Mr. Chairman, thank you for allowing me to address the Subcommittee on VA, HUD, and Independent Agencies of the Committee on Appropriations. Last year, I came before you to discuss a dire budget scenario for the Department of Veterans Affairs. For the fourth consecutive year, the VA faced a flat-line budget for the Department’s medical care system. The only increase in funding was to come from a stream of revenues including veterans’ health insurance and copayments, sharing agreements and other non-appropriated funds. For a number of reasons—some beyond its control—VA has not been successful in obtaining the full amount of these projected revenues.

Fortunately, after a series of congressional interventions, an important lesson was learned. In the current health care environment, outside funding streams for VA health care cannot replace or even significantly diminish the need for a strong appropriation. Just like other health care providers, VA has inflationary costs outside of its control. In recent years, as VA has shifted to outpatient care that more strongly relies upon pharmaceuticals to manage health care conditions, VA’s prescription drug costs have increased at rates from 15-25% annually. Likewise, the cost of medical supplies and capital equipment continue to increase at rates above general inflation. Employee pay raises must be accommodated. VA nurses, some of whom had gone without any pay raise for several years, were long overdue for increases in pay. The VA health care system must also contend with the significant challenge of Hepatitis C that is disproportionately affecting its users. In addition, it must continue to effectively manage the many other chronic conditions, such as hypertension, diabetes, AIDS, and pulmonary disorders that its veteran patients have in higher proportions than the general population. VA health care must also restore some of the capacity it has reduced under financial duress for seriously mentally ill veterans.

The Administration learned that holes in its performance measurements can significantly challenge their perspective on how well the system is doing. Congress and veterans were growing increasingly concerned with waiting times—the time that it took VA to offer veterans its next-available appointment. Long waiting times were a clear indication to many members of Congress of the significant stress on the system. During a meeting with Administration representatives about long waiting times it became clear that the Administration was talking about waiting times from check in until the appointment began. This was a distinction with an important difference. The Administration agreed that there did appear to be a problem with these "waiting times". In addition to requesting additional funding for VA health care for this fiscal year, the Administration now has many initiatives underway to address the problems.

It is clear from the fiscal year 2001 budget submission that communication between Congress and the Administration has greatly improved and that this has translated into a strong budget request—the strongest an Administration has ever made. Yet there are still shortfalls that could undermine VA’s ability to be the type of health care provider we want for our veterans.

In a letter to the Chairman and Ranking Member of the Budget Committee, signed by the Committee on Veterans Affairs Chairman Bob Stump and myself, we noted our objection to the legislative proposal to return to the U.S. Treasury revenues anticipated from new resource collection authorities in the Veterans Millennium Health Care and Benefits Act. When Congress passed the Millennium Act, a pact was made with veterans that their increased co-payments would be put to use in improving care for veterans. Specifically, these new funds would allow VA to fully implement the long-term care provisions and mental health programs in the Millennium Act. As veterans age, finding acceptable long-term care alternatives grows increasingly important to ensuring their health. Without expanding these options, VA will be forced to reduce other services it offers veterans.

Our letter to the Budget Committee leadership also recommended additional funds for Grants for Construction of State Extended Care Facilities. The Chairman and I asked the Budget Committee to consider adding $80 million to the Administration’s request for this important program for fiscal year 2001. The additional funds would ensure a smooth transition from VA’s current funding methodology to an improved formula that will allow more renovation projects to be considered and ensure that the veteran’s "need" is addressed. It will allow all of the "grandfathered" projects to be addressed and, thus, allow VA to determine its new priorities with a clean slate. We urge your favorable action on the needed additional funding.

Let me note here that although I firmly believe that this new formula is a better formula for funding the State Home Construction Grants, this law did unintentionally harm our friends in Texas. Texas is now building its first four state homes and would have benefited from seven additional new state homes under the previous methodology. Texas is in a unique situation in that it’s just now entering the State Home program. Although it does not have any state homes, the State was excluded from the grandfather list because it received construction funds in fiscal year 1999. I would hope that your Committee would consider, on a one-time basis, funding two of the seven state homes Texas requested; this request, which would amount to approximately $15.4 million, could easily be accommodated within the additional funds Chairman Bob Stump and I recommended for FY 2001.

VA Research is also in need of additional resources. While other federal research programs have recognized significant gains in recent years, VA research has been frozen in the last four budgets. Chairman Stump and I have recommended an additional $25 million for VA Research for FY 2001. These funds would allow the program to accommodate inflation, fund additional areas of interest and fund five new centers of excellence in the treatment and research of motor-neuron diseases, such as Parkinson’s Disease. This is obviously an area in which I, in addition to thousands of other veterans, have a personal interest. I urge the Committee to ensure adequate funds (approximately $3 million) are available for this undertaking.

I also urge you to consider earmarking $2 million for creating two new centers of excellence for Multiple Sclerosis (MS). The "centers of excellence" approach has been an excellent means of bringing talented scientists, care providers, and educators together to share their knowledge and expertise to better serve veterans and educate their peers. Multiple Sclerosis is a devastating disease, yet there are many recent innovations that give new hope to those who suffer from it. Unfortunately, VA has not kept pace with the private sector in offering state-of-the-art care. Paralyzed Veterans of America found that the effective A-B-C (Avonex, Betaseron and Copaxone) cocktail has not been as widely available to veterans in VA as it has been to those with MS who use other health care providers. This must change and developing these centers of excellence would be a good start in ensuring that VA has the infrastructure in place to better serve veterans.

Mr. Chairman, there are additional non-health activities that also merit support. VA statistics show the demand for burial benefits will continue to increase sharply, with interments increasing 42% from 1995 to 2010. Unless new national cemeteries are established soon, VA will not be able to meet the need for burial services for veterans in several metropolitan areas of the United States. This means too many of our nation’s veterans will not have access to the final, and for many the only, veterans benefit they will receive from our grateful country. Accordingly, the Millennium Act directed the Secretary of Veterans Affairs to establish cemeteries in the six areas of the United States with the most need. In this regard, the Secretary will take into account the six locations identified by VA reports to Congress in 1987, and again in 1994, as most needy: Miami, FL; Pittsburgh, PA; Detroit, MI; Sacramento, CA; Atlanta, GA; and Oklahoma City, OK.

It is my understanding that the planning process is well underway for a cemetery in Oklahoma City, OK. I was also pleased to see advance-planning funds included in the Administration’s proposal for the Miami, FL and Sacramento, CA cemetery locations. Clearly, however, the needs of veterans in the remaining locations are no less important. For this reason, I strongly urge you to appropriate the $1million in advance planning funds that is necessary for all of the remaining locations to begin the process of master planning and design: Pittsburgh, PA; Detroit, MI; and Atlanta, GA. With projections of an unprecedented demand for national cemetery space by our veterans in the near future, it is particularly important we initiate the master planning and design phase for each of the geographic areas that have been repeatedly identified as most in need of the establishment of a new national cemetery.

In addition, Arlington National Cemetery requires $8 million for the first of a two-phase project to grade and prepare approximately 33 acres of land for in-ground burial. This will provide Arlington with up to 26,000 additional gravesites. Additionally, the project will entail utility relocation, road construction, storm-water system upgrade, and landscape architecture to preserve the aesthetic qualities of the cemetery. A little over $800,000 has been spent to date to design the development of this area.