[Congressional Record Volume 141, Number 62 (Tuesday, April 4, 1995)]
[House]
[Page H4148]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


      INTRODUCTION OF THE VETERANS HEALTH CARE REFORM ACT OF 1995

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Texas [Mr. Edwards] is recognized for 5 minutes.
  Mr. EDWARDS. Mr. Speaker, the Congress has a long record of support 
for America's veterans and for the VA health care system on which so 
many veterans depend.
  That system, like health care delivery generally, is facing an era of 
challenge and change. A critical factor for both the private and public 
health sectors, of course, is the high cost of health care delivery. 
Managing within a fixed budget, the VA has long been a cost-conscious 
provider of care. In recent months, however, VA's leadership has 
initiated additional reforms aimed at achieving more efficient service 
delivery.
  We continue to press the VA to streamline and improve its delivery of 
care. We also recognize, however, that the Department operates within a 
statutory framework which from time to time needs revision. It has 
become clear to me that at least one key element of VA benefits law no 
longer serves the veteran or VA effectively. Specifically, the laws 
governing eligibility for VA care have become archaic and need to be 
modified. Those laws--some reflecting medical practices of years ago--
make it easier to get costly hospital in-patient care than routine 
outpatient treatment. As a result, VA facilities often face the choice 
of denying a veteran routine outpatient treatment, providing that 
treatment illegally, or hospitalizing the individual to circumvent 
statutory limitations.
  There is relatively broad consensus that enactment of health care 
eligibility reform is a top priority. Veterans have been urging 
Congress to enact a law which would guarantee comprehensive health care 
coverage, including long-term care, to service-connected, low-income, 
and others with a high priority to VA services. We attempted to achieve 
that goal last session as part of the broader pursuit of national 
health care reform, but were ultimately unsuccessful. I do not believe 
the prospects for that kind of comprehensive legislation have improved.
  In my judgment, we can best achieve our common goals for VA 
eligibility reform incrementally. The reforms proposed in the Veterans 
Health Care Reform Act of 1995, which I'm introducing today, are 
incremental, but they are also important. My bill would for the first 
time eliminate barriers to routine outpatient treatment, and make 
medical need rather than a questionable legal test the basis for 
determining whether a patient requires hospitalization or a clinic 
visit. The changes would not only make VA eligibility rules more 
rational, they would expand the benefits available to most veterans. 
Under current law, only a limited group of veterans--those 50 percent 
or more service-connected disabled--are assured of receiving 
comprehensive outpatient treatment. The bill calls on VA to manage 
resources so as to provide comprehensive outpatient treatment, as well 
as hospitalization, to a much broader spectrum of veterans, including 
those receiving compensation for a service-connected disability, former 
prisoners-of-war, World War I veterans, and lower income veterans.
  Although I believe VA medical care merits a greater percentage of 
discretionary funding than it receives, the bill's proposed expansion 
of eligibility does not depend on additional appropriations. The bill 
instead envisions that the VA will shift care from its hospital wards 
to its outpatient clinics, and with the shift free up resources. 
Studies have found that some 40 percent of episodes of VA hospital care 
could more appropriately have been provided on an outpatient basis. In 
part, the problem is that VA facilities have more hospital bed capacity 
than they need, but not enough space and staff devoted to providing 
outpatient treatment. The bill would reverse that. It would provide VA 
a means to expand its outpatient treatment capacity by permitting the 
Department to retain for these purposes third-party collections above 
the Congressional Budget Office baseline level.
  Let me stress that this bill is an important step forward, and a step 
on which we can build in the future. While its provisions would only 
have effect for a 3-year period, its implementation will provide the 
kind of data and experience VA and the Congress need for the still more 
comprehensive reforms that veterans seek and deserve.


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