[Congressional Record Volume 140, Number 11 (Tuesday, February 8, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: February 8, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
  TO PRESERVE VA'S FLEXIBILITY IN MEETING ITS MEDICAL WORK FORCE NEEDS

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Mississippi [Mr. Montgomery] is recognized for 5 
minutes.
  Mr. MONTGOMERY. Mr. Speaker, today I am introducing a bill, H.R. 
3808, that would provide VA flexibility in meeting the workforce needs 
of its health care system. The bill would also give the Secretary the 
necessary flexibility to meet his responsibilities in providing medical 
care under national health care reform.
  Mr. Speaker, the Administration's Health Security Act, H.R. 3600, 
reflects a serious, meaningful effort to address the needs of our 
Nation's veterans. The act would require that VA health care facilities 
establish and operate health plans as part of national health care 
reform, and that VA health plans would be enrollment options for 
veterans.
  H.R. 3600 would have the effect of reforming VA's health care 
eligibility by entitling its core beneficiaries to the comprehensive 
benefits provided all Americans under the act. Those core VA 
beneficiaries--primarily lower-income and service-connected veterans--
who enroll with a VA plan would receive needed services without cost-
sharing obligations. Under current law, most of these veterans are not 
now eligible for routine ambulatory care. Entitling enrollees to a 
benefits package that generously covers preventive and primary care is 
among the many aspects of the act which will require substantial 
changes in the VA health care system. VA must change its delivery 
capacity, organizational structure, accounting and other systems, and 
even its culture, to operate effectively within a framework of managed 
competition.
  It had been my belief that VA medical facilities could compete under 
the framework proposed by the act. I am deeply concerned, however, that 
the veterans' provisions of the Health Security Act, and the hopes 
veterans have invested in it, are jeopardized by deep employee 
reductions proposed for the Veterans Health Administration as part of 
the administration's Federal workforce reduction. As imposed on the VA 
health care system, these are arbitrary reductions. By their nature, 
they rob the VA health care system of the very flexibility it will need 
to make health reform work. It is ironic and troubling that while the 
President's Health Security Act would specifically vest VA managers 
with broad flexible authority to hire needed health care personnel, his 
Office of Management and Budget would render that provision useless by 
subjecting the Veterans Health Administration to a reduction of more 
than 20,000 employees over a 5-year period.
  Rather than empowering VA facility directors with tools to make VA a 
cost-effective participant in health care reform, as proposed under the 
act, the administration--by imposing its workforce reduction policy on 
this Federal health care system--would require VA medical facilities to 
make staffing cuts that bear no relation to the operational requirement 
of providing care to entitled enrollees. Compelling VA's hospitals, 
clinics, and nursing homes to downsize before they can assess the needs 
of the patients who will enroll and seek care in those facilities under 
national health care reform weakens that system's ability to compete, 
and ultimately disserves our veterans.
  Even if the Congress fails to enact health care reform legislation, 
imposing these employment reductions on the VA health care system is 
bad public policy. Years of tight budgets have trimmed the VA health 
care system of whatever administrative fat may have existed in the 
past. Employment reductions of the magnitude proposed cannot be 
sustained without eliminating thousands of nurses, doctors, and other 
essential hands-on-care personnel. Since such critical functions cannot 
be eliminated, VA will be forced to meet these workforce needs through 
contracting--often a far more costly avenue.
  Because of these deep concerns, I have developed legislation to give 
VA flexibility to meet its workforce needs. In place of OMB's workforce 
reduction directive, the bill would free VA to meet those workforce 
needs as most appropriate and cost-effective--whether through 
employment or contracting. To give VA the flexibility I think is 
needed, my bill would establish two key policies. First, it would 
provide that during the period October 1994 through 1999, no reduction 
may be made in the number of employees in the Veterans Health 
Administration other than as specifically required by law or by the 
availability of funds. Second, it would ease limitations in current law 
on contracting out activities currently being performed by employees at 
VA health care facilities. It should be clear that the bill does not 
dictate the manner in which VA should meet its workforce needs. To the 
contrary, in the spirit of reinventing government it aims to free VA to 
carry out its critical health mission through whatever mix of employee 
and contractor workforce best meets its needs.
  Mr. Speaker, I would hasten to reassure my colleagues, with respect 
to concerns about the potential impact of a provision that removes 
limits on contracting-out, that the bill provides protections for 
employees not now provided for under existing law. It would require 
that in any such contract-out situation the VA must require the 
contractor to give priority in hiring to any displaced VA employee, and 
provide such displaced employees with all possible assistance in 
obtaining Federal employment or entrance into job training and 
retraining programs.
  I believe it is essential that VA not be forced to make substantial 
reductions in health-care staff at a time when we are about to consider 
an administration proposal designed to allow VA to compete with other 
providers under health reform. I will seek to have this legislation 
reported to the House as soon as possible.

                          ____________________