ranches. We lowered our Nation's massive corporate tax rate, which up 
until January 1 was the highest corporate tax rate in the developed 
world. We expanded business owners' ability to recover investments that 
they make in their businesses, which frees up cash that they can 
reinvest in their operations and their workers. We brought the U.S. 
international tax system into the 21st century by replacing our 
outdated worldwide system with a modernized territorial tax system so 
that American businesses are not operating at a disadvantage next to 
their foreign competitors.
  Now we are seeing the results. I will say it again. Seventy-seven 
percent of manufacturers are planning to increase hiring, 72 percent 
are planning to increase wages or benefits, and 86 percent are planning 
to increase investments, which creates new jobs and new opportunities 
for American workers.
  I haven't even mentioned last week's other survey on small 
businesses. The National Federation of Independent Business released a 
survey last week that shows that 75 percent of small business owners 
think that the Tax Cuts and Jobs Act will have a positive effect on 
their business. The survey also showed that among small business owners 
who expect to pay less in taxes next year, 44 percent plan to increase 
employee compensation, and more than a quarter plan to hire new 
  Those numbers may get even better. As the survey shows, small 
businesses are just starting to explore all the benefits of the new tax 
law since small businesses, unlike large businesses, don't have full-
time tax departments to plan for and take into account the new tax 
changes. Most small businesses spend the first part of each year 
focused on preparing and filing their taxes from the prior year, not to 
mention running their businesses, which means, with tax day now behind 
them, they are just now having the chance to explore the benefits of 
the Tax Cuts and Jobs Act. In addition, their tax advisers--many of 
whom are often small businesses themselves--have also wrapped up most 
of their filing season responsibilities, so now they can help their 
small business clients with factoring the new tax changes into their 
business plans.
  American workers had a tough time during the last administration. 
Wages stagnated, and jobs and opportunities were often few and far 
between. But thanks to the Tax Cuts and Jobs Act and other Republican 
initiatives, our economy is turning around. Unemployment is at its 
lowest level in more than 17 years. Economists have upped their 
projections for economic growth. And the good news for American workers 
just keeps piling up--more jobs, more opportunities, higher wages, and 
better benefits. The American dream is roaring back, and the future is 
looking bright.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. MANCHIN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

                   Unanimous Consent Request--S. 2906

  Mr. MANCHIN. Madam President, I ask unanimous consent that 
notwithstanding rule XXII, the Senate proceed to the immediate 
consideration of S. 2906, which is at the desk; that the bill be read a 
third time and passed, and the motion to reconsider be considered made 
and laid upon the table with no intervening action or debate.
  The PRESIDING OFFICER. Is there objection?
  The Senator from North Carolina.
  Mr. TILLIS. Madam President, reserving the right to object, I want to 
thank my friend Senator Manchin. He and I serve on the VA Committee. I 
know he is absolutely committed to trying to do the best we possibly 
can for our veterans. We may have a disagreement on what he has in mind 
for this particular unanimous consent request, but I don't think there 
is any daylight between us in terms of what we are trying to do for 
  I look forward to working with the chair to get to a good place and 
to address in the Senate committee some of the concerns he has. For 
that reason, I object.
  The PRESIDING OFFICER. Objection is heard.
  Mr. MANCHIN. Madam President, I would like the right to proceed.
  I thank my good friend from North Carolina, Senator Tillis. He is 
always willing to work in a bipartisan way. I thank him very much.
  We have concerns about the VA and all of our veterans. He is in a 
State that has a tremendous population, and

[[Page S2824]]

I am in a State with a tremendous population of veterans. I am 
disappointed there is an objection to my bill.
  I rise to speak to my frustration that the Asset and Infrastructure 
Review, or the so-called AIR Act, provision is being included in what 
is otherwise a very good package. I thank Chairman Isakson, Ranking 
Member Tester, and Senator Tillis for all their hard work on the 
overall MISSION Act.
  The MISSION Act is going to do so many good things. It is going to 
streamline how we provide non-VA care. It is finally expanding 
caregivers for veterans of all eras, and it will make it easier for the 
VA to hire high-quality providers.
  I am against adding the AIR, which is the Asset and Infrastructure 
Review Act, or I like to call it the VA BRAC. This bill could be 
detrimental to rural veterans.
  The AIR Act provision was supposedly added by House Republicans to 
the MISSION Act because the Senate insisted the caregivers bill be 
included. I am a proud cosponsor of the caregivers bill because it does 
not make sense to give a benefit to one era of veterans and not give it 
to them all.
  I thank my colleague Senator Murray for the year she has dedicated to 
the caregivers issue. The AIR Act was never voted on or discussed in 
the Senate Veterans' Affairs Committee. The House Caregivers companion 
bill is bipartisan and has 90 cosponsors. We could pass this bill 
without the AIR Act in a heartbeat.
  While I am generally supportive of efforts to cut waste, the AIR Act 
will not come close to paying for this bill. Instead, it puts rural 
hospitals and facilities like those in West Virginia in the crosshairs 
of the VA bureaucrats and technocrats who do not know my veterans and 
what they need.
  The last time there was an asset review--the CARES Commission--was in 
the early 2000s. It recommended closing the acute inpatient hospital 
beds and contracting for acute care in the community for the Beckley VA 
Medical Center. Only after stakeholders yelled and screamed did the 
Secretary not follow their recommendations.
  Today, those 25 acute care beds and 5 ICU beds are vitally important, 
not just to our Southern West Virginia veteran community but the entire 
community. Administrators at the surrounding hospitals have told me 
they could not absorb the Beckley VA patient load. We were lucky then 
to have vocal stakeholders holler and scream and a Secretary who 
listened, but will we be so lucky in the future? Furthermore, should 
veterans have to endure the uncertainty their VA hospital or CBOC may 
not always be there for them?
  My veteran population is nearly 40 percent Vietnam veterans. In the 
last 10 years, there was a nearly 20-percent decrease in my veteran 
population because our World War II and Korean veterans are dying, and 
our Vietnam veterans are not getting any younger.
  If we send this Commission in and they do the analysis, my fear is, 
resources and funding will be realigned away from our patriotic West 
Virginia veterans--Phoenix gets picked over Clarksburg; Los Angeles 
over Beckley; Washington, DC, over Martinsburg; and Orlando over 
  I feel sure the VA will follow the law, hold their public hearings, 
and read statements put in the Federal Register, but they will still 
have the power to close or downsize West Virginia facilities. Just 
because you are a veteran living in a rural area does not mean you 
don't deserve the same quality and access of care that you would 
receive in an urban area.
  Is this truly about taking evaluation of waste or is this the slow 
filing away of the VA infrastructure as we know it?
  I am aware the MISSION Act just passed out of the House 347 to 70. I 
have a lot of good friends on both sides of the aisle who want the 
overall bill. It has the support of the national veterans service 
organizations, and the effects of this bill will not likely come into 
being until 2025. I will not be serving in the Senate then. Yet, for 
the sake of the veteran population in West Virginia, I have to say 
something publicly.
  The AIR Act could have detrimental second and third order effects in 
our communities. If this bill passes with the AIR Act in it, the powers 
that wish to downsize the level of care we give to veterans will see it 
as a victory, but they should be prepared for robust and exhaustive 
oversight by me and my colleagues on the committee. If we don't have 
the market assessments, access to other population data, and if the 
central office doesn't start filling some of the healthcare provider 
vacancies in West Virginia VA medical centers, I will reluctantly put a 
hold on some nominees for this Commission. I am going to encourage my 
colleagues from rural States who represent rural areas to do the same.
  Thank you.
  The PRESIDING OFFICER. The Senator from North Carolina.
  Mr. TILLIS. Madam President, there are a million reasons why I love 
North Carolina, but one of them is, it is a State of 10 million people. 
Half those people live in urban areas. The other half live in rural 
areas. One in ten people in the State are veterans--a State that 
proudly claims having one of the fastest growing veteran populations in 
the country.
  When I go into the VA Committee and I look at what we have to do, I 
don't look at it as coming from an urban State. I don't look at it as 
coming from a rural State. In many respects, I think North Carolina is 
a microcosm of the Nation as a whole.
  When we look at some of the changes we want to make, what I hope we 
get out of this review is what to do with the 430 empty buildings that 
are as much as 90 years old that are owned by the VA. We may have to do 
basic maintenance on them, but they are properties that may have a 
historic value. Maybe we can convey them to the States and sell them 
and use the resources to plow back into quality care for the veterans.
  I can tell my friend from West Virginia that we share a mountain 
range together. We share a lot of cultures out in the western part of 
our State with West Virginia. There is no way on Earth that I would 
allow the VA to move forward on something I felt was going further away 
from providing quality care to any veterans anywhere in West Virginia, 
North Carolina, or any other rural area.
  On the one hand, we continue to say we don't have enough money for 
veterans. On the other hand, we say we have to find some of those 
additional resources by taking steps to make the VA more efficient and 
shed the assets that are no longer providing value to the veterans. I, 
for one, believe we can do it on a balanced basis.
  As this process goes through, it is actually an authority the VA has 
today. They haven't acted on it. We are trying to put more pressure on 
them to make some concise decisions. The Senator from West Virginia has 
my commitment that any instance where we see a decision being made by 
the VA that is something that is going to take veterans further away 
from care, I will be the first one to join him in making sure we don't 
allow that to happen.
  Thank you.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mr. MANCHIN. I agree with my colleague from North Carolina.
  We don't want to continue if there are areas and assets that can be 
done away with for efficiencies. I understand that can be done without 
  I don't know the underlying reasons for it. The AIR Act was never 
even discussed in our committee. We never had the bill in front of us 
at all. That is all I was saying. How did this all of a sudden get 
thrown in?
  I understand--because of what we put in, the expansion of how we were 
going to take care of caregivers to all populations of veterans--they 
were upset on the House side. This was put in retribution to that. I 
objected to how it was put in being what the intent was.
  I believe the VA can dispose of excess properties that have been 
closed, vacant, and not in utilization. I am concerned they are going 
to come back and say: In the rural areas, we are going to close this 
CBOC and consolidate. We have more need right now and a greater need 
with some of our population base, especially with the conflicts we have 
around the world now.
  I never talked to a veteran who did not want veterans care if there 
was any way they could get to a veterans hospital or clinic. They were 
the people who knew them best and knew how to take care of their 
concerns. That is all I am trying to preserve.
  I don't know what the intentions are of this. That is why I wanted to 

[[Page S2825]]

that removed, and maybe we can discuss it in our Senate VA Committee 
and have a better way of reviewing the excess properties and properties 
not being utilized.
  Thank you.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from South Dakota.
  Mr. ROUNDS. Madam President, I rise today to discuss the legislation 
before us, known as the VA MISSION Act of 2018--a significant change 
for the healthcare delivery system at the Department of Veterans 
  The VA MISSION Act passed the House of Representatives last week and 
is scheduled to be voted on in the Senate in the coming days. The bill 
is a result of months of negotiations and discussions between 
stakeholders, the administration, and the House and Senate Veterans' 
Affairs Committees, of which I am a member.
  While I appreciate the hard work of those involved, unfortunately, 
the final legislation is not something that I am able to support. 
Before I get into my concerns about the bill and what I believe to be 
its fatal flaws, I want to acknowledge that there is a host of good 
provisions in here that I do support.
  The one on the forefront of many minds is the caregivers program 
expansion. The caregivers program, a program that gives support and 
assistance to certain veterans so they can receive home healthcare by a 
family member, has always been limited to post-9/11 veterans. However, 
there are many pre-9/11 veterans' family members who do the same work 
as a caregiver recipient but are not compensated for that work. This 
program is more cost effective over the long term than an alternative 
long-term care accommodation. It is due time for this expansion to 
occur for all families.
  I also support section 101, paragraph (a), which expands extended 
care services, such as nursing home care, through the community care 
program. It is similar to a bill I introduced with the senior Senator 
from North Dakota, the Veterans Access to Long Term Care and Health 
Services Act. This provision will allow long-term care services to more 
easily work with the VA in serving veterans.
  Further, section 101, paragraph (k) of the VA MISSION Act establishes 
in law that a veteran shall not pay a greater amount for receiving care 
or services outside of the VA, compared to receiving care at a VA 
facility. It is similar to the Veterans Equal Cost for Care Act, which 
I introduced in Congress last year. This section makes certain that 
veterans will know that VA policy will not change in this regard and 
that the VA will not place additional financial barriers for veterans 
to access care outside of the VA at a private provider in an effort to 
incentivize in-house VA care.
  Last, section 101, paragraph (d)(1)(D) of this bill, along with 
section 104, requires the VA to develop appropriate access standards 
when seeking healthcare. However, I remain concerned that the VA will 
not implement it properly.
  If the VA implements access standards similar to TRICARE, which is 
the health program at the Department of Defense, then, these sections 
could be good for veterans.
  Let me get into my concerns with the bill. This bill makes 
significant changes to the 40-mile rule under the Choice Program, and I 
am concerned that it puts our rural veterans in jeopardy.
  The Choice Act, which Congress passed in 2014, before I took office, 
allowed all veterans who live 40 or more miles from a VA facility to 
receive care at a local, private hospital or clinic. Under the VA 
MISSION Act, this provision will end for all veterans except those in 
the top five rural States after 2 years.
  When the Choice Act was first enacted, giving rural veterans the 
option to receive care in their communities, rather than at a VA 
facility, they overwhelmingly chose to stay close to home and receive 
private care. They voted with their feet.
  Because of the law, many are getting better local, private care. I 
believe veterans who use this type of eligibility successfully today 
ought to be able to use this program in the future, no matter which 
State he or she is from.
  In fact, these concerns were addressed when the original legislation 
was crafted in the Senate Veterans' Affairs Committee, and all veterans 
who use the Choice Program today were grandfathered into being able to 
use the 40-mile rule in perpetuity. Unfortunately, the proposal agreed 
to in committee is not the one in front of us today.
  I understand that the number crunchers did the math and concluded 
that the bill discussed in committee was too expensive and they didn't 
want to pay this much for the care of our veterans. So the provision I 
offered was cut down significantly to be limited to the top five rural 
States, including my own State of South Dakota.
  While South Dakota was fortunate to be a part of the top five States, 
this country has many rural States and many rural veterans who rely on 
the Choice Program's 40-mile eligibility to get their healthcare.
  There are roughly 750,000 eligible 40-mile veterans across the United 
States. Of this portion, a little less than half, or 330,000 veterans, 
have used this eligibility to receive healthcare.
  In just 2 years, many of these veterans will no longer be eligible to 
receive care outside the VA system based on the 40-mile rule alone, as 
they do today. Instead, more veterans will have to work through more 
gatekeepers and review processes to get their community care request 
granted, if it is granted at all.
  Just as important is the way in which 40-mile-eligible veterans 
receive community care. Currently, when a rural, 40-mile veteran wants 
community care, they get community care. There are little, if any, 
barriers to access community care today. The VA can't decide for the 
veteran where he or she should get the care. The veteran is in total 
control of their care. There are no reviews, gatekeepers, or 
consultations. The veteran just goes.
  Under the VA MISSION Act, as it stands today, a VA clinician acts as 
a gatekeeper for the veteran. Section 101, paragraph (d)(2) states that 
a VA employee must consider certain criteria, some of which are 
peculiar to a rural veteran, when consulting with a veteran on where 
the veteran should go for healthcare. ``Consider'' is not a very tough 
or obligatory word, and it leaves a lot of leeway for our Washington 
bureaucrats to write rules in a way that may not put the care of our 
veterans above all else.
  My concern here is that when this bill is signed into law, rules are 
going to start to be written, and the number crunchers are going to 
influence every rule to meet the bare minimum of the required language.
  Just in case anyone is interested in an example, let me briefly 
remind the Chamber that the original Choice Act intended to provide 
community care to veterans who live 40 miles or more from a VA 
facility. How was that rule initially written? Community care was based 
on 40 miles as the crow flies. That is right--as the crow flies. It 
took intense pressure from the veterans organizations and Congress to 
amend that rule to be based on driving distance, or better known as the 
way almost every veteran travels to a VA facility.
  Why was that rule written to determine community care as the crow 
flies? Cost. Cost and nothing more. The VA wrote the rule in a manner 
that complied with the bare minimum requirements of the law but not 
with the spirit of the law. The VA did not write the rule in a way that 
was in line with the way a normal veteran would access community care. 
By writing the rule this way, the VA was able to restrict community 
care access to veterans to control cost.
  With so much ambiguity in the language as it is currently written, my 
fear is that the same cost-first mentality will be used once this bill 
is signed into law. We believe veterans should be in full control of 
their healthcare, not a bureaucrat.
  Additionally, under the Choice Act, the access standards have been 
clear when it comes to the 30-day rule. It states that if you wait 
longer than 30 days, you can use a private provider, period. Under the 
VA MISSION Act, the standards are fluid, and the cut-and-dry 30-day 
standard goes away. We know that this has been a widely used metric for 
veterans' eligibility to receive care outside the VA. In fact, since 
the Choice Act began in November of 2014, there has been roughly 1.4

[[Page S2826]]

million instances in which a veteran has been authorized for care 
outside of the VA based on the 30-day rule.
  Under the VA MISSION Act, there will be a new review process for 
veterans who request to receive care outside the VA system, based on 
meeting an access standard which has yet to be written. Again, if the 
VA implements these access standards like TRICARE, this could be good 
for veterans. But whether that happens is subject to rulemaking and 
cost constraints.
  Finally, I am concerned about title II of this bill, which is the 
asset and infrastructure review provision that paves the way for what 
is essentially a VA BRAC that could close out some of our most 
vulnerable VA facilities, particularly in rural areas. I know that my 
friend and colleague from West Virginia was just expressing some of the 
same concerns. Of particular concern is a provision that would seek to 
neutralize appropriations language that prohibits the VA from reducing 
services in the Veterans Integrated Services Network 23 unless a series 
of important criteria are made.
  For years, the VA has incrementally sought to close the Hot Springs 
campus in my home State of South Dakota. The VA has not conducted its 
due diligence in deliberating over the future of the Hot Springs 
campus, which provides veterans from three States and Indian Country 
healthcare. This is a pocket of rural America where few healthcare 
options exist.
  This VA BRAC provision puts VA facilities like the one we have in Hot 
Springs in jeopardy. The Hot Springs VA facility has consistently been 
named one of the top VA facilities in the entire United States. If we 
are truly putting the care of our veterans before all else, we should 
be propping up facilities that have a track record of delivering 
timely, high-quality care to our veterans.
  With the asset and infrastructure review provision in this bill, I 
worry about the future of rural VA facilities such as Hot Springs. More 
importantly, I am concerned about our rural veterans' access to 
adequate care, including mental health services, should these vital 
facilities be closed in the future.
  Some have been saying that even though the provision is in there, the 
VA has provided assurances that places like Hot Springs are not in 
jeopardy, despite the law allowing the agency to review and eventually 
close facilities across the Nation if it determines it is necessary.
  While the VA has some great employees, including its leadership, I am 
reluctant to consent to the BRAC process because the appropriations 
language requirements are what I view as due diligence by the VA before 
any decision is made on the closing of campuses like those in Hot 
Springs. In this particular case, the asset and infrastructure review 
language intends to neutralize that appropriations language, and I will 
not support that path forward.
  At the end of the day, all we can count on is what we have enacted 
through legislation, and this bill clearly allows for the VA BRAC to 
  My decision to oppose the VA MISSION Act is not one that I have made 
lightly. I recognize the many good provisions in this bill that would 
go a long way toward improving care for our Nation's veterans. I also 
want to recognize the hard work that went into the final package. I 
particularly want to thank Chairman Isakson, our Senate Veterans' 
Affairs chairman, for making a truly honest effort to address the ideas 
and concerns of all the committee members, including my concerns, which 
were reflected when we passed our bill out of committee earlier this 
year. Unfortunately, those concerns were not included in the final 
package. That said, the fight is not over.
  Even though we expect the VA MISSION Act to pass the Senate and be 
signed into law before Memorial Day, there will be plenty of work to do 
as the law is being implemented. I will continue working with my 
colleagues, the administration, veterans groups across the State, and 
other stakeholders to keep a close watch on the VA's implementation of 
the VA MISSION Act to make certain the agency is putting the proper 
care of our veterans above all else.
  Now, this is something that you never hear in this body, but this is 
an instance in which I would be happy to be wrong in my assessment. In 
fact, I challenge the VA to prove me wrong. We were close to having a 
really good bill with the VA MISSION Act by expanding the caregivers 
program to pre-9/11 veterans, by expanding community care to include 
community services, and in providing payment protections to rural vets 
so they will not pay a greater amount for using community care than 
they would for care at a VA facility, just to name a few.
  I would have happily voted for any of these provisions as separate 
measures, and I am grateful that our veterans will greatly benefit from 
  I had hoped to get a place in the final bill where my concerns would 
be able to be fixed, but at the end of the day, my concerns outweigh 
the good, and I have to vote no.
  I have the privilege of serving on both the Senate Veterans' Affairs 
Committee and the Senate Armed Services Committee, and I cannot tell my 
colleagues what an honor it is to fight every day to make sure that our 
servicemembers and veterans receive the tools and the care they so 
clearly deserve. They make incredible sacrifices so that we can be 
free. We have a responsibility to take care of them when their service 
is complete. I look forward to continuing to work to fulfill that 
  Thank you, Madam President.
  I yield the floor.
  Mr. WYDEN. Madam President, with Memorial Day coming up this weekend, 
I want to offer a few thoughts on this package of legislative reforms 
for the Department of Veterans Affairs, known as the VA MISSION Act of 
2018, being considered by the U.S. Senate.
  I want to start by commending Senator Jon Tester of Montana, the 
senior Democrat on the Senate Veterans' Affairs Committee, for 
negotiating based on what I call principled bipartisanship: taking 
ideas from both parties without sacrificing core values.
  Montanans have every reason to be proud of Senator Tester for 
spending months at the negotiating table with Chairman Isakson, the 
House of Representatives, and the White House.
  Make no mistake, the bill before the Senate will make some important 
reforms to the way the VA does business.
  It will consolidate the VA's multiple community care programs, 
including the Veterans Choice program, into one permanent framework to 
allow veterans to seek care in their communities. Streamlining these 
programs was something sought by the Obama administration as well and 
will help make it easier for veterans to understand their options and 
access the care they need.
  It will also expand a VA program that provides benefits to in-home 
caregivers, an effort I have supported for years. The program is 
currently open to veterans wounded after the terrorist attacks of 
September 11, 2001. The VA MISSION Act will open the program to 
veterans from all eras.
  It will provide more incentives and inducements to help attract 
medical providers to the VA and keep them there. In particular, the 
bill will provide more recruitment, retention, and relocation bonuses, 
it will raise the cap on student loan reimbursement, and it will 
establish a new loan repayment program for specialties where the VA is 
experiencing a shortage.
  As important as these provisions are, I want to express my 
reservations about the VA MISSION Act as well.
  I voted for the Choice Act in 2014 because I said it was unacceptable 
for veterans in Oregon and across the country to be waiting months or 
driving long hours for a VA appointment. I will be the first to say the 
same thing today, but I fear this bill will give broad authority to VA 
leadership to send more veterans out of the VA system.
  Given the relentless push by special interest groups to send an ever 
greater number of veterans into the private sector, I am concerned 
about the Trump administration giving into those folks and turning the 
VA over to ideologues or privatization partisans.
  I am also disappointed to see the asset review provisions included in 
this bill. If the VA has unnecessary infrastructure, it should be able 
to make the case to Congress to close or consolidate those facilities 
just like any other agency without being required to set up a whole new 

[[Page S2827]]

  Taken together, these provisions strike me as essentially asking 
Senators to put more trust in VA leadership and Donald J. Trump, the 
same Donald Trump who publicly attacked the parents of a Muslim soldier 
killed in action and the same Donald Trump who nominated his wholly 
unqualified personal physician to run the VA. Unfortunately, this 
administration has already proven it can't be trusted to take care of 
our veterans.
  I had hoped Senators would be given an opportunity to debate this 
bill and offer amendments that might have addressed the bill's 
shortcomings. The Senate majority has prevented that from happening.
  So the choice before me and every other Senator this week is to 
oppose this bill and the good it will do or to support it with 
significant reservations.
  After hearing from many Oregonians and from the 38 veterans and 
military service organizations and seven former VA Secretaries who 
support this bill, I have chosen the second option and will support the 
bill despite my concerns.
  Mark my words: The ultimate success or failure of this bill will 
depend on whether Donald Trump and his team at the VA choose to work 
with Congress and put our veterans first or whether they sell out to 
the privatization partisans.
  I hope my fears about this bill prove to be unwarranted, but as the 
saying goes, hope is not a strategy, After Donald Trump signs this bill 
into law, I will redouble my efforts to work with Senator Tester and 
others to support and sustain a robust VA worthy of the millions of 
veterans it serves.
  If the Trump administration implements any of these provisions in a 
way that threatens to privatize or undermine the VA as a healthcare 
system, I will pull out all the stops and fight it like hell.
  Mr. SANDERS. Madam President, there are parts of the VA MISSION Act 
that I strongly support. The expansion of the Caregivers program to 
veterans of all generations will help support family members who have 
made enormous sacrifices for their loved ones wounded in war. Raising 
the limits on the Education Debt Reduction Program, an effort that I 
helped lead, will make it easier for the VA to attract the doctors and 
other medical personnel they need.
  I am concerned, however, that despite some very good provisions in 
this bill, it continues a trend toward the slow, steady privatization 
of the VA. No one disagrees that veterans should be able to seek 
private care in cases where the VA cannot provide the specialized care 
they require or when wait times for appointments are too long or when 
veterans might have to travel long distances for that care.
  The way to reduce wait times is not to direct resources outside the 
VA, as this bill does, but to strengthen the VA by recruiting and 
retaining the best healthcare professionals to care for the brave women 
and men who rely on VA healthcare. The way to reduce wait times is to 
make sure that the VA is able to fill the more than 30,000 vacancies it 
currently has. This bill provides $5 billion for the Choice program. It 
provides nothing to fill the vacancies at the VA. That is wrong. My 
fear is that this bill will open the door to the draining, year after 
year, of much needed resources from the VA.
  Further, I am disappointed that the legislative process did not allow 
for votes on amendments that could have made this a stronger bill. The 
amendments I filed, but was prevented from offering, would have 
provided equal funding for the Veterans Health Administration and the 
Choice program, provided real money and a meaningful expansion of the 
Caregivers program, and established a pilot program for VA dental care 
in rural areas. In addition, I authored an amendment that would have 
struck the AIR Act provisions that could result in the closure of VA 
facilities and language clarifying that veterans may not be held 
financially liable for errors made by the VA.
  It is my sincere belief that these amendments would have gone a long 
way to addressing the deficiencies in the bill and providing the care 
and benefits our veterans have earned and deserved. I hope that my 
colleagues on the Senate Veterans Affairs Committee will work with me 
to make these necessary improvements in future legislation. We must do 
a better job in standing together against the effort to privatize the 
  I acknowledge the work done by some of my colleagues to improve this 
bill, but I believe it moves us too far in the direction of 
privatization. That is why I will vote against it.
  Mr. ROUNDS. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. RUBIO. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.