[Congressional Record Volume 141, Number 166 (Wednesday, October 25, 1995)]
[Senate]
[Pages S15703-S15704]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          VETERANS HEALTH CARE ELIGIBILITY REFORM ACT OF 1995

 Mr. WELLSTONE. Mr. President, I understand that the House 
Budget Reconciliation bill incorporates the provisions of the 
``Veterans Health Care Eligibility Reform Act of 1995,'' a draft bill 
which addresses some of the critical problems faced both by veterans 
seeking health care and by the VA in providing health care services. I 
applaud the sponsors of the bill for their efforts to help the VA 
fulfill its lofty purpose: to take care of those who have served their 
country with pride and honor.
  The House bill would enable the VA to provide its services more 
efficiently and in the most appropriate setting, assuring our Nation's 
veterans that they could receive the care they need. Specifically, it 
would ensure that VA health care providers are granted the freedom to 
treat veterans on an outpatient basis when appropriate and would 
broaden the VA's authority to contract for outpatient services. In 
other words, the VA at long last could pursue methods of treatment 
based on medical and economic common sense, benefiting veterans and 
providers alike.
  Let me highlight some of the key provisions of this innovative 
legislation which is of major importance to America's veterans. It 
would:
  Enable VA, within appropriations, to provide all needed hospital care 
and medical services to eligible veterans, including preventive and 
home health care;
  Call for VA to manage the provision of care and services through 
enrollment or registration, based on a system of priorities;
  Assign priority for enrollment in the following order: First, 
veterans 30 percent or more service-connected disabled, second, former 
POW's and veterans with service-connected disabilities rated 10 or 20 
percent, third, veterans receiving aid and attendance or housebound 
benefits and otherwise eligible veterans who suffer from a catastrophic 
disability, fourth, veterans unable to defray the cost of medical 
services, and fifth, all others;
  Give VA discretion to determine how an enrollment system would 
operate and authority to set additional priorities within the above 
priority groups; and
  Protect specialized VA programs, such as those for veterans with 
spinal cord injuries and post-traumatic stress disorder.
  Mr. President, I want to stress that this legislation not only enjoys 
broad bipartisan support in the House, but that it is very much in the 
spirit of the Senate Appropriations Committee report issued last month 
on the VA, HUD, and Independent Agencies Appropriations bill under the 
aegis of my distinguished colleagues Senators Bond and Mikulski.
  This report noted the committee had included a provision ``enabling 
VA to treat veterans eligible for hospital care or medical service in 
the most efficient manner,'' adding that the Committee supported the 
VA's efforts ``to shift as much of its inpatient workload to ambulatory 
care settings as possible, to make better use of its resources.'' This 
is precisely what the House bill seeks to accomplish.
  I also want to underscore that this legislation has won widespread 
support from numerous veterans service organizations [VSO's], experts 
on veterans health care, and the VA.
  There have, however, been widely differing estimates from the VA and 
CBO on how the bill will affect demand for VA services and what impact 
if any it 

[[Page S15704]]

will have on the VA budget, even though the bill specifies that it is 
to be implemented within appropriations. While the VA contends the 
House proposal is budget neutral and that it would make available as 
much as $268 million within 2 years to expand VA outpatient services, 
CBO estimates that any savings will be offset by over $3 billion in 
costs incurred as a result of increased demand for VA outpatient care. 
A number of VSO's have joined the VA in taking sharp issue with the CBO 
cost analysis.
  Mr. President, it seems that proposals which satisfy so many needs of 
both patients and their health care providers deserve our deepest 
commitment and support, but at the same time we need to fully explore 
the consequences of such reforms. We need to change the way veterans 
receive their health care. That much is clear from how eager both sides 
of the equation--patients and providers--are to make the same changes. 
But we also need to ask ourselves: ``What are the costs if any?''; 
Could these reforms cause other unintended problems in the future?; 
Will the proposed reforms alleviate problems plaguing the VA health 
care system?; and Will cuts in Medicare and Medicaid lead to increased 
demand for VA services so that the need for eligibility reform becomes 
even more pressing? We need answers to each of these pivotal questions 
before we can proceed.
  I strongly believe that the provisions in the House bill or some 
variant of these provisions could at the very least provide a vital 
first step to achieve long-overdue eligibility reform, and to do so in 
a responsible manner. However, we first need to sit down and get all 
the facts out on the table so we can come up with clear answers to 
complex questions.
  In anticipation of the possibility that the provisions of the House 
veterans bill will not be included in the final Senate/House version of 
the budget reconciliation package, I propose that the Committee on 
Veterans' Affairs conduct hearings to solicit the views of those who 
would be affected by such reforms and those who have thoroughly 
investigated their future effects on veterans' health care and their 
budgetary impact. I would welcome the chance for the committee to hear 
from representatives from the VA, VSO's, the Congressional Budget 
Office, and anyone else who could bring crucial insights to the forum. 
We need to include all viewpoints, to look critically at all data, and 
to listen to all voices before we can move forward responsibly. We need 
to institute eligibility reform but we need to carefully craft reform 
to ensure that it improves the quality of VA health care, makes it more 
user friendly, and increases its cost effectiveness.
  I have requested that my distinguished colleague Chairman Simpson 
hold hearings on this topic when feasible and, if he concurs, look 
forward to working closely with him on preparations for the 
hearings.

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