[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.
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