Sen. Moran: “I have been working closely, in my view, with the Chairman, the Ranking Member, other members of this committee, those in the VA that you designated for me to work with and with the White House to make certain that the future of community care for veterans works and works well veterans and the providers who serve those veterans.”

Sen. Moran: “It is of upmost importance to me to reform Choice and to pass the right policies that will work for veterans in accessing healthcare that they deserve. It is also critical that members of Congress continue to push for a change in the VA culture to promote implementation of policies directed by Congress instead of VA, often narrowing the scope and thwarting the intent of Congress. This is in fact the conversation that you and I had, almost exclusively, during your confirmation hearing in February of 2017.”

Sen. Moran: “Pushing for a culture that transforms the VA, in my view, we have to hold you and other VA leaders accountable. In my view too often, in commitments and pledges that are made to this committee and to individual members regarding legislative efforts on behalf of our veterans, the follow up, the experience, is typical of what I’ve found with implementation of Congressionally-passed legislation: the VA changes course and it thwarts the intent of Congress. You and I had this conversation during your confirmation hearing.”

Sen. Moran: “On numerous occasions, you and I have met in my office. We have had numerous telephone conversations. And in those meetings and in those telephone conversations  you expressed support for access standards in the eligibility of Choice reform. In every instance in my view, you led me to believe that you and I were on the same page. What I remember you saying is this: the need for “specificity” in legislation is there, and then I quote you, “if it’s left to the Reg process, nothing in the VA will change.” You told me that.”

Sen. Moran: “I learned, though, that you have said something quite different to the Chairman and Ranking Member, and I am of the opinion that our inability to reach an agreement is in significant part related to your ability to speak out of both sides of your mouth, double-talk. My understanding is that others have had this experience and there is a shared frustration about this circumstance… You have been sworn to give testimony today, I am looking for a straightforward answer, a yes or no would be good – do you believe that the eligibility criteria to determine if a veteran can receive care in their community ought to be explicitly linked to the access standards?”

Sec. Shulkin: “Of course I believe that eligibility criteria should be explicitly linked to access standards, and I believe that those access standards need to be determined by the VA.”

Sen. Moran: “And Mr. Chairman, then, let me ask the Secretary, you support the access standards that are in our bill. You’ve told me that. True?”

Sec. Shulkin: “I support the access standards that are in the bill that the Senate committee passed 14-1.”  

Sen. Moran: “And those access standards are very similar. The issue is whether they are then tied to eligibility. Why would you not tie the access standards to eligibility? Why have access standards if they don’t matter in who is eligible for community care?”

Sec. Shulkin: “Senator Moran, first of all I applaud your efforts to get this right. I think it is grossly unfair to make the characterizations that you’ve made of me and I’m disappointed that you would do that. But I think that you have… I do not disagree with where you want to get to. I do believe that it is our job to give veterans more choice about how and where they get their healthcare. I think the issue is is that I am trying to do this in a way that will work for veterans and work for VA. I’ve seen, as you said before, Congress pass legislation that makes it more complicated and that makes it not work for veterans. And what I am trying to do is give you my best advice about how this works. The best way that I know how to do it is the way that the committee, 14-1, passed their vote, and I do believe that because of your efforts we can make those eligibility criteria, those access standards, clear to veterans so they understand them – that should be our goal – and to make sure that they do have choice based upon their clinical needs of their condition. That’s what you do in a healthcare system. That’s what I’m driving to get at. I don’t believe that we are at a far way position, here. We’re now talking about the best way to implement what we all want for veterans, which is the best care and giving them the most choice that they can get in that care.”

Sen. Moran: “Mr. Secretary, I’m sorry that you’re disappointed in my approach to this hearing today. I chose my words intentionally. I believe it to be the case. I think you tell me one thing and you tell others something else, and that’s incompatible with our ability to reach an agreement and to work together. I intend to be a member of Congress who holds you accountable for what you tell me. I hope the next step is, the Chairman indicated that the White House was sending language. I certainly would welcome a conversation, a discussion among members of this committee, the Ranking Member and the Chairman, the White House and you. This is, as you say, not that difficult. But it is an important issue. It’s not one that’s just a matter of a few words. It matters in the result that we get for accountability at the VA.”