[Congressional Record Volume 143, Number 63 (Wednesday, May 14, 1997)]
[Extensions of Remarks]
[Pages E915-E916]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      EQUITY IN ALLOCATION OF VA HEALTH CARE RESOURCES, H.R. 1580

                                 ______
                                 

                        HON. BENJAMIN A. GILMAN

                              of new york

                    in the house of representatives

                         Tuesday, May 13, 1997

  Mr. GILMAN. Mr. Speaker, I rise today to introduce legislation to 
address some of the multitude of problems that have arisen out of the 
veterans equity resource allocation plan for VA health care.
  In last year's veterans appropriations legislation, the Veterans 
Administration was mandated by Congress to develop and implement a more 
equitable method for allocating VA health care resources. In response, 
the VA has devised the veterans equity resource allocation [VERA] model 
and based their reallocation process on this plan.
  The primary result of this has been the steady hemorrhaging of vital 
health care funds away from VA VISN's in the Northeast in favor of 
VISN's in the South and Southwest. While VA officials in the Northeast 
have gone out of their way to assure congressional offices that the 
quality of care will not decrease under VERA, this has not been the 
case.
  While VERA is a noble effort, it is based on a fundamentally flawed 
model. As a research method, VERA is unfairly biased against older 
veterans in major metropolitan areas. These veterans are those in need 
of inpatient, comprehensive health care, and they will suffer if VERA 
is allowed to go forward as planned.
  As it currently stands, the VERA model would reallocate health care 
resources based upon demand for VA health care. The argument that the 
VA has used with my congressional office is that there is greater 
demand for VA care in the South and Southwest, while the Northeast and 
Rust Belt have lower levels of demand.
  Under current law, VA health care is freely available to all veterans 
for problems related to their service-connected disabilities. Non-
service-connected care is available for World War I veterans, former 
prisoners of war, veterans receiving pensions and those who qualify 
under a means test. The means test is currently $21,660 for a single 
veteran with no dependents, and $25,660 for a married veteran.
  The problem with a national means test, is that it benefits veterans 
living in low-income areas, such as Arizona, West Virginia and 
Mississippi, and penalizes veterans living in high-cost areas, such as 
New York, Washington, and Chicago. After all, $21,660 goes a lot 
farther in Jackson, MS, than in Manhattan.
  A married veteran who is struggling to get by with an income of 
$27,000 in New York City would be unable to take advantage of free 
health care through the VA. Yet a similar veteran making $24,000 in 
Mississippi, would be living much more comfortably, as well as have the 
advantage of going to the VA for his health care. This shows that the 
means test does not accurately reflect the economic conditions for each 
geographic area.
  The VERA model also fails to differentiate between the types of care 
delivered at VA facilities. Initially, it does appear that VA health 
care in the Southwest is delivered more efficiently than in the 
Northeast. The important point to consider, however, is the type of 
care delivered. VA hospitals in the Northeast tend to have more 
specialized care patients--spinal injury, alcohol/drug abusers, mental 
health patients, and homeless cases--which obviously cost more than the 
outpatient cases, which are more plentiful in the Southwest.
  Logic would dictate that a true comparison be made between regions 
before any health care resources are reallocated. Yet the VA has not 
done this with the VERA model. Instead, the VERA model compares the 
apples of specialized care in the Northeast with the oranges of 
outpatient care in the Southwest.
  This legislation corrects these inherent flaws within the VA model in 
three ways.
  First, the bill would raise the income level in the means test by 20 
percent for any veteran who lives in a standard metropolitan 
statistical area [SMSA] as defined by the Bureau of the Census. This 
would make the VA more accessible to veterans who live in high-cost 
areas, thus increasing the number of veterans who use VA in those 
regions. Consequently, there would be more outpatient cases treated in 
the Northeast and Rust Belt.
  Second, the bill would move veterans with catastrophic health care 
expenses from category C--those would must meet the means test for non-
service-connected care--to category A--those eligible for free non-
service-connected care. These veterans are defined as those individuals 
whose medical expenses for the previous year exceeded 7.5 percent of 
their adjusted gross income.
  Third, the bill would level the playing field between the Northeast 
and Southwest by removing the high-cost, inefficient speciality care 
programs from those funds which can be considered in reallocation 
calculations under VERA. The programs removed would include: 
readjustment counseling and treatment, counseling and psychiatric care 
for the mentally ill, drug and alcohol related programs, programs for 
the homeless, PTSD programs, spinal cord injury programs, aids programs 
and geriatric and extended care programs.
  This provision protects the resources being used by those veterans 
most at risk, the majority of whom live in the Northeast and in major 
urban centers. The above programs help to remove these veterans from 
the immediate risk by providing them with sanctuary. They can then be 
diagnosed and treated after which they are reintegrated into society. 
This process takes time, and is expensive--some would say inefficient. 
Furthermore, it cannot be done very well on an outpatient basis--one

[[Page E916]]

needs to remove substance abusers from the drug or alcohol in question 
before any treatment could be effectively initiated. The majority of VA 
facilities for such programs exist in the Northeast. It is foolish not 
to utilize them in the name of efficiency, especially when the 
comparison is between outpatient care and inpatient treatment--applies 
and oranges.
  I believe that this bill adequately addresses the problems posed by 
the VERA-based model for VA health care reallocation. Rather than 
simply reacting to the VERA model, this legislation is proactive, and 
changes VERA to make for true equity in VA health care allocation. The 
VERA model does offer many constructive suggestions for improving the 
manner in which the VA delivers health care services. Yet these 
improvements should not benefit some veterans at the expense of others.
  The veterans of the Northeast and the Rust Belt gave just as much for 
their country as their counterparts in the Sun Belt and Deep South. 
There is no reason why they should be punished with their VA health 
care, simply due to where they have chosen to live.
  Accordingly, I urge my colleagues to join me in supporting this 
important legislation which will guarantee true equity in the 
allocation of veterans health care funding.

                               H.R. 1580

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. CRITERIA FOR REQUIRED COPAYMENT FOR MEDICAL CARE 
                   PROVIDED BY THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) Exception Based on Prior Catastrophic Health Care 
     Expenses.--Subsection (a) of section 1722 of title 38, United 
     States Code, is amended--
       (1) by striking out ``or'' at the end of paragraph (2);
       (2) by striking out the period at the end of paragraph (3) 
     and inserting in lieu thereof ``; or''; and
       (3) by adding at the end the following new paragraph:
       ``(4) the veteran's expenses for medical care (as defined 
     in section 213 of the Internal Revenue Code of 1986) for the 
     previous year are in excess of 7\1/2\ percent of the 
     veteran's adjusted gross income for the previous year (as 
     determined for purposes of the personal income tax under the 
     Internal Revenue Code of 1986).''.
       (b) Adjustment in Income Thresholds for Veterans Residing 
     in SMSAs.--Subsection (b) of such section is amended by 
     adding at the end the following new paragraph:
       ``(3) The amounts in effect for purposes of this subsection 
     for any calendar year shall be increased by 20 percent for 
     any veteran who resides in a Standard Metropolitan 
     Statistical Area (SMSA), as defined by the Bureau of the 
     Census.''.
       (c) Amendments Within Existing Resources.--The Secretary of 
     Veterans Affairs shall carry out the amendments made by this 
     section for fiscal years 1998 and 1999 within the amount of 
     funds otherwise available (or programmed to be available) for 
     medical care for the Department of Veterans Affairs for those 
     fiscal years.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 1998.

     SEC. 2. SERVICES FOR MENTALLY ILL VETERANS.

       (a) Membership of Committee on Care of Severely Chronically 
     Mentally Ill Veterans.--Section 7321 of title 38, United 
     States Code, is amended--
       (1) in subsection (a), by inserting ``and members of the 
     general public with expertise in the care of the chronically 
     mentally ill'' in the second sentence after ``chronically 
     mentally ill''; and
       (2) by adding at the end the following new subsection:
       ``(e) The Secretary shall determine the terms of service 
     and (for members appointed from the general public) the pay 
     and allowances of the members of the committee, except that a 
     term of service may not exceed five years. The Secretary may 
     reappoint any member for additional terms of service.''.
       (b) Centers for Mental Illness Research, Education, and 
     Clinical Activities.--Paragraph (3) of section 7320(b) of 
     such title is amended to read as follows:
       ``(3) The Secretary shall designate at least one center 
     under this section in each service network region of the 
     Veterans Health Administration.''.

     SEC. 3. ALLOCATION OF MEDICAL CARE RESOURCES FOR THE 
                   DEPARTMENT.

       (a) In General.--(1) Chapter 81 of title 38, United States 
     Code, is amended by inserting after section 8116 the 
     following new section:

     ``Sec. 8117. Allocation of medical care resources

       ``In applying the plan for the allocation of health care 
     resources (including personnel and funds) known as the 
     Veterans Equitable Resource Allocation system, developed by 
     the Secretary pursuant to the requirements of section 429 of 
     Public Law 104-204 (110 Stat. 2929) and submitted to Congress 
     in March 1997, the Secretary shall exclude from consideration 
     in the determination of the allocation of such resources the 
     following (resources for which shall be allocated in such 
     manner as the Secretary determines to be appropriate):
       ``(1) Programs to provide readjustment counseling and 
     treatment.
       ``(2) Programs to provide counseling and treatment 
     (including psychiatric care) for the mentally ill.
       ``(3) Programs relating to drug and alcohol abuse and 
     dependence.
       ``(4) Programs for the homeless.
       ``(5) Programs relating to post-traumatic stress disorder.
       ``(6) Programs relating to spinal cord dysfunction.
       ``(7) Programs relating to AIDS.
       ``(8) Programs relating to geriatric and extended care.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     8116 the following new item:
       ``8117. Allocation of medical care resources.''.
       (b) Effective Date.--Section 8117 of title 38, United 
     States Code, as added by subsection (a), shall apply with 
     respect to the allocation of resources for each fiscal year 
     after fiscal year 1997.

     

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