[Congressional Record Volume 142, Number 72 (Tuesday, May 21, 1996)]
[Senate]
[Pages S5443-S5448]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WELLSTONE:
  S. 1786. A bill to require the Secretary of Veterans Affairs and the 
Secretary of Health and Human Resources to carry out a demonstration 
project to provide the Department of Veterans Affairs with 
reimbursement from the Medicare Program for health care services 
provided to certain Medicare-eligible veterans; to the Committee on 
Finance.


                 VA HEALTH CARE ELIGIBILITY LEGISLATION

  Mr. WELLSTONE. Madam President, I am pleased and honored to introduce 
legislation which I believe will demonstrate the cost effectiveness and 
feasibility of Medicare subvention funding to the Department of 
Veterans Affairs [VA] for treatment of some Medicare-eligible veterans 
at VA medical facilities. This legislation would authorize a 
demonstration project of Medicare subvention whereby Medicare would 
reimburse VA for delivering health care to some veterans age 65 and 
over.
  My legislation would authorize the Secretaries of Veterans Affairs 
and of Health and Human Services to enter into an agreement to carry 
out the demonstration project. This bill would bar reimbursement to the 
VA until the expenditure for health care services for participating 
veterans by a veterans integrated service network exceeds the amount 
that the VA would expend for such services in the absence of the 
project.
  In effect, this ensures that VA will receive Medicare reimbursement 
only for additional health care costs that are directly attributable to 
the demonstration project. My bill would ensure that costs to the 
Medicare program of providing services under the project do not exceed 
the usual costs Medicare would incur in providing such services.
  To prevent red tape from delaying the start of this test, the 
legislation specifies that VA health care facilities chosen to 
participate in the demonstration project will automatically be deemed 
to meet Medicare standards. Reimbursement to the VA will be on a 
capitated basis and veterans age 65 and over who are not eligible for 
VA health care for a service-connected disability may be selected to 
participate in the project.
  Madam President, I now want to address the two key reasons I am 
introducing this legislation and will press for its passage. First, 
reforming veterans' health care is one of my highest priorities and I 
am quite frankly disappointed that the Senate has not yet emulated the 
House in taking significant bipartisan legislative action to reform 
unwieldy, arcane, and obsolete eligibility rules that Minnesota and 
other veterans face when they visit VA hospitals and clinics. While 
Secretary of Veterans Affairs Jesse Brown and his Under Secretary for 
Health Ken Kizer have taken bold and innovative steps to modernize, 
restructure and decentralize VA health care, their efforts to overhaul 
the VA health care system--so that it will remain viable and serve the 
needs of veterans into the 21st century--are being hamstrung by 
outmoded eligibility criteria that stress inpatient care even when 
outpatient care would be more appropriate, user-friendly and cost 
effective.
  I believe that Medicare reimbursement is an important and, with an 
aging veterans population, even an essential component of eligibility 
reform. My view is shared by major veterans service organizations 
[VSO's] which have submitted two different eligibility reform proposals 
that would authorize the VA to receive Medicare reimbursement for 
treating Medicare-eligible veterans. Medicare reimbursement will allow 
the VA to offset the costs of delivering care to older veterans who may 
gain access to outpatient and preventive care when eligibility reform 
legislation is enacted.

  The GAO, however, has questioned both the feasibility and cost of 
providing Medicare reimbursement to the VA. While I lean toward the 
VSO's view that Medicare reimbursement would be both feasible and cost-
effective, the only way to prove it is by means of a demonstration 
project. This is precisely what my legislation authorizes.
  Second, because the VA is facing and will likely continue to face 
severe funding constraints that probably will reduce its capabilities 
to provide access to quality health care, the VA will be under strong 
pressure to deny some vital health care services to Medicare-eligible 
veterans.
  In recent years the VA health care budget has lagged behind medical 
cost inflation and under the budget resolution adopted by Congress last 
year the VA medical care budget would be frozen for 7 years, thus 
lagging behind overall inflation and probably even further behind 
medical cost inflation. As a consequence, the VA may be compelled to 
further ration care, with veterans 65 and over one of the groups likely 
to be affected. Even before the VA was faced with a flat health care 
budget, many of its facilities were compelled to resort to rationing.
  In this connection it is important to note that recent GAO testimony 
before the Senate Subcommittee on VA, HUD, and Independent Agencies 
Appropriations underscored the fact that in 1993 ``118 VA medical 
centers reported rationing some types of care to eligible veterans when 
the centers ran short of resources.'' There is no doubt whatever that a 
flat VA health care budget for 7 years can only lead to more extensive 
rationing of health care for veterans. This will further fray our 
solemn contract with the men and women who selflessly defended our 
country.
  Madam President, this bill is intended to ensure that our aging 
veterans population is not denied access to VA health care precisely 
when they need it most. I believe that this demonstration project will 
show that Medicare subvention will at least be budget neutral, and may 
even save Medicare dollars by using less costly VA care. But I would 
hope that even those who do not share my views would agree that the 
demonstration project that I

[[Page S5448]]

am proposing is the best way of determining the impact on Medicare, the 
VA, and most important, our aging veterans. These brave men and women 
deserve the best health care that can be provided, not rationed care 
whose quality is determined by an eroding VA health care budget and not 
by the health care needs of veterans who risked their lives for this 
country at times when it was in dire peril.
  Madam President, improving and protecting health care for the 
increasing numbers of older veterans should be a priority issue for my 
colleagues on both sides of the aisle. I hope all of my colleagues will 
carefully scrutinize this bill, strongly support it, and join me in the 
fight to ensure its passage.
  Madam President, I am introducing a bill today that focuses on health 
care eligibility in the VA health care system. It is, interestingly 
enough, analogous to a bill that the majority leader, Senator Dole, has 
introduced that essentially says for those Department of Defense 
retirees, that there can be a Medicare third-party payment for them to 
continue to receive health care within the military health care system. 
That is put on a demonstration project basis. I think it is an 
important piece of legislation.
  What the bill I have introduced says, again, on the demonstration 
model basis--demonstration project basis--is that for some of the 
veterans within a certain narrow framework, they also will be able to 
receive health care within the VA health care coverage--within the VA 
health care system--with a Medicare third-party payment.
  I now sit on the Veterans' Committee. It has taken me several years 
to get on that committee. These issues are near and dear to my heart. 
It is clear to me, and I think it is clear to all Senators on both 
sides of the aisle, that health care eligibility is at the very top of, 
if you will, an agenda that is responsive to the concerns and 
circumstances of the veterans community. This will be a demonstration 
model. That is what this bill calls for. I think it is extremely 
important.
  There is a debate as to whether or not, for example, Medicare third-
party payment for the VA health care system will work well or not. The 
only way we can find out, without having to debate ad nauseam, is to 
put this on a pilot project basis.
  I think this is only a step, but this piece of legislation, if 
passed, either as a piece of legislation or an amendment on the 
appropriate vehicle, I think it is an extremely important step in the 
right direction of enabling us to do some things within our VA health 
care system that will enable us to provide very efficient and very 
effective and very compassionate health care for veterans.
  Also, Madam President, I want to mention that Dr. Ken Kizer, with the 
VA health care system, I think is really making a heroic effort to 
think deeply about VA health care and where it is going into the next 
century.
  I think he is joined by Secretary Jesse Brown. Secretary Brown, in my 
view as a Senator from Minnesota--and I think I have been a fierce 
advocate for veterans--has been a very powerful and very articulate 
advocate for veterans in this country. I know that he has put health 
care eligibility reform at the very top of his list of priorities. I 
know that he cares deeply about veterans. I know as someone who was 
very active within the DAV, Disabled Veterans of America, he knows 
these issues. They are not abstract or intellectual to him. He came to 
this Cabinet position as someone who has been down in the trenches 
struggling not only for disabled veterans but for all vets.
  So with the time I have on the floor, again I am devoted to this 
piece of legislation which I have introduced. I think there is going to 
be strong bipartisan support for this.
  I also want to say a few words about the Secretary of Veterans 
Affairs because I think he has been a great Secretary for the veterans 
of Minnesota and across the country.
                                 ______