Kyrsten Sinema

Ms. SINEMA

Ms. SINEMA. Mr. Speaker, I yield 2 minutes to the gentlewoman from Nevada (Ms. Titus), my colleague on the Veterans' Affairs Committee.

Ms. SINEMA. Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Castro).

Ms. SINEMA. Mr. Speaker, I yield 2 minutes to the gentleman from Florida (Mr. Garcia).

Ms. SINEMA. Mr. Speaker, Mr. Miller, just know that folks on both sides of the aisle are very, very grateful for his leadership, in particular the research that was done to uncover the tragedy that occurred in the Phoenix VA in my district. So know that folks on both sides of the aisle here in the House are very, very grateful for the bipartisan nature in which the Veterans' Affairs Committee has conducted its affairs during his tenure, and we appreciate his leadership. Mr. Speaker, I yield 2 minutes to the gentleman from California (Mr. Takano), my colleague who serves on the Veterans' Affairs Committee.

Ms. SINEMA. Mr. Speaker, I yield 2 minutes to the gentlewoman from California (Ms. Brownley), my colleague who serves on the Veterans' Affairs Committee and the ranking member on the Health Subcommittee.

Ms. SINEMA. Mr. Speaker, I yield 2 minutes to the gentlewoman from Florida (Ms. Brown), who serves on the Veterans' Affairs Committee.

Ms. SINEMA. Mr. Speaker, how much time remains?

Ms. SINEMA. Mr. Speaker, I reserve the balance of my time to close.

Ms. SINEMA. Mr. Speaker, I yield myself the balance of my time. Mr. Speaker, I want to thank Chairman Miller and Ranking Member Michaud for their tremendous leadership and the work that they have done over the years to provide veterans with the best possible care, holding multiple hearings and passing a multitude of bipartisan bills. By working together, I know we can address this crisis and create a VA system that our veterans deserve. I urge our colleagues to support this motion to instruct, so we get a bill to the President's desk quickly. This is not the end of our work, but it is an important step forward to meet the needs of our veterans. I trust that Chairman Miller, Ranking Member Michaud, and the members of the conference committee will represent the interests of veterans very well in our conference committee. Mr. Speaker, I yield back the balance of my time.

Ms. SINEMA

Ms. SINEMA. Madam Chair, I have an amendment at the desk.

Ms. SINEMA. Madam Chair, the amendment today is a commonsense, budget-neutral amendment that provides colleges and universities with additional resources to prevent and respond to sexual violence on campus. This amendment increases funding for the Department of Justice's grants to reduce domestic violence, dating violence, sexual assault, and stalking on campus program by $1 million and offsets this increase by reducing DOJ general administration funding by the same amount. Madam Chair, I offer this amendment because nearly one in five female undergraduate students report being sexually assaulted in college. According to the Department of Education, 60 higher education institutions across the country--including Arizona State University, which I represent--are under investigation for their handling of sexual violence and harassment complaints. We must do more to protect students and equip universities to respond appropriately to sexual assault on campus. This amendment will allow more institutions of higher education to implement comprehensive, coordinated responses to sexual violence through the campus grant program. The campus grant program was created by the Violence Against Women Act of 2005 and reauthorized by the Violence Against Women Reauthorization Act of 2013, a bill which I worked hard to pass. Increasing funding to this vital program represents an important step in empowering victims of sexual assault and protecting both men and women on college campuses in Arizona and across the country. I urge my colleagues to support this amendment. Before I close, I want to thank the chairman of the Appropriations Committee, Mr. Rogers, and the chairman of the Commerce, Justice, Science Appropriations Subcommittee, Mr. Wolf, and the ranking member, Mr. Fattah, for working with me on this issue. Finally, I would like to thank Mr. Wolf for the years he has devoted to public service over the course of his very distinguished career. I yield back the balance of my time.

Ms. SINEMA

Ms. SINEMA. Mr. Speaker, I rise today in recognition of Yom Ha'Atzmaut, Israel's Independence Day. Sixty-six years ago, the state of Israel celebrated its first independence day. The creation of a modern Jewish homeland is no small achievement, and I am honored to join with Israelis and millions of other people around the world to continue this celebration. I have now been fortunate enough to visit Israel twice, most recently as part of a Congressional delegation last summer. I was again struck by the diversity that exists in such a small country and the creativity and energy that makes Israel so special. In speaking with political, business, and social leaders, I learned so much more about what links our two countries. The similarities between Arizona and Israel, where people work hard, embrace ingenuity and creativity, and build stronger communities for their families, are also striking. On this anniversary I reaffirm my commitment to Israel's security and to a lasting peace in the region. I am proud of the bond between our two countries, a bond built on mutual respect for human rights, democracy and freedom. As we celebrate Yom Ha'Atzmaut in Israel and the United States, we can reflect on a shared past and look towards a safe and secure future.

Ms. SINEMA

Ms. SINEMA. Mr. Chairman, I have an amendment at the desk.

Ms. SINEMA. Mr. Chairman, the Sinema-Salmon amendment is a commonsense, budget-neutral fix that helps restore our veterans' trust in the VA by transferring additional resources to the VA Office of Inspector General so that it can carry out its mission to provide oversight and accountability. Our amendment increases funding for the VA OIG by $1 million and offsets this increase by reducing VA General Administration funding by the same amount. I want to thank the chairman and ranking member of the Military Construction and VA appropriations subcommittee, Mr. Culberson and Mr. Bishop, for supporting this amendment and for working with us on this issue. Mr. Chairman, we offer this amendment because the recent allegations of secret lists and long wait times at the Phoenix VA, which may have caused some 40 veteran deaths, require answers and action. This is immoral, unconscionable, irresponsible, and un-American. We need answers in Phoenix. But this is not an isolated incident. A December 2012 GAO report found that Veterans Health Administration wait times are unreliable. Stories of health complications and deaths because of wait times have surfaced in other parts of the country, including South Carolina and Texas. That this is happening to the good people who have defended our flag and our freedoms is beyond the pale. I have worked on veterans' issues for a long time, and it is wrong that it took deaths to get action--but there had better be action now. I vow to help veterans and veteran families in any way I can, and I urge families to reach out to my office so we can help. The morning after the story was reported in Arizona, the parents of Daniel Somers, a veteran who committed suicide in my district last summer, called me, and they told me that they believe Daniel may have been one of the 40 on that list. Our veterans and their families--families like the Somers--need answers, and we must hold accountable those responsible. That is the only way that we can restore veterans' trust and the public trust in the VA health care system. The Sinema-Salmon amendment, which will improve oversight and accountability at the VA, is a step towards restoring that trust. Mr. Chairman, I yield back the balance of my time.

Ms. SINEMA. Will the gentleman yield?

Ms. SINEMA. Mr. Chair, I just want to thank the chair of the committee, Mr. Culberson; our ranking member, Mr. Bishop; and Mr. Salmon for cosponsoring the amendment, as well as all of my colleagues from Arizona and around the country for joining together on this bipartisan amendment.

Ms. SINEMA

Ms. SINEMA. Mr. Speaker, I rise today to remember the victims of the Rwanda Genocide and to ask my colleagues to join me in commemorating the twenty-year anniversary of this horrific period in our human history. Over the course of just ninety days in 1994, extremists in the Rwandan government executed a highly organized plan to exterminate the country's entire Tutsi minority population. Sadly, they very nearly succeeded. Nearly one million Rwandans were killed in this horrendous conflict, and it is estimated that over three-fourths of all Tutsis living in Rwanda in 1994 were killed before the end of the summer. In 2010 and 2011, I traveled to Rwanda while researching my doctoral dissertation on the Rwandan Genocide. I met the prosecutors in Arusha, Tanzania, where the International Criminal Tribunal for Rwanda was headquartered, as well as the archivists and researchers engaged in preserving its history. Their stories remind us all why we must recommit to ending genocide. Today, on the Day of Remembrance of the Victims of the Rwanda Genocide, I ask that my colleagues join me and the people of Rwanda in honoring the victims. May we learn from the Rwandan Genocide, and may we ensure that such atrocities are never again permitted to take place.

Ms. SINEMA

Ms. SINEMA. Mr. Speaker, I rise today to ask my colleagues to join me in supporting the bipartisan Strengthening Healthcare Options for Vulnerable Populations Act. This legislation, which I will introduce today, extends the authorization of Medicare Advantage Dual Special Needs Plans, D-SNPs, and makes necessary improvements to this valuable program for vulnerable seniors. Special Needs Plans, or SNPs, are a type of Medicare Advantage Plan with membership limited to a specific population with specific diseases or characteristics, and tailored benefits, provider choices, and drug formularies developed to best meet the needs of the group they serve. Dual Special Needs Plans, or D-SNPs, are plans developed for individuals who are both Medicare and Medicaid eligible. The Medicare dual eligible population is low-income and more likely to have complex and costly healthcare needs. Nationally, it costs $300 billion to care for this population. D-SNPs are driving improved care outcomes and greater efficiency eliminating redundancies between the two programs. There are 125,000 dual eligible individuals in Arizona and nine million nationally. More than half of the dual eligibles in my state are enrolled in a D-SNP. D-SNPs in Arizona are well-run and have demonstrated success: 31 percent lower rate of hospitalization; 43 percent lower rate of days in hospital; 9 percent lower emergency use; 21 percent lower readmission rate; 3 percent higher preventive care services. But D-SNPs are not just about controlling cost and improving healthcare delivery for a vulnerable population. D-SNPs, because of their innovative and targeted services, are a valuable option for seniors trying to live with dignity or people with disabilities trying to live fuller lives. Bonnie Grant is in her 60s and lives in south Phoenix. Through her D- SNP, she has access to a transportation called Van Go. Bonnie uses the service to go shopping and other places ``instead of being stuck at home.'' She said that it helps because ``instead of being holed up in your home,'' she can be engaged in the community and enjoy her life. The Van Go benefit is the type of creative service offered by D-SNPs that improve the wellbeing of enrollees. Joseph Ford lives in suburban Phoenix. He was disabled in a car accident. The hands-on managed care he receives through his D-SNPs, including in-home visits, allows Mr. Ford to stay in his home and live a fuller life. Keeping individuals like Mr. Ford in their homes instead of institutional care facilities is better for the beneficiary and a significant cost savings to the Medicaid and Medicare programs. We need creative and commonsense solutions to control the cost and improve the quality of services provided to this vulnerable population, which includes seniors and single working mothers. That is what D-SNPs are doing and that is why we introduce this bill today. The Strengthening Healthcare Options for Vulnerable Populations Act will allow seniors to have greater choice, help drive down cost and improve outcomes. First, this bill extends authorization for D-SNPs and requires that plans fully integrate Medicare and Medicaid services, while providing states with flexibility to make the plans work for their citizens. This long term authorization will create stability in the SNP program, thereby allowing states, the federal government and the private sector to begin to develop consistent strategies for addressing care for dual eligibles. Beneficiaries will also know that the plan they have chosen will not be taken away. Second, the bill directs CMS in coordination with State Medicaid Directors to develop a clearly defined role for state Medicaid agencies in contracting and oversight of integrated D-SNPs. Third, the legislation follows the recommendation of National Association of Medicaid Directors (NAMD) to designate the Medicare- Medicaid Coordinating Office within CMS as the dedicated point of contact to assist states with ongoing D-SNP administration issues, including eliminating redundancies and improving coordination of Medicare and Medicaid services and streamlining the flow of information to beneficiaries. The bill would also allow HHS to adjust Medicare's processes, timelines and requirements to improve the seamless delivery of patient-centered services across the care continuum. Fourth, the bill provides additional protections to beneficiaries by requiring CMS, in coordination with states, to establish a streamlined dispute resolution process and by requiring Medicare to continue to provide coverage during the dispute process. Lastly, our legislation improves the Medicare Advantage star ratings program to better evaluate and incentivize D-SNP performance. The bill directs CMS to take the necessary steps to recognize and incentivize performance by plans who serve more difficult or complex populations like the dual population. Ensuring that vulnerable seniors continue to have access to these valuable plans is an important part of ensuring that they can live out their golden years with dignity. The Strengthening Healthcare Options for Vulnerable Populations Act extends an important program for one of Arizona's most vulnerable populations. This bill ensures that seniors and others in these plans will be able to keep the managed care services they have selected. This bill provides states with greater flexibility to control cost and provide improved services. Finally, this bill can help control cost for a very expensive population nationally while at the same time improving healthcare outcomes. I urge my colleagues to join me in cosponsoring this important legislation.

Ms. SINEMA

Ms. SINEMA. Thank you, Congressman Murphy, for hosting this Special Order so that we can stand up and speak out for seniors in our districts. We are here today because CMS, the Centers for Medicare and Medicaid Services, has proposed cuts to Medicare Advantage. Next week, CMS will publish its final rule. I urge CMS to not cut Medicare Advantage. These cuts will decrease choice, create uncertainty, and undermine access to care for our seniors. I oppose these cuts. Like Mr. Murphy and many of our colleagues participating in this Special Order, I have repeatedly called on the Federal Government to reconsider its proposal and make no further cuts to Medicare Advantage. Medicare Advantage is a popular and effective alternative to traditional fee-for-service Medicare, especially in Arizona, where statewide, 38 percent of Medicare-eligible beneficiaries choose a Medicare Advantage plan. In my district, nearly 43 percent of Medicare- eligible beneficiaries choose a Medicare Advantage plan. Medicare Advantage plans consistently receive high customer satisfaction ratings and are helping to control cost, drive innovation, and improve health outcomes for beneficiaries. I keep saying ``beneficiaries.'' But what I should say is, our parents, our grandparents, and our loved ones. These plans provide affordable, high- quality care for our loved ones. Bonnie Grant, a proud Arizonan in my district, is in her sixties and lives in Phoenix. Through her Medicare Advantage plan, she has access to a transportation system called Van Go. Bonnie uses the service to go shopping and to go other places ``instead of being stuck at home.'' She said that it helps because ``instead of being holed up in your home,'' she can be engaged in the community and enjoy her life. The Van Go benefit is the type of creative service offered by Medicare Advantage plans that improves the well-being of enrollees. Joseph Ford, another constituent, lives in suburban Phoenix. He was disabled in a car accident. The hands-on managed care he receives through his Medicare Advantage plan, including in-home visits, allows Mr. Ford to stay in his home and live a fuller life. Keeping individuals like Mr. Ford in his home instead of in institutional care facilities is better for the beneficiary and presents a significant cost savings to the Medicaid and Medicare programs. I am concerned that the proposed payment reductions for 2015 will undermine the choices made by my fellow Arizonans, by Ms. Grant, by Mr. Ford, and by others in my congressional district by causing our loved ones to lose needed services and to experience increases in premiums. These cuts could also have the unintended and costly consequence of putting our seniors at risk of being placed in institutions, rather than staying in their homes. Instead of cutting funding for these popular plans, we should work together to find reasonable solutions that drive down cost, increase choice, address waste, fraud, and abuse, spur innovation, and ultimately improve the quality of life provided to our seniors. Again, I urge CMS to maintain payment levels for Medicare Advantage so that our loved ones do not experience increased out-of-pocket costs, negative disruptions, or confusion in 2015. Thank you, Congressman Murphy, for working with me on this important issue and for hosting this Special Order today.

Ms. SINEMA

Ms. SINEMA. Thank you to the gentleman from Pennsylvania for hosting that bipartisan Special Order. Unfortunately, these days in Washington there are too few issues that bring Republicans and Democrats together to find reasonable solutions to the challenges facing our country, but supporting the National Guard is one issue that certainly brings us together, which is why I appreciate the opportunity to join my colleagues today. The United States needs a fully functional and operational National Guard. The active military and the National Guard may have different attributes, but they train and certify to the same standards, and Guard units and personnel can function interchangeably with their Active Duty brothers and sisters. We rely on the National Guard to protect our country overseas and here at home. Arizona has a proud tradition of service, and we are proud of our fellow Arizonans who become citizen soldiers. Since September 11, over 12,000 members of the Arizona National Guard have deployed, and we have 150 members currently mobilized. Not only does the Arizona National Guard deploy overseas, it has a critical mission here at home: responding to natural disasters, improving border security, and performing counterdrug operations. The Arizona National Guard is also leading the way in helping our citizen soldiers and their families balance the challenges of service with civilian life. Under the leadership of Lieutenant Colonel Denise Sweeney, Director of Arizona's National Guard Total Force Team, the Be Resilient Program is promoting mission readiness and retention by increasing the resilience of each servicemember and their family. The Total Force Team focuses on integrating and coordinating the efforts of all resilience and support programs for Arizona National Guard members and their families, and it leverages public-private partnership to engage the broader community. This program is strengthening servicemembers and their families and is another example of why the Arizona National Guard is so important to our State and why the National Guard deserves our full support. I support a defense budget that responsibly uses taxpayer dollars and keeps our country safe and secure. I have serious concerns that the proposed cuts to our National and Reserve component would undermine the ability of Arizona's National Guard to perform its critical missions. Substantially reducing the size of National Guard, and in particular, removing all helicopter attack aviation, could hurt Arizona and our national security. You can't build emergency response, combat, and leadership capabilities overnight. We will continue to call on our National Guard in times of need. We should make sure they have all the training, tools, and force strength to answer that call. As a member of a military family, I understand that these citizen soldiers and their families make great sacrifices in order to serve our country. We should stand up and support these brave and committed men and women, and give them the tools that they need to keep us safe. Thank you, Colonel Perry, for hosting this time. I look forward to working with my colleagues on this important issue more.

Ms. SINEMA

Ms. SINEMA. Mr. Chair, I have an amendment at the desk.

Ms. SINEMA. Mr. Chairman, I yield myself such time as I may consume. My amendment would strike language that expands eligibility for the National Priorities List in section 204, which is overseen by the Environmental Protection Agency. My amendment also reinstates language that directs listings of the ``highest priority facilities'' for cleanup and guarantees that State- recommended sites receive priority. In 2003, an agreement was finalized to provide much-needed cleanup to the North Indian Bend Wash site in my district. The site, formerly used for industrial production and manufacturing, now spans several housing developments in which thousands of Arizona families, students and seniors reside. Since then, Federal, State, and local stakeholders have worked together to put a 25-year plan in place to address soil and water contamination at this site, but those plans have not gone uninterrupted. In January of 2008, more than 3.5 million gallons of contaminated water were mistakenly delivered from this site to homes in Paradise Valley, and in July of that same year, irrigation water used from this site triggered a study at an elementary school in my district to determine if the school grounds had been contaminated. The North Indian Bend Wash site is one of many sites across the country listed under the National Priorities List, which provides much- needed funding to assist States with cleanup efforts. In keeping with the mission of the National Priorities List, which is to protect public health, my amendment protects funding for important cleanup projects, like the North Indian Bend Wash, that are taking place in hundreds of communities across the country. The underlying bill would expand eligibility for the National Priorities List, stretching its mission beyond its current financial means without providing additional funding to accommodate this expansion. My amendment prevents this unfunded expansion. In times of financial shortfall, we should ensure that we efficiently and responsibly use taxpayers dollars to prioritize projects by need and maximize our impact on improving public health. While I agree that providing more robust State input is essential to crafting better environmental policy, H.R. 2279 would actually repeal language that requires the administration to prioritize the most urgent and impactful State projects for cleanup. I also believe that striking the ``highest priority facilities'' language, as called for in the underlying bill, may have the unintended consequence of diminishing the statutory role that States would have in determining the EPA's cleanup priorities. The underlying bill strikes the only clause in the current law that explicitly protects states' rights with NPL. Without this language, it is possible that the underlying bill could result in the EPA's placing certain projects that States have requested at the bottom of its funding priorities on the NPL while still following the law. My amendment reinstates this language, directing the EPA to make tough choices that necessarily respect the interests of our States. We all share the desire to work towards commonsense, reasonable solutions, using tax dollars wisely, facilitating job growth and improving public health. This amendment provides a meaningful fix to the underlying bill by preventing an unfunded expansion of the NPL and directing the administration to make tough choices that respect the rights of States. I urge my colleagues to vote ``yes'' on this amendment. Mr. Chair, I reserve the balance of my time.

Ms. SINEMA. Mr. Chair, I yield 1 minute to the gentleman from New York (Mr. Sean Patrick Maloney), my colleague.

Ms. SINEMA. Mr. Chairman, I yield myself the balance of my time. I share the desire of my Republican colleagues to increase the input provided by and the role of States in listing facilities on the National Priorities List, but by adding more sites to an already overwhelmed program, we may diminish the effectiveness of this important program. I am also concerned that the underlying bill, by striking the current statutory language that directs the EPA to give State-recommended sites priority, could have the unintended consequence of decreasing the role of States in this process. For these reasons, Mr. Chair, I urge my colleagues to support the amendment. I yield back the balance of my time.

Ms. SINEMA. Mr. Chair, I demand a recorded vote.