[Congressional Record Volume 140, Number 57 (Wednesday, May 11, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: May 11, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
               VA HEALTH CARE UNDER THE PRESIDENT'S PLAN

                                 ______


                             HON. BOB STUMP

                               of arizona

                    in the house of representatives

                        Wednesday, May 11, 1994

  Mr. STUMP. The following is my statement regarding H.R. 3600, the 
Health Security Act, during markup today on title 8 of the bill before 
the Subcommittee on Hospitals and Health Care in the Veterans' Affairs 
Committee.
  Thank you, Mr. Chairman. Political forces external to the VA 
Committee have brought us here today, not unlike a budget 
reconciliation bill, demanding action notwithstanding Members 
displeasure over the process or result. If we fail to amend and report 
title 8 of H.R. 3600 then the title will progress as written by the 
White House. Hopefully, we can be mindful of our bipartisan approach to 
all veterans issues as we proceed with the difficult matters facing us 
today.
  Mr. Chairman, you and Chairman Montgomery have put forth a proposal 
which makes substantial improvements to the health services and funding 
provided in title 8 of H.R. 3600, the President's health security act. 
There are parts of your amendment which clearly demonstrate that you 
heard and attempted to address many of the concerns of minority Members 
of the committee. In particular, I note that the VA for the first time 
will have a clear mandate to provide institutional long-term care. This 
is an issue which has concerned me greatly and which led to my 
introduction of H.R. 3122, the Veterans Long-Term Care Act of 1993. 
While your amendment does not go as far as my bill, it is a major step 
in the right direction in caring for our older veteran population.
  I applaud your efforts and willingness to go to the mat for veterans. 
Your steadfast support of veterans has once again gained you support of 
the major service organizations. They have all submitted letters 
endorsing the amendment to H.R. 3600 being offered today.
  Mr. Chairman, in the bipartisan tradition of this committee, I will 
support your amendment and the wishes of the veterans organizations--
but I must also warn the representatives of those organizations to be 
careful what you ask for, because you just might get it. Acting within 
the confines of the four walls of this committee, we can do our best 
for veterans. However, the provisions we agree to today are based upon 
the structure of the President' Health Security Act, including employer 
mandates, mandatory alliances, and a new National Health Board 
bureaucracy. Those portions of H.R. 3600 are not contained in title 8 
of the bill and therefore, have not been referred to the Committee on 
Veterans' Affairs. It is because of these issues that I will not 
support H.R. 3600 if it comes to the floor.
  The most significant concern I have with H.R. 3600 is that it bases 
its funding on employer mandates. Last year the veterans organizations 
vehemently opposed shifting the Federal responsibility for providing 
care of service-connected conditions to private insurance companies. 
And at a hearing this year, the VSO representatives all testified in 
opposition to the employer mandates in H.R. 3600. Yet H.R. 3600 and the 
amendment to be considered today claims substantial federal savings due 
to the shifting of costs directly onto employers.

  Second, H.R. 3600 will force the VA health care system into direct 
competition with private sector providers for veteran patients. 
Veterans outside the beltway are very skeptical about VA's ability to 
compete--they wait months for appointments, stand in long lines once 
they get to the hospital and their access to health care services is 
severely limited by resources. Rather than provide substantial 
resources to prepare the VA for this new competitiveness, the 
administration has held badly needed funding for major VA medical 
construction hostage to passage of the Health Security Act.
  The chairman's amendment improves funding prospects for VA 
construction and tomorrow we will mark-up an authorization bill 
disconnecting a modest list of ambulatory care addition projects from 
the Health Security Act Investment Fund. But the need throughout VA for 
substantial restructuring overwhelms the availability of resources and 
probably outpaces the bureaucracies ability to respond. Many facilities 
may find it very difficult to hold on to current patient levels. 
Various estimates have placed the loss of veteran patients at 25 to 50 
percent of VA's current patient population, under national health care 
reform.
  Additionally, Mr. Chairman, the creation of a new National Health 
Board and attending bureaucracy seriously suggest the VA may not be 
able to maintain its former independence as an exclusive veterans 
health care system. It also raises questions as to whether VA will 
control its own destiny under this new regime. If, for instance, one VA 
facility proves to be less than cost-effective or competitive in the 
alliance atmosphere, who decides whether to spend millions to make it 
competitive or cut losses and shut it down?
  Mr. Chairman, there are other considerations which should be weighed. 
Members should be mindful of the grassroots backlash which occurred 
after Congress enacted the much-heralded Medicare Catastrophic Coverage 
Act in 1988. Senior citizen groups lobbied hard for the bill and 
convinced Members that beneficiaries would consider it a good deal in 
order to get catastrophic coverage. Everyone who was here at the time 
will recall how quickly Congress repealed that bill the very next year 
after a deluge of complaints from Medicare beneficiaries. The very same 
thing could happen here. Not only might the American public call for 
repeal of H.R. 3600 if it were implemented, but veterans might feel 
betrayed by its negative impact on the VA health care system. By then 
it just might be too late.
  I hope that H.R. 3600 will not pass and that Members can reach a 
consensus on a more moderate set of reforms. That is why I will 
introduce a separate eligibility reform bill, which could stand alone 
or be made part of other reform bills subsequent to consideration of 
the President's plan.

  Finally, Mr. Chairman, having insisted on the amendment we consider 
today, I believe it is incumbent on the Veterans Service Organizations 
to make their membership aware that certain risks remain to the VA 
health care system under H.R. 3600. In several other countries, 
separate, independent veterans health care systems have ceased to exist 
or have been severely downsized following adoption of national health 
plans. To tell veterans the VA Committee did a good job improving the 
provisions of H.R. 3600 without educating them as to the inherent 
remaining risks would be a great disservice.
  I hope the Veterans Service Organizations will responsibly report on 
these issues as action is taken on the floor. It is my personal belief 
that the service organizations should not support efforts to 
nationalize the U.S. health care industry. I have never received a 
letter from a veteran claiming that one of the reasons he or she served 
in our Armed Forces was to preserve the power of the Federal Government 
to nationalize entire sectors of the U.S. economy--never.
  Mr. Chairman, let me conclude by again commending you and the staff 
for your efforts on behalf of veterans. I truly believe you have done 
the best you can given the framework of the Health Security Act. While 
your amendment goes a long way toward improving VA's chances of 
survival, no amendment to H.R. 3600 would ensure its survival. Veterans 
need to be aware of this risk. Thank you, Mr. Chairman.

                          ____________________