[Congressional Record Volume 140, Number 94 (Tuesday, July 19, 1994)]
[Extensions of Remarks]
[Page E]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: July 19, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
              INTRODUCTION OF ELIGIBILITY REFORM PROPOSAL

                                 ______


                             HON. BOB STUMP

                               of arizona

                    in the house of representatives

                         Tuesday, July 19, 1994

  Mr. STUMP. Mr. Speaker, I rise today, with the support of all 
Republican members on the House Committee on Veterans' Affairs to 
introduce the Veterans' Health Care Eligibility Reform Act of 1994. The 
purpose of this legislation is to revise and reform the current system 
of eligibility for health care services provided by the Department of 
Veterans Affairs.
  It is well known that the VA's current eligibility criteria is 
fragmented and difficult to understand. The rules for access to VA 
medical services have evolved piecemeal and do not authorize a full 
continuum of services for many of VA's patients. A veteran may receive 
inpatient hospital care only to be barred from access to outpatient 
care because of differing eligibility rules. I am submitting a chart 
which demonstrates exactly how complex and confusing such criteria are 
and the simplification provided by the legislation which I am 
introducing today.
  Today's eligibility criteria at the VA has been imposed to help the 
Department contend with its perennially inadequate budget. The VA 
portion of Federal outlays for health care has shrunk continually since 
1969 when it comprised 12.6 percent. In 1992 it fell to 6 percent. 
There is no indication that this trend will change. However, one thing 
is certain, allowing VA to continue on its current course will lead to 
its demise.
  The House Committee on Veterans' Affairs, on which I serve as ranking 
minority member, has recognized the importance of eligibility reform. 
In fact, the committee held the first of a series of hearings on this 
crucial issue on May 20, 1992.
  The hearing reinforced our belief that maintaining the status quo 
will result in continued erosion of the VA health care system. In order 
to identify solutions, though, we need to concern ourselves not only 
with the current situation, but also with the future needs of our 
Nation's veterans. It is clear that the VA needs a realistic, 
achievable strategic plan, which includes eligibility reform, to meet 
the health care needs of a rapidly aging veteran population.
  Prior to introduction of the President's Health Security Act, the 
Committee on Veterans' Affairs, the VA, and the Veterans Service 
Organizations [VSOS] were working together to formulate eligibility 
reform legislation for veterans. All efforts toward eligibility reform 
came to a halt with the advent of the new administration.
  However, there is a bipartisan consensus that veterans once eligible 
should have access to a full continuum of health services, including 
long-term care and certain specialized services such as spinal cord 
injury and blind rehabilitation. This legislation preserves the 
services that VA does best and allows VA the flexibility it needs to 
design a strong future health delivery system.

  Mr. Speaker, the fate of the President's Health Security Act is 
unknown. The administration has hung all hopes of VA health reform on 
passage of H.R. 3600. My legislation provides a vehicle for VA health 
care reform to move forward regardless of what happens to national 
health reform. If the Health Security Act fails to be enacted and it is 
my intention to oppose it for many reasons including its impact of the 
VA, Congress should not let VA health care reform die with it. Veterans 
have waited long enough for reform. Every week that goes by leads to 
further cannibalization of the system and erosion of veterans health 
care services. My legislation was not drafted in conjunction with any 
particular national health care reform bill. It could become part of an 
alternative plan. We cannot and should not hold VA hostage to the 
Clinton national health reform bill.
  The Veterans' Health Care Eligibility Reform Act of 1994 envisions an 
eligibility reform proposal for VA to maintain a viable and independent 
health care system for veterans which:
  Simplifies the criteria used to determine eligibility for VA health 
care services.
  Promotes the delivery of a continuum of care by removing statutory 
barriers that currently constrain patient access to the system or 
patient referral to the most appropriate treatment setting.
  Promotes a shift from acute inpatient care and nursing home care to 
outpatient and noninstitutional care.
  Promotes wellness through comprehensive prevention and screening 
programs.
  Preserves VA's long history of leadership in the areas of long-term 
care, spinal cord injury, blind rehabilitation, and prosthetics by 
providing a full continuum of care.
  Changes the practice of medicine within the Veterans Health 
Administration to employ managed care.
  Continues VA as an independent health care system for veterans.
  Continues VA as backup to DOD in times of national emergency and 
preserves VA's research mission.
  In addition, the measure would mandate that the secretary establish a 
separate insurance program for veterans who do not meet the criteria 
for free VA care and for spouses and children of all eligible veterans. 
This insurance program known as the VA Group Health Plan would provide 
protection to individuals who have preexisting conditions and to whom 
insurance costs might be prohibitive if attempting to purchase private 
health insurance.
  We have no official cost estimate for this measure. Informal 
estimates have placed the cost anywhere from cost-neutral to a high of 
$3 billion the first year. One thing however is certain, allowing VA to 
collect from Medicare the cost of care rendered to non-service-
connected veterans who are already entitled under Medicare is a measure 
which is long over due. Because VA is barred from collecting Medicare 
reimbursement, it has in effect been subsidizing Medicare for decades. 
Informal estimates put the first year savings to VA from Medicare 
reimbursements at $7 billion and the figure climbs from there. It is 
unreasonable for VA, in these times of severe fiscal constraint, to 
subsidize Medicare, an entitlement account from VA's discretionary 
medical care funds.
  Mr. Speaker, this legislation is my attempt to identify workable 
solutions to ensure the future viability of our Nation's veterans 
health care delivery system. I urge my colleagues to cosponsor the 
bill.

                          ____________________