MR.AKAKA. Mr. President, I rise today with my friend, Senator Murray, to offer an amendment to address the costs of providing health care to troops serving in Iraq and Afghanistan.

Following the 1991 Gulf War, returning servicemembers began to report unexplained illnesses and ailments that many linked to their service. Only those who had been granted a claim for a service-connected disability or demonstrated a financial need could turn to VA for health care services. Reservists and Guard members were particularly vulnerable, as military health care is lost after separation from service.

Back in 1998, this very body voted unanimously to ensure that no combat veteran would be caught up in stringent eligibility rules and be denied treatment. Today, any servicemember who participates in a theater of combat is eligible for free VA health care for two full years after separation or release from active duty, without regard for strict eligibility rules.

This benefit is more important than ever, especially to Reservists and Guard members. Experts calculate that about 40 percent of the lower enlisted grades in these services do not have any kind of health insurance. Because TRICARE eligibility is lost after separation or deactivation, VA is the only place many of these servicemembers can turn.

Mr. President, my colleagues in the Senate have already recognized the need to provide funds that would allow VA to absorb an influx of new patients from Operations Iraqi and Enduring Freedom. In 2003, $175 million was added for VA to the Supplemental Appropriations Bill. I would point out that this amount was provided only one month after the war in Iraq began and before we knew about the level of troop commitment.

This amendment we offer today allows VA to provide care for returning troops -- without displacing those veterans currently using the system. We are now two years into this conflict, and VA has already begun to see real impact. Last year, VA spent $63 million on returning veterans. Using data from the first quarter, VA will spend an unbudgeted $120 million this year. Yet, the lion's share of our troops have not yet returned home, are rehabilitating in the DoD health care system, or are pending separation.

Mr. President, the amount of this amendment -- $1.9 billion -- is drawn from what we know about past use of the VA health care system, coupled with what we know to be the cost associated with shoring up the system for all veterans.

This is what we know: VA tells us that 20 percent of returning servicemembers are now turning to VA for care. Using this figure and VA's costs, we know that $600 million in additional funding will be needed for returning servicemembers alone.

We also know that right now VA hospitals are running deficits of about $40 million per each health care network. Let me share some specifics:

Outpatient clinics have stopped seeing even the poorest of patients -- sending them hundreds of miles away to other facilities. The Townsend, Massachusetts, clinic is only seeing a tiny percent of those who need care.

In Network 20, which serves the Northwest and Alaska, we have now seen the beginnings of what could very well become a nationwide trend. Priority 7 veterans -- who often make as little as $26,000 a year -- are being denied care, as the Network is running about a $40 million deficit.

Veterans in need of treatment for PTSD or addiction treatment will have one less place to go due to the VA budget. The Psychiatric Rehabilitation Program at the Chillicothe VA hospital is being shut down. Thirty nursing home beds at the VA hospital in Manchester, New Hampshire, will not be opening. VA officials expect to save $1.3 million by not opening these beds.

As my good friend Senator Collins has pointed out, the hospital in Togus, Maine, is operating under a $14.2 million deficit. This Maine facility has a hiring freeze and cannot replace equipment.

The Kansas City VA Hospital is short-staffed because they are already $10 million in the hole. The Denver VA Hospital and its affiliated clinics are $7.25 million short. The Maryland Health Care System is $14.5 million in the red already this year. The list goes on and on.

The Network that serves Minnesota, Nebraska, Iowa, North Dakota, and South Dakota is facing an overall shortfall of $61 million. South Dakota's facilities are $2.4 million short right now; Minnesota's are $25 million short; and Iowa's hospitals are at least $14 million short of what is currently needed. Bed frames are being held together by duct tape in some facilities, and cleaning staff cannot be hired to keep the facilities sanitary for patients. Health care provider positions also remain open, resulting in shortages of doctors, nurses, and medical technicians, to name a few.

Furthermore, Florida's facilities are $150 million in the red. And again, this has resulted in key health care specialist positions going unfilled. In a region where so many veterans and active duty servicemembers reside, a shortfall of this magnitude is shameful.

This trend towards hiring freezes and under-staffing of vital health care programs and services is one that is of great concern to me. I know that the American Federation of Government Employees is also very concerned about the measures being taken by many facilities to compensate for the numerous shortfalls around the country, and I commend AFGE for its support of this amendment.

It will be impossible for VA to care for returning veterans in the midst of this kind of situation. While we know that many members of this body have worked hard to see that their VA facilities remain in good condition, we must do more to ensure quality of care throughout the entire VA system.

We also know that VA mental health must be improved if we are to meet the needs of returning servicemembers. Experts predict that as many as 30 percent may need psychiatric care when they come home. Yet, we are told that the system is nowhere near ready to handle this type of workload. Steady budget cuts over the years have diminished VA mental health care capacity.

GAO recently found that VA has lagged in the implementation of recommendations made by its own Advisory Committee on Post-Traumatic Stress Disorder to improve treatment of veterans who suffer from this very serious mental illness. Furthermore, GAO concluded that it is questionable as to whether or not VA can keep pace with the demand for mental health treatment from veterans of Operations Iraqi and Enduring Freedom.

And while veterans' clinics now dot the landscape, they don't have the ability to meet mental health needs. Vet Centers -- which provide vital outreach and readjustment counseling to veterans of yesterday and today -- have seen their workload double, but not one additional nickle has been sent their way. There are large pockets of this country without any access to VA mental health care whatsoever.

Fixing these problems requires resources of at least $525 million. We know this is a conservative estimate. Advocates believe that it would take more than three times this amount to bring VA mental health care up to what it should be, but this amendment gets us going down the right track. The National Mental Health Association's letter of support for this amendment states that "...the nation has no higher obligation than to heal its combatants' wounds, whether physical or mental, and it has long looked to the VA health care system to carry out that obligation. To date, however, planning and budgeting for the VA health care system has been badly flawed and is failing America's veterans, and particularly the growing numbers from war." I ask for unanimous consent that the Association's letter, as well as one from the National Alliance for the Mentally Ill, be entered into the record.

The costs of the war we are fighting today will continue to add up long after the final shot is fired, mainly in the form of veterans' health care and benefits.

I urge my colleagues to join us in this effort to see that they are provided the care they are currently earning. Thank you.