[Congressional Record Volume 142, Number 120 (Thursday, September 5, 1996)]
[Senate]
[Pages S9926-S9934]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




DEPARTMENTS OF VETERANS AFFAIRS AND HOUSING AND URBAN DEVELOPMENT, AND 
             INDEPENDENT AGENCIES APPROPRIATIONS ACT, 1997

  The Senate continued with the consideration of the bill.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, while the distinguished majority leader 
is here, I would just like to state I think Senator Gramm is going to 
offer an amendment which I will accept, and then we will vote on the 
Domenici-Wellstone amendment as amended by the Gramm amendment.


                Amendment No. 5196 to Amendment No. 5194

  Mr. GRAMM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Texas.
  Mr. GRAMM. I send an amendment to the desk and ask for its immediate 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows.

       The Senator from Texas [Mr. Gramm] proposes an amendment 
     numbered 5196 to amendment No. 5194.

  Mr. DOMENICI. Could we have order, Mr. President.
  The PRESIDING OFFICER. The Senator will suspend.
  The Senate is not in order. Senators will take their conversations to 
the cloakroom, please, so the Senator from Texas can be heard.
  The Senator from Texas.
  Mr. GRAMM. Mr. President, it is a very short amendment. It will 
minimize the debate if we just have it read.
  The PRESIDING OFFICER. The clerk will report.
  The assistant legislative clerk read as follows:
       At the appropriate place in the amendment, insert the 
     following: Notwithstanding the provisions of this title, if 
     the provisions of this title result in a one percent or 
     greater increase in the cost of a group health plan's 
     premiums, the purchaser is exempt from the provisions of this 
     title.

  Mr. GRAMM. Mr. President, this amendment says that if Senator 
Domenici is wrong, and there are more than de minimis costs in 
expanding this coverage, and those costs exceed 1 percent, then the 
purchaser of that policy would be exempt.
  I think this is a good stopgap measure. If the Senator is right and 
this coverage can be provided for one-sixth of 1 percent, then it will 
be provided. If it raises the cost of the policy more than 1 percent, 
the purchaser of the policy would be exempt.
  I think it does improve the underlying amendment, and I am grateful 
the Senator has accepted it.
  Mr. DOMENICI addressed the Chair.
  The PRESIDING OFFICER. The Senator from New Mexico.
  Mr. DOMENICI. Mr. President, consistent with everything I knew when I 
brought the amendment to the floor,

[[Page S9927]]

the cost should not exceed a 1 percent increase, and therefore, in good 
faith to the Senators who supported me and supported the amendment, I 
accept this amendment as further evidence of what I have been saying in 
the Chamber for the last hour and a half.
  The PRESIDING OFFICER. Is there further debate on the amendment? If 
not, the question is on agreeing to the amendment by the Senator from 
Texas.
  Mr. LOTT addressed the Chair.
  The PRESIDING OFFICER. The majority leader.
  Mr. LOTT. Mr. President, after working with the Democratic leader, I 
ask unanimous consent that the following amendments be the only 
amendments in order between now and 9:30 p.m.; that any votes ordered 
with respect to those amendments be stacked to begin at 9:30. They are 
as follows: Gramm second-degree amendment to Domenici, Domenici-
Wellstone, Harkin Veterans' Administration amendment, Daschle spina 
bifida, and the Lott-Daschle Iraq resolution.
  The PRESIDING OFFICER. Is there objection?
  Mr. DASCHLE. Mr. President, reserving the right to object, only for 
the purposes of clarification, it is my understanding that the spina 
bifida amendment will either be up or down or a tabling motion. Is that 
correct?
  Mr. LOTT. That is correct.
  The PRESIDING OFFICER. Is there objection?
  Mr. DOMENICI. Reserving the right to object.
  Mr. LOTT. Mr. President, let me consult before I respond completely 
on that point. Let me double check with the managers of the bill to 
make sure.
  Is there something we can do in the interim while we make sure of the 
answer to that question?
  Mr. GRAMM. Sure. Finish the amendment.
  The PRESIDING OFFICER. The pending business is the amendment of the 
Senator from Texas.
  Is there further debate? If not, the question is on agreeing to the 
amendment.
  The amendment (No. 5196) was agreed to.
  Mr. GRAMM. Mr. President, I move to reconsider the vote.
  Mr. DOMENICI. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. DOMENICI. Do we have the yeas and nays ordered on the underlying 
amendment?
  The PRESIDING OFFICER. The yeas and nays have not been ordered on the 
underlying amendment.
  Mr. DOMENICI. I ask for the yeas and nays on the Domenici-Wellstone 
amendment.
  The PRESIDING OFFICER. Is there a sufficient second?
  There is a sufficient second.
  The yeas and nays were ordered.
  The PRESIDING OFFICER. Is there further debate?
  Mr. DOMENICI. I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. LOTT. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LOTT. Let me renew the unanimous-consent request and read it from 
the beginning again, because there have been some changes already.
  I ask unanimous consent that the following amendments be the only 
amendments in order between now and 9:30, that any votes ordered with 
respect to those amendments be stacked to begin at 9:30. They are as 
follows: Since we have already dealt with the Gramm second-degree 
amendment to Domenici, the first vote beginning at 9:30 would be 
Domenici-Wellstone, followed by a motion to table the Harkin amendment, 
followed by a vote on a point of order on germaneness on the Daschle 
spina bifida amendment, followed by a vote on the Iraq resolution.
  The PRESIDING OFFICER. Is there objection?
  Mr. LOTT. There was not objection to that?
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LOTT. On the final passage of VA-HUD, they are checking on that. 
That could also occur tonight or will occur stacked with other votes on 
Tuesday, probably beginning at 2:15. But the leader and I have 
discussed this, and I have his commitment that we will either do it 
tonight or we will do it in stacked votes on Tuesday. So we will 
basically be prepared to complete the VA-HUD appropriations bill either 
tonight, depending on one other outstanding issue, or we will 
definitely have the final vote on it at 2:15 on Tuesday. And we will 
plan on asking consent there be 10 minutes between these votes 
beginning at 9:30, so if Members stay in the Chamber, we could get them 
done quickly. And you will have time here now to get a bite to eat, and 
we will start this series of votes at 9:30 and hope we can wrap it up 
tonight.
  Ten-minute votes, 10-minute votes, not between each vote.
  Mr. President, let me go ahead and ask that now.
  When the votes occur at 9:30, I ask unanimous consent that they be 
10-minute votes; that there be 2 minutes between each vote equally 
divided to explain briefly exactly what the vote is, so Members will 
make sure they understand exactly what the vote is.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. LOTT. I yield the floor.
  Mr. BOND. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Burns). The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BOND. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. BOND. Mr. President, I see the Senator from Iowa is present. I 
yield the floor.
  The PRESIDING OFFICER. The Senator from Iowa is recognized.


                           Amendment No. 5197

 (Purpose: To provide that funding for veterans medical care shall not 
                         be reduced to states)

  Mr. HARKIN. I send an amendment to the desk on behalf of Senator 
Moynihan, myself, and Senator Specter, and ask for its immediate 
consideration.
  The PRESIDING OFFICER. The clerk will report.
  The legislative clerk read as follows:

       The Senator from Iowa [Mr. Harkin], for himself, Mr. 
     Moynihan and Mr. Specter, proposes an amendment numbered 
     5197.
       At the appropriate place, add the following:
       Sec.   . Without regard to any provision in this bill, no 
     plan for the allocation of health care resources (including 
     personnel and funds) used or implemented by the Department of 
     Veterans Affairs among the health care facilities of the 
     Department shall reduce the funding going to any state for 
     veterans medical care for the fiscal year ending September 
     30, 1997, below its fiscal year 1996 level of funding if the 
     total funding provided for veterans medical care in fiscal 
     year 1997 exceeds the fiscal year 1996 funding level.

  Mr. HARKIN. Mr. President, I wanted to have the amendment fully read 
so all Senators and staff watching on their television sets would know 
exactly what this amendment is all about.
  The veterans of the United States have earned the right to decent 
health care and medical care. They have risked their health and their 
lives to secure the liberties that we all enjoy. As we allocate scarce 
dollars for veterans' health care, we must ensure that no State is 
unfairly cut. That is why I am rising here to offer an amendment that 
will ensure that no State will lose funding for veterans' health care 
this year if the overall budget for veterans' medical care increases, 
which it does in this bill. The budget goes from $16.6 billion in 
fiscal year 1996 to $17 billion in this bill, an increase of about 2.4 
percent.
  Why this amendment? Yesterday this body voted for an amendment by 
Senator McCain that calls for changes in the funding formula for 
veterans' health care. I hope my colleagues understand the full impact 
of that amendment. I want to make sure my colleagues know the amendment 
that was adopted yesterday goes far beyond a mere study of the funding 
formula. I listened to some of the debate yesterday, and I talked with 
some Senators. They said to me, ``This is just a study of the funding 
formula.''
  That amendment, adopted yesterday, calls for implementation of the 
plan without further action by Congress. Let me read the relevant part 
of that amendment.


[[Page S9928]]


       (d) Implementation.--The Secretary shall implement the plan 
     developed under subsection (a) [``shall'' implement the plan 
     developed under subsection (a)] not later than 60 days after 
     submitting the plan to Congress under subsection (c), unless 
     within that time the Secretary notifies Congress that the 
     plan will not be implemented in that time and includes with 
     the notification an explanation why the plan will not be 
     implemented in that time.

  That is the end of it.
  So subsection (d) says the Secretary shall implement the plan within 
60 days, not later than 60 days. It does not say that Congress has to 
do a darn thing. He just has to submit it to Congress, and then within 
60 days, he has to implement it, unless within that time he submits or 
notifies Congress that the plan will not be implemented and spelling 
out the reasons why it will not be implemented.
  I hope we all understand the full force and effect of this. The 
Secretary of Veterans Affairs will submit a plan to Congress for 
reorganization. The McCain amendment says it shall be implemented not 
later than 60 days, unless the Secretary turns right around and tells 
Congress, ``Oh, no, we don't want to implement it, and here are the 
reasons why we shouldn't.''
  That is about as bizarre as you can get, that the Secretary would 
come up with an implementation plan and then turn right around and tell 
Congress, ``But it's no good, and we don't want to implement it.''
  I urge my colleagues, each and every one of the Senators here, to 
call your regional network director to find out what the amendment will 
do to their States. I think you may be in for some surprises, because 
the VA, without notice to all of us, is already working to phase in a 
change in payments to the States over the next 2 years, and that 
change, which is similar to that called for under the McCain amendment 
this body adopted, would result in substantial cuts to many States' VA 
medical care budgets, even with the 2.4 percent increase that this bill 
provides nationally.
  The draft VA plan would significantly cut funds to Iowa. I only found 
out about the cuts because of an article in the August 23 issue of the 
Cedar Rapids Iowa Gazette that indicated that veterans centers in Iowa 
and Nebraska would be receiving $12 million less in fiscal year 1997 
than in fiscal year 1996. This reduction was confirmed by John T. 
Carson, director of the Central Plains Network, in a letter to my 
office.
  Mr. President, this article goes on to show that there are going to 
be huge cuts in Iowa and in Nebraska, at least, under this article, and 
others, even though the total amount of money for VA health care is 
increased next year.
  I have a letter from Mr. Carson spelling out the details of what it 
would mean for Network 14. The fiscal year 1996 base of distribution is 
$268,035,000. The recommended fiscal 1997 allocation is $255,942,000, a 
difference of over $12 million less for that network, even though the 
funding nationally is going up.
  Mr. President, I ask unanimous consent that this article and the 
letter be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

          [From the Cedar Rapids Iowa Gazette, Aug. 23, 1996]

                 VA Official Warns of Future Iowa Cuts

                            (By Lyle Muller)

       Iowa City.--Iowa's Veterans Affairs medical centers may 
     have to cut more jobs next year if they cannot trim non-
     personnel expenses, a VA official said Thursday.
       Any cuts would follow the 100-plus scheduled for after Oct. 
     1 at VA hospitals in Iowa City, Des Moines and Knoxville.
       ``One of the worrisome things is, will we have to continue 
     that next year?'' Tom Carson, director of the Department of 
     Veterans Affairs' regional office, said in Iowa City.
       ``I believe we all hope that we do not face what we faced 
     this year,'' he said, referring to a year of furloughs and 
     finally decisions to cut jobs during the federal budget year 
     that begins Oct. 1. ``It's a major troubling item we have 
     facing us for fiscal year 1997.''
       Carson said he expects the three Iowa centers and three 
     more hospitals he oversees in Nebraska to spend $12 million 
     less next budget year than they received in federal funding 
     this year.
       The centers, which make up the VA Health Administration's 
     Central Plains Network, would be able to spend $256 million 
     next budget year, according to current plans.
       That is about 4 percent less than this year's $268 million 
     and marks a radical change from what Carson previously was 
     expecting. Until this week, plans called for boosting 
     spending at the Iowa and Nebraska centers by 2.5 percent.
       Carson was in Iowa City for a monthly meeting with the 
     directors of the Iowa and Nebraska centers. The anticipated 
     funding cut was to receive most of the attention, he said.
       On Tuesday, Iowa City's VA Medical Center announced it will 
     eliminate 39 jobs after Oct. 1.
       Gary Wilkinson, director of the 1,200-employee, 165-bed 
     Iowa City center, said he expected to spend $72.6 million 
     next budget year. That will be adjusted, however, because it 
     reflected a 2.5 percent increase, he said.
       ``This last year we were in financial trouble; there's no 
     question about that,'' Wilkinson said. ``We decided there was 
     this number of people that we couldn't afford.''
       Eliminating 39 jobs at the Iowa City center will save about 
     $1 million, officials there estimate.
       The Des Moines center announced last month that it will 
     drop 25 jobs. Knoxville has targeted 32 filled positions and 
     18 vacant ones for elimination.
         Department of Veterans Affairs, Network 14, Miracle Hills 
           Parkview Professional Center,
                                       Omaha, NE, August 23, 1996.
     Peter Reinecke,
     Legislative Director, Senator Harkin's Office, U.S. Senate, 
         Washington, DC.
       Dear Mr. Reinecke: Thank you for your inquiry regarding the 
     projected FY 97 budget for Network 14. As VHA changes its 
     reimbursement methodology to a capitation system, the 
     following resource adjustment occurs for Network 14:

Network 14:
  FY 96 Base for Distribution..............................$268,035,000
  Recommended FY 97 Allocation..............................255,942,000
                                                       ________________
                                                       
      Difference.............................................12,093,000

       The specific details of the allocation methodology can be 
     developed at your request. Mr. Steve Varnum, our Chief 
     Financial Officer, is the best person to discuss this issue. 
     Unfortunately, he is on vacation until September 3. If it is 
     agreeable, we will have him call you on that day to discuss 
     the allocation methodology.
       We have asked each medical center for information on 
     Category C veterans per your request. We will fax the 
     information to you by September 3, 1996, if this is 
     satisfactory.
       Please contact us for any additional information you need.
           Sincerely,
                                                   John T. Carson,
                                 Director, Central Plains Network.
  Mr. HARKIN. Mr. President, if that article had not appeared, I 
probably would have blindly gone forward and voted for the McCain 
amendment and voted for this bill, assuming that Iowa would get a 2.4 
percent increase in its VA health care budget. After all, that is what 
is in the bill. The bill contains a 2.4 percent increase.
  If we do not adopt the amendment that I just sent to the desk, I am 
concerned that my colleagues from the Midwest and many other States 
will also see massive cuts.
  All my amendment does is ask for a little fairness in allocating the 
veterans health care budget. Our veterans in Iowa are older than the 
national average. We have the highest percentage of citizens over age 
85 in the Nation--the highest. The health care that these, our oldest, 
veterans require is much more expensive than that for the general 
veteran population.
  Any capitation funding formula that does not adequately account for 
these factors will be grossly unfair to States like Iowa, and the 
McCain amendment does not do the job. In fact, the amendment of the 
Senator from Arizona was specifically revised to strike the factoring 
in of the medical condition and, thus, the cost of caring for veterans 
from the distribution formula.
  Let me repeat that. The Senator from Arizona specifically revised his 
amendment to strike the factoring in of the medical condition and, 
thus, the cost of caring for veterans from the distribution formula.
  My friend, the Senator from Arizona, argues that the sheer number of 
veterans moving to his State creates an unfairness, but it is the 
younger, healthier, and generally better off retired vets who are 
moving to the sunshine States. It is the older, the sicker, and the 
poorer vets who are increasing in other States like Iowa. As a result, 
the McCain amendment and the VA draft plan are grossly unfair to our 
States.
  While on the surface it may sound very nice to say we ought to 
allocate the money for just every veteran, that every veteran ought to 
count the same in allocating the money. On the surface it sounds 
generally reasonable that, if you have more veterans in one State,

[[Page S9929]]

they ought to get proportionally more than veterans in another State if 
that State has fewer veterans. But what about a State like Iowa or New 
York or Pennsylvania or Wisconsin or Indiana, or a lot of other States, 
where, again, our populations are older and they are poorer and they 
require this VA medical help?
  I suppose my friend from Arizona might say, ``Well, they are moving 
to Arizona,'' but I am sorry, Mr. President, that is not the case. It 
is the younger, the healthier, and the more prosperous ones who are 
moving to Arizona. What we are left with are those who are older and 
sicker and poorer, and they cost more to care for, especially in a 
rural area. This has to be taken into account.
  It would be grossly unfair to equate an 80-year-old veteran, let's 
say, who is making $12,000 a year or less and living in Iowa and has 
severe health problems with a 65-year-old veteran fully mobile who has 
moved to Arizona and plays golf every day. So the formula that the VA 
comes up with has to take the medical condition into account.
  Mr. DASCHLE. Will the Senator from Iowa yield? I apologize for 
interrupting.
  Mr. HARKIN. I will be delighted to yield, if I do not lose my right 
to the floor.
  Mr. DASCHLE. Without losing his right to the floor. We have a number 
of pieces of legislation that have to be addressed in the next hour. We 
anticipated, given what the Senator from Iowa indicated to me that he 
only had 10 minutes, that it would take 10 minutes. We have now used a 
half hour of that time allotted. He certainly did not consume it all. 
But I am wondering whether it would be appropriate to get a unanimous-
consent agreement that the time on the Harkin amendment will be 
terminated at 8:45 to allow other amendments to be debated so that we 
can assure the opportunity to vote on all of these at 9:30, as the 
unanimous-consent request was proposed.
  Mr. HARKIN. I say to my leader, I thought it would only take about 10 
minutes. I only wanted to make my point on them. I think the Senator 
from Arizona is probably going to rebut them. I am sorry. I apologize, 
I did not know we had a 9:30 time.
  Mr. McCAIN. Mr. President, reserving the right to object, the Senator 
from Florida and I do not intend to take a lot of time. We understand 
what the distinguished Democratic leader is saying. In 2 or 3 minutes 
we can rebut the arguments of the Senator from Iowa.
  I think it is very important we provide courtesy to other people with 
other amendments so they will have ample time, too. So, please, don't 
base your continued conversation on the fact that the Senator from 
Florida and I will take a lot of time. We don't need a lot of time, 
frankly, to rebut your arguments.
  Mr. DASCHLE. Mr. President, I ask unanimous consent that the time on 
the Harkin amendment, with appropriate responses from the Senator from 
Arizona and others, be limited to no more than 20 minutes.
  Mr. BOND. Mr. President, reserving the right to object, I think there 
are a couple minutes for both the Senator from Arizona and the Senator 
from Florida. I had 5 minutes. We started this at 8 o'clock. And I 
notified the Senator from Iowa we were trying to get going. If we could 
divide this. He has had an opportunity. If he could take 5 more 
minutes, and we could have 10 minutes.
  Mr. HARKIN. I did not start at 8 o'clock. I apologize to my friends 
on the floor. I have been talking now for just a little over 7 minutes. 
I started about 7 minutes ago.
  Mr. DASCHLE. Mr. President, 8:16 is when we were told from the desk 
you started. That is not the point. How much more time does the Senator 
from Iowa need?
  Mr. McCAIN. I would take 2 minutes. I do not know about the Senator 
from Florida.
  Mr. GRAHAM. Two minutes.
  Mr. DASCHLE. That is 4 minutes. The Senator from Missouri had 5 
minutes. That would be 9 minutes. How much time does the Senator from 
Iowa need?
  Mr. HARKIN. Ten minutes.
  Mr. DASCHLE. Mr. President, I propound the unanimous-consent request 
20 minutes to be divided, 2 minutes, 2 minutes, 5 minutes and 10 
minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. HARKIN. Mr. President, this body is making a major change in the 
dark, without adequate information of its impact on the States. I have 
asked the VA for a State-by-State breakdown of their draft reallocation 
plan so I could share it. However, the VA will not provide it to me. 
They will not provide it to me.
  After begging and pleading for information, I found out that 8 of the 
22 regional networks are scheduled to receive cuts under the draft 
plan. I believe that more would be cut under the McCain amendment 
because the VA is phasing in their change over 2 years. Under the draft 
VA plan, networks could see cuts as high as 15 percent next year alone.
  Mr. President, I have an incomplete list of States and these networks 
that would be cut, up to 15 percent, despite a 2.4 percent increase in 
this bill. They are Iowa, Nebraska, California, Nevada, Michigan, 
Illinois, Indiana, Wisconsin, New York, New Jersey, Massachusetts, 
Connecticut, Rhode Island, New Hampshire, Maine, Pennsylvania, West 
Virginia, Delaware, and Vermont. This is an incomplete and unofficial 
list. I have derived it from information provided by VA officials. So I 
want to assure you that this is not in any way complete.
  Let me tell you about the probable impact on Iowa veterans.
  Until a month ago the regional network for Iowa and Nebraska was 
counting on a budget increase commensurate with the proposed 2.4-
percent increase in the VA medical budget for fiscal year 1997. Even 
with this increase there have been significant layoffs at our hospitals 
and an increase in the number of veterans being turned away from 
medical care. They are being told ``tough luck.''
  Let me just relay a couple of the stories. One of the Iowa veterans 
who has been shut out has multiple sclerosis. He qualifies for Social 
Security disabilities. But Medicare does not come close to covering all 
his medication costs. He is classified as a category C veteran because 
his wife works and makes about $18,000.

  Mr. President, let me remind you category C veterans are treated at 
the discretion of the VA. Because of the tight budgets, this veteran is 
being turned away without warning after coming to rely upon the 
Veterans' Administration for help. He is justifiably angry he is being 
dropped by the Government. He is worried about his medication bills. He 
and his wife are trying to be independent, but they need help from the 
VA medical center to make it.
  There is another Iowa veteran who has diabetes, back problems, 
depression. He is on Social Security disability, Medicare. He has 
bought Medicare supplemental. He has been going to the VA medical 
center for his medications which cost over $10,000 a year. If he were 
single he would be eligible for VA medical services. But his wife makes 
about $25,000 a year. He is classified as category C. The local VA 
medical center has turned him away because of tight budgets. This 
veteran who faithfully served this country is trying to decide between 
dropping most of his medication for diabetes, depression and pain or 
separating from his wife.
  Mr. President, can we in good conscience do this to our veterans?
  A third Iowa veteran had rectal cancer. He had his anus, rectum, part 
of his colon, and part of a lung removed. He has had painful 
chemotherapy and radiation therapy. Despite all this, he is managing to 
keep a small business going, but he has been told he earns too much, 
cannot come back to the VA medical center for treatment. He is now 
faced with giving up his business just so he can get medical care.
  These three veterans are far from unique in Iowa. And now, if Iowa is 
subject to this big cut, as opposed to a 2.4-percent increase in the 
Nation, it will get much, much worse.
  This amendment has the support of the American Legion in Iowa, the 
Iowa AMVETS, the Iowa VFW.
  Mr. President, I ask unanimous consent that letters from them be 
printed in the Record.
  There being no objection, the letters were ordered to be printed in 
the Record, as follows:

         The American Legion Department of Iowa, Office of the 
           Department Services Office,

[[Page S9930]]

                                                September 5, 1996.
     Hon. Tom Harkin.
       Dear Senator Harkin: It was brought to our attention that 
     you are going to be presenting an amendment before Congress 
     proposing funding for the Department of Veterans Affairs 
     medical centers not be reduced to the states.
       We wanted you to know that The American Legion, Department 
     of Iowa, wholeheartedly approves of this proposed Amendment.
       We have many veterans who fall into the VA's Category C 
     (veterans who make too much money to receive VA Health Care), 
     and we do not wish any other veterans to be cut from the 
     system.
       The veterans of the United States deserve better treatment 
     from our government and we hope that you are also working on 
     getting rid of the ``categories'' that prohibit certain 
     veterans from receiving health care they so desperately need. 
     They served our country and believed our country would be 
     there for them. It is ironic that the government called on 
     them--yet will turn around and cut the funding for the 
     veterans at the drop of a hat.
       We thank you for your support and hope that your proposal 
     is victorious.
           Sincerely,
                                                  Kristin Waldron,
     Senior Claims Representative.
                                                                    ____

                                                           AMVETS,


                                           Department of Iowa,

                                Des Moines, IA, September 5, 1996.
     To: Senator Tom Harkin.
     Attn: Kevin Aylesworth.
     From: Robert O. Steben, National Service Officer, American 
         Veterans of World War II, Korea, and Vietnam (AMVETS).
       On behalf of the American Veterans of WWII, Korea, and 
     Vietnam, I want to express our sincere support for your 
     effort to ensure that funding for veterans medical care shall 
     not be reduced to states.
       We have many veterans who are already feeling the effects 
     of cuts in services to veterans who had been receiving 
     discretionary services. Further cuts would be devastating. . 
     . . These veterans have served our country without concerns 
     for their lives--many were wounded and died to save our 
     country from tyranny. The least we can do for them is 
     maintain 1st class medical programs for them--if it were not 
     for the veterans we wouldn't have the comforts we all enjoy 
     in this Great United States.
                                         Robert O. Steben, AMVETS,
     National Service Officer, Iowa.
                                                                    ____

                                         Veterans of Foreign Wars,


                                   Department Service Officer,

                                Des Moines, IA, September 5, 1996.
     Senator Tom Harkin,
     Attn: Kevin Aylsworth.
       Dear Sir: The Veterans of Foreign Wars, Department of Iowa, 
     supports your proposal to retain equitable and appropriate 
     funding for Iowa's veterans, and wish to thank you for your 
     continued efforts on their behalf.
           Very truly yours,
                                                 M. Terry Lipovac,
                                       Department Service Officer.

  Mr. HARKIN. Mr. President, I ask my colleagues, what is the 
Department of Veterans Affairs planning to do to the veterans of your 
State? We are doing something here in the dark without any information 
on their impact on the States. My amendment simply says this, that if 
there is an increase like there is in this bill, that no State will get 
less than what they did last year.
  That means that Mr. McCain in Arizona and perhaps Mr. Graham in 
Florida and other sunshine States, they can get the increase, but at 
least do no harm. That is what my amendment does. It borrows from the 
adage: First, do no harm. We are about to rush in, make rash changes in 
the VA medical care funding allocations, and in a lot of our States, a 
lot of veterans are going to get hurt.
  So let us not do any harm. All my amendment says is--we will cede the 
increase--but let us next year hold the States harmless, that no State 
will get a cut next year. And then let us see what the VA's plan really 
does when they come to Congress next year. I reserve the balance of my 
time.
  Mr. BOND. Mr. President, the Senator from Arizona has agreed that his 
2 minutes can be allocated to the Senator from Florida. So I ask the 
full 4 minutes be allocated to the Senator from Florida.
  The PRESIDING OFFICER. The Senator from Florida is recognized.
  Mr. GRAHAM. Thank you, Mr. President.
  Mr. President, this amendment which was adopted overwhelmingly by the 
Senate, today being the third or fourth instance in which this 
amendment has been adopted, speaks to a simple principle. And that is, 
that the Nation's commitment to provide for the health care of its 
veterans is a national commitment, and that that commitment runs to 
individual veterans, not to them through the State in which they happen 
to live.
  These facilities that provide the services are facilities of the 
Federal Government, financed and administered under laws that we enact. 
Our responsibility is to individual veterans. The principle of this 
amendment is that those veterans should be treated equitably.
  The fundamental operative provision of the amendment which this 
Senate has adopted is that the Department of Veterans Affairs, among 
the health care networks of the department, shall allocate health care 
resources so as to assure that veterans who have similar economic 
status and eligibility priority and who are eligible for medical care 
have similar access to such care regardless of the region of the United 
States in which such veterans reside, a fundamental principle of 
fairness. And that, Mr. President, has been the objective of the 
Veterans' Administration for over a decade.
  Prior to 1985, the Veterans' Administration followed the principle 
that the Senator from Iowa is advocating we return to. And that is, 
that you look first at what were expenditures in the previous year, 
make incremental adjustments to those previous expenditures, and that 
becomes the funding level for the future.
  According to a report by the General Accounting Office, dated 
February 1996, the VA historically allocated funds to facilities on the 
basis of the facility's past expenditures with incremental increases 
for such factors as inflation and new programs.
  Beginning in 1985--I repeat, beginning in 1985--the Veterans 
Administration modified its allocation system because it recognized the 
need to more directly relate funding to the work performed, the cost to 
perform it, and to improve the efficiency and productivity with which 
medical care is delivered to veterans. We have not had the plan that 
the Senator from Iowa suggested for a decade.

  This same GAO report indicates we need to move further in order to 
accomplish the objective, that we still have a system which does not 
treat all of our veterans fairly according to their eligibility 
standards, their economic status, and their eligibility for and need 
for medical services. The GAO report states in part, ``Because of 
differences in facility rationing practices, veterans' access to care 
systemwide is uneven. We found that higher income veterans receive care 
at many facilities while lower income veterans were turned away at 
other facilities.''
  That is the system that we have today. Mr. President, there are a 
number of reasons why this is occurring. A fundamental reason is the 
fact that veterans are, as a part of our population, becoming a smaller 
group. We have fewer veterans today than we did 5 years ago and we will 
have still fewer 5 years into the future, and veterans are not 
distributing themselves proportionately across the country.
  For example, in the State of Arizona, between 1980 and 1995, the 
number of veterans increased by 89,000 or 24 percent. There were 24 
percent more veterans in Arizona in 1995 than in 1980. In the State of 
the proponent of this amendment, the number of veterans in the same 15-
year period declined by 68,000 or almost 19 percent. Yet the Senator is 
advocating a proposition that says regardless of the number of veterans 
being served--my State happens to have a declining population while 
another State has an increasing population--we should, for some 
arbitrary reason, fix on the past and say that will be the basis on 
which we will distribute our Veterans' Administration funds for medical 
care, not taking into account what that means in terms of per patient 
recipient of funds or what it may mean in terms of encouraging greater 
efficiency and effectiveness in the use of funds available.
  I could give stories similar to the one that the Senator from Iowa 
has just given about former residents of his State who now live in my 
State who say, ``When I lived in my previous residence I was able to 
get certain prescriptions from the VA center. I cannot get them now in 
my new home. I was able to get treatment for a condition in my previous 
residence through the VA. I cannot receive it in my new home because of 
inadequate resources and inequitable allocation of funds.''
  Mr. President, the principle of the amendment of the Senator from 
Arizona and myself is a simple one: The Nation's responsibility is to 
individual

[[Page S9931]]

veterans wherever they live. And to fulfill that responsibility, we 
should pursue the goal of treating all veterans equally wherever they 
might live, and the responsibility is upon the Veterans Administration 
to reach that goal.
  We have outlined a plan which the Veterans' Administration supports. 
They support the amendment that this Senate has already adopted because 
they recognize that it is a road back to achieve the objective which 
they have been pursuing since 1985.
  Mr. President, I urge the Senate recommit itself to the principle of 
fairness that was adopted earlier in the debate on this issue and 
reject the amendment of the Senator from Iowa, which would return us to 
a period of a decade in the past and would return us to a time in which 
we did not accept the principle that all veterans should be treated 
equally, because all veterans in the same economic conditions, the same 
health status, have served this Nation with equal valor and commitment 
and deserve to be treated fairly.

  Mr. BOND. Mr. President, reluctantly I state that I cannot support 
the Harkin amendment. The amendment, as has been recognized, is 
directly in conflict with the McCain amendment we adopted yesterday, 
which the Senate approved in a 79 to 18 vote. I am very sympathetic to 
the concerns of the Senator from Iowa that certain VA facilities may be 
losing resources relative to other facilities as the Veterans 
Administration changes its operations to become more like an efficient, 
modern, managed care organization.
  I am fully supportive of the steps VA is taking to change the way it 
operates. Frankly, I believe the changes initiated by the VA under 
Secretary for Health Dr. Ken Kaizer represent very positive steps for 
the betterment of veterans' health care, and the McCain amendment is 
completely consistent with the bold and necessary steps being taken by 
Dr. Kaizer to ensure approved quality of care for veterans.
  I do not minimize that the steps being taken are painful. The VA has 
never experienced so much change in so little time. However, with 
declining discretionary resources, a shift in the veteran population to 
Sunbelt States, a decline in the veteran population, and rapid changes 
in health care delivery, the VA must, indeed, make changes.
  The McCain amendment reflected the findings of a GAO report of 
February 1996 which found the VA's traditional method of allocating 
resources was not equitable, it was not population based, and some 
facilities were receiving twice as much funding per patient as other 
facilities. In response to GAO's findings and in recognition of the 
need to change its traditional resource allocation method, the 
Veterans' Administration has begun moving toward a parity-based 
capitated model for resource allocation. I emphasize that, despite what 
some newspaper stories may have stated, no final allocations have yet 
been determined.
  In the process of allocating the resources more equitably, a process 
which is to be fully implemented in fiscal year 1998, there are going 
to be some areas in some facilities which are winners. There are going 
to be some facilities which are losers. There are different populations 
served by those facilities. It is the right direction for the VA to be 
pursuing. It will bring about efficiencies, fairness, and improved 
care. We should not stand in the way of these important improvements. 
We have already seen the elimination of some redundancies as closely 
located facilities merge their administrative services and as VA opens 
community-based outpatient clinics in lieu of providing high-cost 
hospital-based care.
  In my own State of Missouri, the Poplar Bluff, MO, Veterans' 
Administration recently closed inpatient surgical procedures because of 
the inadequate workload and excessive mortality rates. The decision to 
close that portion of the facility was painful and four doctors lost 
their jobs. But it was the right decision. It was the right decision 
for the facility, for the system, but, most importantly, it was the 
right decision for veterans' health care.
  The Harkin amendment is unacceptable partly because at this time VA 
does not know what the specific allocation to each hospital will be for 
fiscal year 1997 since the model for resource allocation for fiscal 
year 1997 is still under development. Frankly, it is possible that some 
facilities could receive less than the fiscal year 1996 level. 
Moreover, the allocation will not be individually to hospitals but 
rather to the 22 networks, each of which encompass several VA 
facilities and which we can hope will be based on the need and the 
population in each area.
  I should add, very importantly, that the Veterans' Administration is 
opposed to the amendment as it takes a step backward to the progress it 
is attempting to make. The VA has said the only obstacle to better 
health care for veterans is likely to be Congress. If we are looking at 
how many jobs in how many facilities and trying to legislate those into 
place and into being, we will prevent an improvement in the system.
  The VA has stated it intends to provide health care services to the 
2.8 million veterans currently receiving care. Even with the resource 
adjustments within the system, VA does not expect to deny patients care 
who are now getting care in any of its 22 networks.
  I reserve the remainder of my time.
  The PRESIDING OFFICER. Who seeks recognition?
  Mr. HARKIN. Mr. President, how much time do I have?
  The PRESIDING OFFICER. The Senator from Iowa has 4 minutes.
  Ms. MIKULSKI. Will the Senator yield 1 minute to me?
  Mr. HARKIN. I am delighted to yield a minute to the Senator from 
Maryland.
  Ms. MIKULSKI. Mr. President, I see no discrepancy between the McCain 
amendment that we adopted last night and what Senator Harkin is doing. 
Senator Harkin is essentially doing a bridge and ensuring that those 
States that might have to make readjustments under the new plan that is 
being suggested can do so, which I voted for; I voted for McCain. But 
doing McCain without Harkin is going to send out panic in the 
Northeast-Northwest corridor. We want to have full-scale cooperation. 
We want to do the plan being suggested in an orderly, rational way. We 
don't need administrators doing damage control instead of patient 
management. I do not see the discrepancy.
  Senator Harkin's amendment is for 1 year, this fiscal year, providing 
the bridge, because the Veterans' Administration does not have a plan. 
This does not prohibit McCain from going forward in terms of the plan 
and giving us the report in 60 days, beginning to implement the 60 
days. You can do that, but it is going to take a full year to do it. 
With all due respect to the VA, they are, at times, a bit sluggish. 
This will at least give a year. I see that as a bridge. I thank the 
Senator from Iowa. I support the McCain amendment, I support the Harkin 
amendment, and I support the veterans. God bless America.
  Mr. HARKIN. I thank the Senator from Maryland. I had written down 
here that a vote for my amendment does not contradict a vote for McCain 
at all. The Senator from Maryland pointed that out. What I am saying is 
that, for the first year, all of the increase can go to Florida and can 
go to Arizona, these high-growth States. All we are saying is, don't 
cut the legs out from underneath those States, so we at least have 1 
year to figure out what is going on here. That is why I offered this 
amendment. I am not trying to fix on the past. I am not advocating that 
at all. I want efficiencies. But any plan that does not take into 
account the age and the illness, rural areas, that type of thing, I am 
sorry, that is not a good plan.
  Again, I point out that last night the Senator from Arizona modified 
his amendment. If you read the first page, what was modified and 
stricken out--it says this as it was first written:

       The Secretary of Veterans Affairs shall develop a plan for 
     the allocation of health care resources in the Department of 
     Veterans Affairs among the health care facilities of the 
     department so as to ensure that veterans who have similar 
     economic status and eligibility priority or medical 
     conditions. . . .

  Guess what was stricken out? ``Or medical conditions.'' That is what 
I am talking about. This amendment says wait a minute, you have to take 
into account medical conditions. I say to my friend from Florida, that 
is why I think we need a year, as the Senator from Maryland said, as a 
bridge. I know that the number of veterans in Iowa is going down. They 
are going up in Florida and in Arizona. I understand that. But keep in 
mind, as I keep saying, that the ones we have left are the

[[Page S9932]]

older and the poorer of the veterans. They don't deserve to have their 
legs cut out from underneath them in one fell swoop. Let us be careful.
  The PRESIDING OFFICER. All time has expired on debate on this 
amendment.
  Mr. DASCHLE addressed the Chair.
  The PRESIDING OFFICER. The minority leader is recognized.


                           Amendment No. 5190

(Purpose: To provide benefits for certain children of Vietnam veterans 
who are born with spina bifida, and to offset the cost of such benefits 
 by requiring that there be an element of fault as a precondition for 
 entitlement to compensation for a disability or death resulting from 
 health care or certain other services furnished by the Department of 
                           Veterans Affairs)

  Mr. DASCHLE. Mr. President, I send an amendment to the desk and ask 
for its immediate consideration.
  The PRESIDING OFFICER. The clerk will report.
  The bill clerk read as follows:

       The Senator from South Dakota [Mr. Daschle], for himself, 
     Mr. Kerry, Mr. Rockefeller, Mr. Wellstone, Ms. Mikulski, Mr. 
     Byrd, Mr. Dodd, Mr. Conrad, Mr. Inouye, Mr. Pell, Mr. Simon, 
     Mr. Feingold, Mr. Breaux, Mrs. Boxer, Mr. Dorgan, Mrs. 
     Feinstein, Mr. Glenn, Mr. Harkin, Mr. Robb, Mr. Kennedy, Mr. 
     Ford, Mr. Reid, Ms. Moseley-Braun, Mr. Leahy, Mr. Hollings, 
     and Mr. Kohl, proposes an amendment numbered 5190.

  Mr. DASCHLE. Mr. President, I ask unanimous consent that reading of 
the amendment be dispensed with.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The amendment is as follows:

       On page 97, between lines 15 and 16, insert the following:
       Sec. 421. (a) The purpose of this section is to provide for 
     the special needs of certain children of Vietnam veterans who 
     were born with the birth defect spina bifida, possibly as the 
     result of the exposure of one or both parents to herbicides 
     during active service in the Republic of Vietnam during the 
     Vietnam era, through the provision of health care and 
     monetary benefits.
       (b)(1) Part II of title 38, United States Code, is amended 
     by inserting after chapter 17 the following new chapter:

 ``CHAPTER 18--BENEFITS FOR CHILDREN OF VIETNAM VETERANS WHO ARE BORN 
                           WITH SPINA BIFIDA

``Sec.
``1801. Definitions.
``1802. Spina bifida conditions covered.
``1803. Health care.
``1804. Vocational training and rehabilitation.
``1805. Monetary allowance.
``1806. Effective date of awards.

     ``Sec. 1801. Definitions

       ``For the purposes of this chapter--
       ``(1) The term `child', with respect to a Vietnam veteran, 
     means a natural child of the Vietnam veteran, regardless of 
     age or marital status, who was conceived after the date on 
     which the veteran first entered the Republic of Vietnam 
     during the Vietnam era.
       ``(2) The term `Vietnam veteran' means a veteran who 
     performed active military, naval, or air service in the 
     Republic of Vietnam during the Vietnam era.

     ``Sec. 1802. Spina bifida conditions covered

       ``This chapter applies with respect to all forms and 
     manifestations of spina bifida except spina bifida occulta.

     ``Sec. 1803. Health care

       ``(a) In accordance with regulations which the Secretary 
     shall prescribe, the Secretary shall provide a child of a 
     Vietnam veteran who is suffering from spina bifida with such 
     health care as the Secretary determines is needed by the 
     child for the spina bifida or any disability that is 
     associated with such condition.
       ``(b) The Secretary may provide health care under this 
     section directly or by contract or other arrangement with any 
     health care provider.
       ``(c) For the purposes of this section--
       ``(1) The term `health care'--
       ``(A) means home care, hospital care, nursing home care, 
     outpatient care, preventive care, habilitative and 
     rehabilitative care, case management, and respite care; and
       ``(B) includes--
       ``(i) the training of appropriate members of a child's 
     family or household in the care of the child; and
       ``(ii) the provision of such pharmaceuticals, supplies, 
     equipment, devices, appliances, assistive technology, direct 
     transportation costs to and from approved sources of health 
     care, and other materials as the Secretary determines 
     necessary.
       ``(2) The term `health care provider' includes specialized 
     spina bifida clinics, health care plans, insurers, 
     organizations, institutions, and any other entity or 
     individual who furnishes health care that the Secretary 
     determines authorized under this section.
       ``(3) The term `home care' means outpatient care, 
     habilitative and rehabilitative care, preventive health 
     services, and health-related services furnished to an 
     individual in the individual's home or other place of 
     residence.
       ``(4) The term `hospital care' means care and treatment for 
     a disability furnished to an individual who has been admitted 
     to a hospital as a patient.
       ``(5) The term `nursing home care' means care and treatment 
     for a disability furnished to an individual who has been 
     admitted to a nursing home as a resident.
       ``(6) The term `outpatient care' means care and treatment 
     of a disability, and preventive health services, furnished to 
     an individual other than hospital care or nursing home care.
       ``(7) The term `preventive care' means care and treatment 
     furnished to prevent disability or illness, including 
     periodic examinations, immunizations, patient health 
     education, and such other services as the Secretary 
     determines necessary to provide effective and economical 
     preventive health care.
       ``(8) The term `habilitative and rehabilitative care' means 
     such professional, counseling, and guidance services and 
     treatment programs (other than vocational training under 
     section 1804 of this title) as are necessary to develop, 
     maintain, or restore, to the maximum extent practicable, the 
     functioning of a disabled person.
       ``(9) The term `respite care' means care furnished on an 
     intermittent basis for a limited period to an individual who 
     resides primarily in a private residence when such care will 
     help the individual to continue residing in such private 
     residence.

     ``Sec. 1804. Vocational training and rehabilitation

       ``(a) Pursuant to such regulations as the Secretary may 
     prescribe, the Secretary may provide vocational training 
     under this section to a child of a Vietnam veteran who is 
     suffering from spina bifida if the Secretary determines that 
     the achievement of a vocational goal by such child is 
     reasonably feasible.
       ``(b) Any program of vocational training for a child under 
     this section shall be designed in consultation with the child 
     in order to meet the child's individual needs and shall be 
     set forth in an individualized written plan of vocational 
     rehabilitation.
       ``(c)(1) A vocational training program for a child under 
     this section--
       ``(A) shall consist of such vocationally oriented services 
     and assistance, including such placement and post-placement 
     services and personal and work adjustment training, as the 
     Secretary determines are necessary to enable the child to 
     prepare for and participate in vocational training or 
     employment; and
       ``(B) may include a program of education at an institution 
     of higher education if the Secretary determines that the 
     program of education is predominantly vocational in content.
       ``(2) A vocational training program under this subsection 
     may not include the provision of any loan or subsistence 
     allowance or any automobile adaptive equipment.
       ``(d)(1) Except as provided in paragraph (2) and subject to 
     subsection (e)(2), a vocational training program under this 
     section may not exceed 24 months.
       ``(2) The Secretary may grant an extension of a vocational 
     training program for a child under this section for up to 24 
     additional months if the Secretary determines that the 
     extension is necessary in order for the child to achieve a 
     vocational goal identified (before the end of the first 24 
     months of such program) in the written plan of vocational 
     rehabilitation formulated for the child pursuant to 
     subsection (b).
       ``(e)(1) A child who is pursuing a program of vocational 
     training under this section and is also eligible for 
     assistance under a program under chapter 35 of this title may 
     not receive assistance under both such programs concurrently. 
     The child shall elect (in such form and manner as the 
     Secretary may prescribe) the program under which the child is 
     to receive assistance.
       ``(2) The aggregate period for which a child may receive 
     assistance under this section and chapter 35 of this title 
     may not exceed 48 months (or the part-time equivalent 
     thereof).

     ``Sec. 1805. Monetary allowance

       ``(a) The Secretary shall pay a monthly allowance under 
     this chapter to any child of a Vietnam veteran for any 
     disability resulting from spina bifida suffered by such 
     child.
       ``(b)(1) The amount of the allowance paid to a child under 
     this section shall be based on the degree of disability 
     suffered by the child, as determined in accordance with such 
     schedule for rating disabilities resulting from spina bifida 
     as the Secretary may prescribe.
       ``(2) The Secretary shall, in prescribing the rating 
     schedule for the purposes of this section, establish three 
     levels of disability upon which the amount of the allowance 
     provided by this section shall be based.
       ``(3) The amounts of the allowance shall be $200 per month 
     for the lowest level of disability prescribed, $700 per month 
     for the intermediate level of disability prescribed, and 
     $1,200 per month for the highest level of disability 
     prescribed. Such amounts are subject to adjustment under 
     section 5312 of this title.
       ``(c) Notwithstanding any other provision of law, receipt 
     by a child of an allowance under this section shall not 
     impair, infringe, or otherwise affect the right of the child 
     to receive any other benefit to which the child may otherwise 
     be entitled under any law administered by the Secretary, nor 
     shall receipt of such an allowance impair, infringe, or 
     otherwise affect the right of any individual to receive any 
     benefit to which the individual is entitled under any law 
     administered by the Secretary that is based on the child's 
     relationship to the individual.

[[Page S9933]]

       ``(d) Notwithstanding any other provision of law, the 
     allowance paid to a child under this section shall not be 
     considered income or resources in determining eligibility for 
     or the amount of benefits under any Federal or federally 
     assisted program.

     ``Sec. 1806. Effective date of awards

       ``The effective date for an award of benefits under this 
     chapter shall be fixed in accordance with the facts found, 
     but shall not be earlier than the date of receipt of 
     application for the benefits.''.
       (2) The tables of chapters before part I and at the 
     beginning of part II of such title are each amended by 
     inserting after the item referring to chapter 17 the 
     following new item:
``18. Benefits for Children of Vietnam Veterans Who Are Born With Spina 
    Bifida..................................................1801''.....

       (c) Section 5312 of title 38, United States Code, is 
     amended--
       (1) in subsection (a)--
       (A) by striking out ``and the rate of increased pension'' 
     and inserting in lieu thereof ``, the rate of increased 
     pension''; and
       (B) by inserting after ``on account of children,'' the 
     following: ``and each rate of monthly allowance paid under 
     section 1805 of this title,''; and
       (2) in subsection (c)(1), by striking out ``and 1542'' and 
     inserting in lieu thereof ``1542, and 1805''.
       (d) This section and the amendments made by this section 
     shall take effect on January 1, 1997.
       Sec. 422. (a) Section 1151 of title 38, United States Code, 
     is amended--
       (1) by striking out the first sentence and inserting in 
     lieu thereof the following:
       ``(a) Compensation under this chapter and dependency and 
     indemnity compensation under chapter 13 of this title shall 
     be awarded for a qualifying additional disability or a 
     qualifying death of a veteran in the same manner as if such 
     additional disability or death were service-connected. For 
     purposes of this section, a disability or death is a 
     qualifying additional disability or qualifying death if the 
     disability or death was not the result of the veteran's 
     willful misconduct and--
       ``(1) the disability or death was caused by hospital care, 
     medical or surgical treatment, or examination furnished the 
     veteran under any law administered by the Secretary, either 
     by a Department employee or in a Department facility as 
     defined in section 1701(3)(A) of this title, and the 
     proximate cause of the disability or death was--
       ``(A) carelessness, negligence, lack of proper skill, error 
     in judgment, or similar instance of fault on the part of the 
     Department in furnishing the hospital care, medical or 
     surgical treatment, or examination; or
       ``(B) an event not reasonably foreseeable; or
       ``(2) the disability or death was proximately caused by the 
     provision of training and rehabilitation services by the 
     Secretary (including by a service-provider used by the 
     Secretary for such purpose under section 3115 of this title) 
     as part of an approved rehabilitation program under chapter 
     31 of this title.''; and
       (2) in the second sentence--
       (A) by redesignating that sentence as subsection (b);
       (B) by striking out ``, aggravation,'' both places it 
     appears; and
       (C) by striking out ``sentence'' and substituting in lieu 
     thereof ``subsection''.
       (b)(1) The amendments made by subsection (a) shall take 
     effect on October 1, 1996.
       (2) Section 1151 of title 38, United States Code (as 
     amended by subsection (a)), shall govern all administrative 
     and judicial determinations of eligibility for benefits under 
     such section that are made with respect to claims filed on or 
     after the effective date set forth in paragraph (1), 
     including those based on original applications and 
     applications seeking to reopen, revise, reconsider, or 
     otherwise readjudicate on any basis claims for benefits under 
     such section 1151 or any provision of law that is a 
     predecessor of such section.

  Mr. DASCHLE. Mr. President, I ask unanimous consent that the amount 
of time allocated to this amendment not exceed 15 minutes with the time 
evenly divided between myself and the Senator from Missouri, Senator 
Bond.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DASCHLE. Mr. President, we had the debate on this amendment this 
morning, so this is meant simply to be a summary statement. Let me 
begin by reminding my colleagues about the mission of agent orange and 
the Agent Orange Act of 1991.
  The Agent Orange Act of 1991 was passed unanimously, 99-0, with the 
cosponsorship of my colleague from Wyoming, Senator Simpson. It 
requires the Department of Veterans Affairs to evaluate scientific 
findings from the National Academy of Sciences, based on their review 
of all related evidence.
  This year, the National Academy of Sciences found compelling 
evidence, based on scientifically sound epidemiological studies, to 
place spina bifida in the second category of compensated diseases. As I 
mentioned earlier, the VA already covers all of the conditions in 
categories 1 and 2, except spina bifida, because the Secretary doesn't 
have the authority to provide these benefits to children of veterans.
  We are not here today to debate the underpinnings of the original 
law. What we are here today to do is to talk about our obligation. The 
battle about the original law was fought and won. That ended 5 years 
ago.
  We have a reasonable proposal to address the unique needs of these 
kids, whose disabilities are linked to their parent's exposure to agent 
orange. I don't have to remind any of my colleagues that the National 
Academy of Sciences is a highly respected, nonpartisan research 
organization. Congress regularly relies on the National Academy of 
Sciences to provide unbiased, scientifically sound information. It is 
very unfortunate, as some of my colleagues have done, to criticize 
their professionalism simply because one disagrees with its findings.
  NAS has assembled a panel of expert scientists to review all of the 
signs associated with agent orange exposure. They found several 
epidemiological studies that supported an association between parental 
exposure to agent orange and the presence of spina bifida in children. 
NAS found the reanalysis of the Ranch-Hand study particularly 
compelling. They compared Vietnam veterans with non-Vietnam veterans 
and accounts of exposure. Despite the comments of the Senator from 
Wyoming this morning, they have indeed found a higher incidence of 
spina bifida in the children of Vietnam veterans. That is what led them 
to conclude what they did in the report last spring.
  That report states simply:

       Neural tube birth defects were in excess among offspring of 
     Ranch Hands with four total cases in contrast to none among 
     the comparison infants.

  This translates into a rate of 5 per 1,000, significantly higher than 
CDC's normal spina bifida rate of 4.5 per 10,000.
  In other words, there is a four times higher level of incidence of 
spina bifida with agent orange exposure than there is with no agent 
orange exposure, according to this study. These findings are 
statistically significant. And that is what the law requires. If you 
see a significant statistical difference, you have to reflect that in 
the requirements provided in the law that passed in 1991.
  Furthermore, in addition to the Ranch Hand study, a number of studies 
of veterans appear to show an elevated relative risk for either service 
in Vietnam or estimated exposure to herbicides or dioxin, and the 
presence of neural tube defects in their offspring. For those 
interested in reading an unbiased analysis of the strengths and 
weaknesses of each study, I certainly refer you to the NAS report.
  Mr. President, we could talk for the rest of the night, if we had the 
time, about the science of this issue. The real question is: Who ought 
to get the benefit of the doubt? Who should deserve the benefit of the 
doubt, given the commitment made by our veterans in Vietnam, now more 
than 20 years ago? Do we give it to the veterans and their children, or 
do we give it to those who would argue that we need more information, 
more science, more data, even though the accumulation of data has 
already demonstrated a clear association?

  By placing spina bifida in the second category, NAS, the experts we 
chose 5 years ago to advise us, concluded there is evidence suggestive 
of an association. The law set a standard of positive association that 
we are relying upon in this amendment. When the credible evidence for 
an association is equal to or outweighs the evidence against an 
association, the benefit of the doubt, by law, must go to the veteran. 
The law specifically does not require evidence of cause and effect.
  Reconciliation has not happened and is not in sight. As a result, the 
provision identified in the amendment can be used as savings to pay the 
very limited benefits we are talking about today. This widely supported 
provision would insert into the law a fault requirement to limit the 
VA's liability in non-malpractice related cases.
  Regardless of what arguments can be put forth by others, the fact 
that a hearing is being held later this month is an argument that, in 
my view, is not relevant to the debate on this amendment. It is not 
even dealing with the issue. Those interested in addressing

[[Page S9934]]

the issues raised by the March report have been working for months to 
design an appropriate solution.

  This amendment is strongly supported by veterans and disability 
communities. Veterans and their families have waited decades for the 
confirmation embedded in these findings. They should not have to wait 
any longer.
  This amendment is clearly germane to the underlying bill. It is a 
veterans issue, and this is a veterans bill. We are not going to be 
fooling America's veterans by suggesting that somehow this is not 
germane. Opponents of this amendment should not be able to hide behind 
some convenient, questionable procedural motion. This is germane. It is 
relevant. And the time to act is now.
  We cannot wait any longer. Let us treat spina bifida as we do all the 
other diseases that we have already determined have a direct 
association to agent orange exposure. Let us give veterans and their 
children the means and support necessary to deal with the problems 
associated with this crippling disability.
  I yield the floor.
  Mr. BOND. Mr. President, we have had a lot of debate, a lot of heated 
rhetoric, and a lot of stirring stories of personal tragedies during 
this morning's session and tonight, and there is a lot of emotion 
involved. I think it is reasonable to understand why there is emotion, 
because every year in the United States there are approximately 150,000 
babies born with serious birth defects. There are congenital heart 
defects, Down's syndrome, neural tube defects, primarily spina bifida. 
Of those birth defects, about 4,000 babies have spina bifida.
  Over the past several years, I have worked with the March of Dimes 
attempting, with some success, to get the Centers for Disease Control 
funding for their prevention programs in research to find out what 
causes these problems, to set up a surveillance and monitoring program 
so that we can have some sound evidence as to what causes these 
defects. Some research on spina bifida is already bearing fruit. There 
is a connection between mothers taking folic acid early in pregnancy, 
and reduced rates of the incidence of spina bifida have been found. 
This is good news. This is good science. We are making some progress. 
But a lot more work needs to be done on the causes, the incidence, and 
the protections.
  Now we come to the recent actions by the National Academy of 
Sciences. Let me be clear that the agent orange law does not require us 
to expand an entitlement on this bill. The Agent Orange law does not 
apply to children or offspring of veterans. The agent orange law sets 
up some presumptions, but they have to be based on science, which is 
not present here.
  The National Academy of Sciences in their review this past spring 
found in one study what the authors called a possible association 
between exposure and spina bifida in the offspring of veterans. The 
National Academy of Sciences then presented this information to the 
Veterans' Administration with the caution on how the study should be 
used. In fact, in that study, the task force emphasizes that its 
conclusions ``made for the limited purposes of PL-10234 do not reflect 
a judgment that a particular health outcome has shown to be caused by, 
or in some cases even definitely associated with, herbicide exposure 
under the standards ordinarily governing such conclusions for purposes 
of scientific inquiry and medical care.''
  So much for the contentions that there is compelling scientific 
evidence. They said there was not.
  Later this summer, the author of the study, the Ranch Hand study, 
told us in testimony before the House that his study was not adequate 
to make a decision that there was a causal link. He cautioned the 
House, and said do not count on a causal link from this study. It does 
not show it.
  Then, on July 29, the minority leader introduced legislation which 
used the study to create this new entitlement program. There has not 
been a hearing held on it in the authorizing committee.

  But there is also some new information that, frankly, I just came 
across. The Air Force has now sent a letter to Congress, dated August 
29, in which they state in their 1996 progress report on the bottom of 
page 3--this is on the Ranch Hand study, the one study which reported 
to show any connection:

       We found no indication of increased birth defects severity, 
     delays in development, or hyperkinetic syndrome with paternal 
     dioxin. The data provides little or no support for the theory 
     that external exposure to Agent Orange and its dioxin 
     contaminant is associated with adverse reproductive outcomes.

  Mr. President, I think that there is a very real question of whether 
there is any--certainly this has not been demonstrated--scientific 
evidence of a linkage.
  It is time for cooler heads to prevail. We have all expressed our 
concerns over birth defects. The amendment is not supported by sound 
scientific evidence. It is not even uniformly supported by veterans 
groups who recognize that the impact of the amendment will mean reduced 
benefits to veterans as a result of new entitlements and health care 
for dependents.
  There are many questions which the debate has raised which deserve 
full consideration in the normal legislative process before the 
authorizing committee. The opponents of this amendment have every bit 
as much compassion for people with these disabilities such as spina 
bifida. All we are saying is let us get the science that establishes 
the linkage. It is not there. Let us not jump into something that is so 
lacking in scientific evidence.
  That is precisely why we have a separate procedure in this body to 
consider legislation, particularly legislation setting up an 
entitlement program with hearings and actions before an authorizing 
committee.
  Since this is an attempt to set up an entitlement program, and it has 
not been heard before or acted upon by the authorizing committee, I 
raise a point of order that this amendment is not germane.
  The PRESIDING OFFICER. The Chair would suggest that the manager of 
the bill withhold his request as the minority leader still has 50 
seconds of his time.
  Mr. DASCHLE. Mr. President, I yield that time to the distinguished 
Democratic whip.
  The PRESIDING OFFICER. The Senator from Kentucky.
  Mr. FORD. Mr. President, I have listened to my colleague from 
Missouri talk about the March of Dimes. I started with the March of 
Dimes. We raised $800 trying to find a polio vaccine until it was 
completed. For 25 years I have worked with the March of Dimes and 
scholarships. The March of Dimes can't be used to stop this amendment. 
The veterans and their children deserve the vote of this Senate.
  If you could listen to the Democratic leader and the statements he 
has made, if you want to vote against the Vietnam veterans' children 
with spina bifida, you go ahead and do it. Then we will see who suffers 
the consequences. We are talking about children here. Let us be 
compassionate tonight, and not be so hard that we say to these Vietnam 
veterans there is even the possibility that they should not be taken 
care of.
  I hope the Senate will join the Democratic leader and support his 
amendment.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Missouri has 49 seconds.
  Mr. BOND. Mr. President, the argument about political retribution for 
somebody who demands scientific evidence and wants to provide a fair 
hearing and a scientific basis for action is one which does not, I 
think, serve this body well. I think we have a proper procedure for 
determining whether there is scientific evidence. To date, there has 
been none shown. That is why when I said this is entitlement 
legislation being offered on an appropriations bill, it is not germane 
to the appropriations process. And, for that reason, I raise this point 
of order that this amendment is not germane.
  The PRESIDING OFFICER. The question should be submitted to the 
Senate.
  Does the Senator request the yeas and nays?
  Mr. BOND. I ask for the yeas and nays on the question of germaneness.
  The PRESIDING OFFICER. Is there a sufficient second? There is a 
sufficient second.
  The yeas and nays were ordered.

                          ____________________