[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.
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