[Congressional Record Volume 143, Number 137 (Monday, October 6, 1997)]
[House]
[Pages H8362-H8367]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




            VETERANS HEALTH PROGRAMS IMPROVEMENT ACT OF 1997

  Mr. STUMP. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 2206) to amend title 38, United States Code, to improve 
programs of the Department of Veterans Affairs for homeless veterans, 
and for other purposes, as amended.
  The Clerk read as follows:

                               H.R. 2206

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veterans Health Programs 
     Improvement Act of 1997''.

     SEC. 2. TREATMENT AND REHABILITATION FOR SERIOUSLY MENTALLY 
                   ILL AND HOMELESS VETERANS.

       (a) Codification and Revisions of Veterans Homeless 
     Programs.--Chapter 17 of title 38, United States Code, is 
     amended by adding at the end the following new subchapter:

 ``SUBCHAPTER VII--TREATMENT AND REHABILITATION FOR SERIOUSLY MENTALLY 
                       ILL AND HOMELESS VETERANS

     ``Sec. 1771. General treatment

       ``In providing care and services under section 1710 of this 
     title to veterans suffering from serious mental illness, 
     including veterans who are homeless, the Secretary may 
     provide (directly or in conjunction with a governmental or 
     other entity)--
       ``(1) outreach services;
       ``(2) care, treatment, and rehabilitative services 
     (directly or by contract in community-based treatment 
     facilities, including halfway houses); and
       ``(3) therapeutic transitional housing assistance under 
     section 1772 of this title, in conjunction with work therapy 
     under section 1718(a) or (b) of this title and outpatient 
     care.

     ``Sec. 1772. Therapeutic housing

       ``(a) The Secretary, in connection with the conduct of 
     compensated work therapy programs, may operate residences and 
     facilities as therapeutic housing.
       ``(b) The Secretary may use such procurement procedures for 
     the purchase, lease, or other acquisition of residential 
     housing for purposes of this section as the Secretary 
     considers appropriate to expedite the opening and operation 
     of transitional housing and to protect the interests of the 
     United States.
       ``(c) A residence or other facility may be operated as 
     transitional housing for veterans described in paragraphs (1) 
     and (2) of section 1710(a) of this title under the following 
     conditions:
       ``(1) Only veterans described in those paragraphs and a 
     house manager may reside in the residence.
       ``(2) Each resident, other than the house manager, shall be 
     required to make payments that contribute to covering the 
     expenses of board and the operational costs of the residence 
     for the period of residence in such housing.
       ``(3) In order to foster the therapeutic and rehabilitative 
     objectives of such housing (A) residents shall be prohibited 
     from using alcohol or any controlled substance or item, (B) 
     any resident violating that prohibition may be expelled from 
     the residence, and (C) each resident shall agree to undergo 
     drug testing or such other measures as the Secretary shall 
     prescribe to ensure compliance with that prohibition.
       ``(4) In the establishment and operation of housing under 
     this section, the Secretary

[[Page H8363]]

     shall consult with appropriate representatives of the 
     community in which the housing is established and shall 
     comply with zoning requirements, building permit 
     requirements, and other similar requirements applicable to 
     other real property used for similar purposes in the 
     community.
       ``(5) The residence shall meet State and community fire and 
     safety requirements applicable to other real property used 
     for similar purposes in the community in which the 
     transitional housing is located, but fire and safety 
     requirements applicable to buildings of the Federal 
     Government shall not apply to such property.
       ``(d) The Secretary shall prescribe the qualifications for 
     house managers for transitional housing units operated under 
     this section. The Secretary may provide for free room and 
     subsistence for house managers in addition to, or instead of 
     payment of, a fee for such services.
       ``(e)(1) The Secretary may operate as transitional housing 
     under this section--
       ``(A) any suitable residential property acquired by the 
     Secretary as the result of a default on a loan made, 
     guaranteed, or insured under chapter 37 of this title;
       ``(B) any suitable space in a facility under the 
     jurisdiction of the Secretary that is no longer being used 
     (i) to provide acute hospital care, or (ii) as housing for 
     medical center employees; and
       ``(C) any other suitable residential property purchased, 
     leased, or otherwise acquired by the Secretary.
       ``(2) In the case of any property referred to in paragraph 
     (1)(A), the Secretary shall--
       ``(A) transfer administrative jurisdiction over such 
     property within the Department from the Veterans Benefits 
     Administration to the Veterans Health Administration; and
       ``(B) transfer from the General Post Fund of the Department 
     of Veterans Affairs to the appropriate revolving fund under 
     chapter 37 of this title an amount (not to exceed the amount 
     the Secretary paid for the property) representing the amount 
     the Secretary considers could be obtained by sale of such 
     property to a nonprofit organization or a State for use as a 
     shelter for homeless veterans.
       ``(3) In the case of any residential property obtained by 
     the Secretary from the Department of Housing and Urban 
     Development under this section, the amount paid by the 
     Secretary to that Department for that property may not exceed 
     the amount that the Secretary of Housing and Urban 
     Development would charge for the sale of that property to a 
     nonprofit organization or a State for use as a shelter for 
     homeless persons. Funds for such charge shall be derived from 
     the General Post Fund.
       ``(f) The Secretary shall prescribe--
       ``(1) a procedure for establishing reasonable payment rates 
     for persons residing in transitional housing; and
       ``(2) appropriate limits on the period for which such 
     persons may reside in transitional housing.
       ``(g) The Secretary may dispose of any property acquired 
     for the purpose of this section. The proceeds of any such 
     disposal shall be credited to the General Post Fund of the 
     Department of Veterans Affairs.
       ``(h) Funds received by the Department under this section 
     shall be deposited in the General Post Fund. The Secretary 
     may distribute out of the fund such amounts as necessary for 
     the acquisition, management, maintenance, and disposition of 
     real property for the purpose of carrying out such program. 
     The Secretary shall manage the operation of this section so 
     as to ensure that expenditures under this subsection for any 
     fiscal year shall not exceed by more than $500,000 proceeds 
     credited to the General Post Fund under this section. The 
     operation of the program and funds received shall be 
     separately accounted for, and shall be stated in the 
     documents accompanying the President's budget for each fiscal 
     year.

     ``Sec. 1773. Additional services at certain locations

       ``(a) Subject to the availability of appropriations, the 
     Secretary shall operate a program under this section to 
     expand and improve the provision of benefits and services by 
     the Department to homeless veterans.
       ``(b) The program shall include the establishment of not 
     fewer than eight programs (in addition to any existing 
     programs providing similar services) at sites under the 
     jurisdiction of the Secretary to be centers for the provision 
     of comprehensive services to homeless veterans. The services 
     to be provided at each site shall include a comprehensive and 
     coordinated array of those specialized services which may be 
     provided under existing law.
       ``(c) The program shall include the services of such 
     employees of the Veterans Benefits Administration as the 
     Secretary determines appropriate at sites under the 
     jurisdiction of the Secretary at which services are provided 
     to homeless veterans.

     ``Sec. 1774. Coordination with other agencies and 
       organizations

       ``(a) In assisting homeless veterans, the Secretary shall 
     coordinate with, and may provide services authorized under 
     this title in conjunction with, State and local governments, 
     other appropriate departments and agencies of the Federal 
     Government, and nongovernmental organizations.
       ``(b)(1) The Secretary shall require the director of each 
     medical center or the director of each regional benefits 
     office to make an assessment of the needs of homeless 
     veterans living within the area served by the medical center 
     or regional office, as the case may be.
       ``(2) Each such assessment shall be made in coordination 
     with representatives of State and local governments, other 
     appropriate departments and agencies of the Federal 
     Government, and nongovernmental organizations that have 
     experience working with homeless persons in that area.
       ``(3) Each such assessment shall identify the needs of 
     homeless veterans with respect to the following:
       ``(A) Health care.
       ``(B) Education and training.
       ``(C) Employment.
       ``(D) Shelter.
       ``(E) Counseling.
       ``(F) Outreach services.
       ``(4) Each assessment shall also indicate the extent to 
     which the needs referred to in paragraph (3) are being met 
     adequately by the programs of the Department, of other 
     departments and agencies of the Federal Government, of State 
     and local governments, and of nongovernmental organizations.
       ``(5) Each assessment shall be carried out in accordance 
     with uniform procedures and guidelines prescribed by the 
     Secretary.
       ``(c) In furtherance of subsection (a), the Secretary shall 
     require the director of each medical center and the director 
     of each regional benefits office, in coordination with 
     representatives of State and local governments, other Federal 
     officials, and nongovernmental organizations that have 
     experience working with homeless persons in the areas served 
     by such facility or office, to--
       ``(1) develop a list of all public and private programs 
     that provide assistance to homeless persons or homeless 
     veterans in the area concerned, together with a description 
     of the services offered by those programs;
       ``(2) seek to encourage the development by the 
     representatives of such entities, in coordination with the 
     director, of a plan to coordinate among such public and 
     private programs the provision of services to homeless 
     veterans;
       ``(3) take appropriate action to meet, to the maximum 
     extent practicable through existing programs and available 
     resources, the needs of homeless veterans that are identified 
     in the assessment conducted under subsection (b); and
       ``(4) attempt to inform homeless veterans whose needs the 
     director cannot meet under paragraph (3) of the services 
     available to such veterans within the area served by such 
     center or office.''.
       (b) Conforming Amendments.--(1) Section 1720A of such title 
     is amended--
       (A) by striking out subsections (a), (e), (f), and (g); and
       (B) by redesignating subsections (b), (c), and (d) as 
     subsections (a), (b), and (c), respectively.
       (2) The heading of such section is amended to read as 
     follows:

     ``Sec. 1720A. Treatment and rehabilitative services for 
       persons with drug or alcohol dependency''.

       (c) Conforming Repeals.--The following provisions are 
     repealed:
       (1) Section 7 of Public Law 102-54 (38 U.S.C. 1718 note).
       (2) Section 107 of the Veterans' Medical Programs 
     Amendments of 1992 (38 U.S.C. 527 note).
       (3) Section 2 of the Homeless Veterans Comprehensive 
     Service Programs Act of 1992 (38 U.S.C. 7721 note).
       (d) Clerical Amendments.--The table of sections at the 
     beginning of chapter 17 of such title is amended--
       (1) by striking out the item relating to section 1720A and 
     inserting in lieu thereof the following:

``1720A. Treatment and rehabilitative services for persons with drug or 
              alcohol dependency.'';

and
       (2) by adding at the end the following:


 ``subchapter vii--treatment and rehabilitation for seriously mentally 
                       ill and homeless veterans

``1771. General treatment.
``1772. Therapeutic housing.
``1773. Additional services at certain locations.
``1774. Coordination with other agencies and organizations.''.

     SEC. 3. EXTENSION OF HOMELESS VETERANS COMPREHENSIVE SERVICE 
                   GRANT PROGRAM.

       (a) Extension for Two Fiscal Years.--Subsection (a)(2) of 
     section 3 of the Homeless Veterans Comprehensive Service 
     Programs Act of 1992 (38 U.S.C. 7721 note) is amended by 
     striking out ``September 30, 1997'' and inserting in lieu 
     thereof ``September 30, 1999''.
       (b) Repeal of Limitation on Number of Projects.--Subsection 
     (b)(2) of such section is amended by striking out ``, which 
     shall'' and all that follows through ``paragraph (1)''.
       (c) Technical Correction.--Subsection (a)(1) of such 
     section is amended by striking out ``, during''.

     SEC. 4. ANNUAL REPORT ON ASSISTANCE TO HOMELESS VETERANS.

       Section 1001 of the Veterans' Benefits Improvements Act of 
     1994 (38 U.S.C. 7721 note) is amended--
       (1) in subsection (a)(2)--
       (A) by striking out ``and'' at the end of subparagraph (B);
       (B) by striking out the period at the end of subparagraph 
     (C) and inserting in lieu thereof ``; and''; and
       (C) by adding at the end the following new subparagraphs:

[[Page H8364]]

       ``(D) evaluate the effectiveness of the programs of the 
     Department (including residential work-therapy programs, 
     programs combining outreach, community-based residential 
     treatment, and case-management, and contract care programs 
     for alcohol and drug-dependence or abuse disabilities) in 
     providing assistance to homeless veterans; and
       ``(E) evaluate the effectiveness of programs established by 
     recipients of grants under section 3 of the Homeless Veterans 
     Comprehensive Service Programs Act of 1992 (38 U.S.C. 7721 
     note), and describe the experience of such entities in 
     applying for and receiving grants from the Secretary of 
     Housing and Urban Development to serve primarily homeless 
     persons who are veterans.''; and
       (2) by striking out subsection (b) and redesignating 
     subsection (c) as subsection (b).

     SEC. 5. NONINSTITUTIONAL ALTERNATIVES TO NURSING HOME CARE.

       Section 1720C of title 38, United States Code, is amended--
       (1) in subsection (a), by striking out ``During'' and all 
     that follows through ``furnishing of'' and inserting in lieu 
     thereof ``The Secretary may furnish''; and
       (2) in subsection (b)(1), by striking out ``pilot''.

     SEC. 6. PERSIAN GULF WAR VETERANS.

       (a) Scope of Counseling.--Section 703 of the Veterans 
     Health Care Act of 1992 (Public Law 102-585; 106 Stat. 4976) 
     is amended by adding at the end the following new subsection:
       ``(c) Form of Counseling.--Counseling provided in this 
     section may not be provided through written materials only, 
     but shall include verbal counseling.''.
       (b) Criteria for Priority Health Care.--(1) Subsection 
     (a)(2)(F) of section 1710 of title 38, United States Code, is 
     amended by striking out ``environmental hazard'' and 
     inserting in lieu thereof ``other conditions''.
       (2) Subsection (e)(1)(C) of such section is amended--
       (A) by striking out ``the Secretary finds may have been 
     exposed while serving'' and inserting in lieu thereof 
     ``served'';
       (B) by striking out ``to a toxic substance or environmental 
     hazard''; and
       (C) by striking out ``exposure'' and inserting in lieu 
     thereof ``service''.
       (3) Subsection (e)(2)(B) of such section is amended by 
     striking out ``an exposure'' and inserting in lieu thereof 
     ``the service''.
       (c) Demonstration Projects for Treatment of Persian Gulf 
     Illness.--(1) The Secretary shall carry out a program of 
     demonstration projects to test new approaches to treating, 
     and improving the satisfaction with such treatment of, 
     Persian Gulf veterans who suffer from undiagnosed and ill-
     defined disabilities. The program shall be established not 
     later than July 1, 1998, and shall be carried out at up to 10 
     geographically dispersed medical centers of the Department of 
     Veterans Affairs.
       (2) At least one of each of the following models shall be 
     used at no less than two of the demonstration projects:
       (A) A specialized clinic which serves Persian Gulf 
     veterans.
       (B) Multidisciplinary treatment aimed at managing symptoms.
       (C) Use of case managers.
       (3) A demonstration project under this subsection may be 
     undertaken in conjunction with another funding entity, 
     including agreements under section 8111 of title 38, United 
     States Code.
       (4) The Secretary shall make available from appropriated 
     funds (which have been retained for contingent funding) 
     $5,000,000 to carry out the demonstrations projects.
       (5) The Secretary may not approve a medical center as a 
     location for a demonstration project under this subsection 
     unless a peer review panel has determined that the proposal 
     submitted by that medical center is among those proposals 
     that have met the highest competitive standards of clinical 
     merit and the Secretary has determined that the facility has 
     the ability to--
       (A) attract the participation of clinicians of outstanding 
     caliber and innovation to the project; and
       (B) effectively evaluate the activities of the project.
       (6) In determining which medical centers to select as 
     locations for demonstration projects under this subsection, 
     the Secretary shall give special priority to medical centers 
     that have demonstrated a capability to compete successfully 
     for extramural funding support for research into the 
     effectiveness and cost-effectiveness of the care provided 
     under the demonstration project.

     SEC. 7. PERSONNEL POLICY.

       Section 7425 of title 38, United States Code, is amended by 
     adding at the end the following new subsection:
       ``(c)(1) Notwithstanding any other provision of law, 
     employees described in paragraph (2), and the personnel 
     positions in which such employees are employed, are not 
     subject to any reduction required by law or executive branch 
     policy in the number or percentage of employees, or of 
     personnel positions, within specified pay grades.
       ``(2) Paragraph (1) applies to employees, and personnel 
     positions, of the Veterans Health Administration performing 
     the following functions:
       ``(A) The provision of, or the supervision of the provision 
     of, care and services to patients.
       ``(B) The conduct of research.''.

     SEC. 8. PURCHASES OF PHARMACEUTICAL PRODUCTS.

       Section 8125 of title 38, United States Code, is amended--
       (1) by redesignating subsection (e) as subsection (f); and
       (2) by inserting after subsection (d) the following new 
     subsection (e):
       ``(e)(1) A drug, pharmaceutical or biological product, or 
     hematology-related product that is listed on the 
     pharmaceutical supply schedule described in section 8126(a) 
     of this title may only be procured or ordered from that 
     supply schedule by or for any entity specified in paragraph 
     (2), notwithstanding any other provision of law (whether 
     enacted before, on, or after the date of the enactment of 
     this subsection).
       ``(2) An entity specified in this paragraph is (A) any 
     agency or instrumentality of the Federal Government, or (B) 
     any other entity that is specified in Federal law or 
     regulation, as in effect before July 1, 1997, as eligible to 
     procure or order drugs, pharmaceutical or biological 
     products, or hematology-related products from such 
     pharmaceutical supply schedule.''.

     SEC. 9. TECHNICAL AMENDMENTS.

       (a) Section Cross Reference.--Section 1717(a)(2)(B) of 
     title 38, United States Code, is amended by striking out 
     ``section 1710(a)(2)'' and inserting in lieu thereof 
     ``section 1710(a)''.
       (b) References to Medical Centers.--(1) Paragraphs (1) and 
     (11) of section 7802 of such title are amended by striking 
     out ``hospitals and homes'' and inserting in lieu thereof 
     ``medical facilities''.
       (2) Section 7803 of such title is amended--
       (A) by striking out ``hospitals and homes'' each place it 
     appears and inserting in lieu thereof ``medical facilities''; 
     and
       (B) by striking out ``hospital or home'' both places it 
     appears and inserting in lieu thereof ``medical facility''.
       (c) Name of Medical Center.--The Wm. Jennings Bryan Dorn 
     Veterans' Hospital in Columbia, South Carolina, shall 
     hereafter be known and designated as the ``Wm. Jennings Bryan 
     Dorn Department of Veterans Affairs Medical Center''. Any 
     reference to such hospital in any law, regulation, document, 
     map, record, or other paper of the United States shall be 
     deemed to be a reference to the Wm. Jennings Bryan Dorn 
     Department of Veterans Affairs Medical Center.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Arizona [Mr. Stump] and the gentleman from Illinois [Mr. Evans], each 
will control 20 minutes.
  The Chair recognizes the gentleman from Arizona, [Mr. Stump].


                             General Leave

  Mr. STUMP. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous materials on H.R. 2206.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Arizona?
  There was no objection.
  (Mr. STUMP asked and was given permission to revise and extend his 
remarks.)
  Mr. STUMP. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, H.R. 2206 is a bill to improve VA programs for 
homeless veterans and health care for Persian Gulf veterans. It also 
includes several other provisions designed to improve the 
administration of the veterans' health care system.
  As a result of the concerns expressed by Members and after consulting 
with the gentleman from Illinois [Mr. Evans], the ranking member of the 
Committee on Veterans' Affairs, we have decided to drop section 8 
affecting the veterans canteen service from the bill under 
consideration this afternoon.
  Madam Speaker, I reserve the balance of my time.
  Mr. EVANS. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise in support of H.R. 2206, as amended, the 
Veterans Health Programs Improvement Act. The bill before us today 
extends several important authorities which are scheduled to expire and 
approves a number of programs critical to meeting the needs of veterans 
with health care problems.
  Specifically, this measure takes important steps to address some of 
our most serious concerns about homelessness among our veterans in our 
country. On any given night in America, a third of those living in the 
streets of America are veterans. I find this hard to live with both as 
a veteran and as an American citizen. I believe we must do more to 
respond to this problem.
  As the VA's health care system makes important changes, at a minimum 
we must assure that the VA maintains both the quality and quantity of 
services delivered to homeless veterans today. This proposal will 
ensure the VA is able to continue such worthwhile activities which are 
allowing veterans to become independent and restore dignity to their 
lives.

[[Page H8365]]

  Importantly, this legislation makes Persian Gulf veterans eligible 
for VA health care by virtue of their service in the gulf rather than 
through a particular exposure. The medical literature has yet to 
pinpoint a single cause of the problem many veterans are facing and 
varies on its determinations of whether health differences exist 
between military service persons who served in the gulf and their peers 
who served elsewhere. The bill we are proposing today takes cognizance 
of the variation in the literature and gives veterans the benefit of 
the doubt.

                              {time}  1415

  The VA exists to treat veterans with health problems related to their 
service to this country, and this bill will allow gulf war veterans 
with illnesses to access this care.
  The measure also authorizes a grant program to improve health care 
provided to these veterans. The VA Health Administration is 
enthusiastic about using its competitive grants to encourage their care 
providers to be innovative in treating the symptoms veterans have 
related to their deployment to the gulf and in developing centers of 
excellence for this care.
  Our Nation cannot forget these veterans as time marches on. We are 
obligated to investigate not only the causes of their illnesses but to 
find the best treatments for their symptoms for those people who 
honorably served in that war for our country.
  Several years ago the VA realized a substantial increase in drug 
prices due to unanticipated changes in the Medicaid pharmaceutical 
pricing policies. Manufacturers' representatives have stated they would 
not hesitate to raise prices to the VA again if State and local 
purchasers are allowed to benefit from the prices that the VA 
negotiates on behalf of Federal purchasers. This would increase the 
prices VA and others who benefit from the negotiation pay for 
pharmaceuticals. Because of this response, we do not believe State and 
local purchasers should benefit from access to the Federal fee 
schedules.
  Furthermore, our Committee on Veterans' Affairs believes because of 
the inadequate resources that we have, that as many as 50,000 veterans 
would lose their access to the health care system if the VA was 
required to pay more for their drugs. We cannot allow this to happen.
  This bill is extremely important to America's veterans. I hope my 
colleagues from both sides of the aisle will join me in supporting this 
legislation.
  Madam Speaker, I reserve the balance of my time.
  Mr. STUMP. Madam Speaker, I yield such time as he may consume to the 
gentleman from Florida [Mr. Stearns], the chairman of the Subcommittee 
on Health.
  Mr. STEARNS. Madam Speaker, I thank the gentleman from Arizona [Mr. 
Stump], the chairman, and I rise to urge my colleagues to support H.R. 
2206, the Veterans Health Programs Improvement Act of 1997.
  While this bill includes a number of important measures, its key 
provisions would improve care for homeless veterans and Persian Gulf 
veterans. The bill, as amended and reported out of the full committee, 
also incorporates other pieces of legislation which have the strong 
support of the Committee on Veterans' Affairs and the veterans 
community.
  First, H.R. 2206 would extend, consolidate, and strengthen VA 
programs which have proven effective in helping rehabilitate homeless 
veterans. One-third of homeless adults are veterans. Of that number, 
over 85 percent have a serious psychiatric or substance abuse disorder. 
Studies indicate that a substantial number of those who rely on VA care 
are homeless or at risk of becoming homeless.
  Madam Speaker, this bill recognizes that assisting the homeless is 
not solely a Federal or VA responsibility. In fact, it specifically 
envisions a VA role that involves working in partnership with 
Government agencies and community providers. Nevertheless, the bill 
would give the VA clearer and less restrictive authority to provide 
care and rehabilitative services to the homeless, and particularly 
those suffering from chronic and mental illness. It would enable 
veterans to provide a full range of needed services to restore health, 
independence, and dignity to many previously homeless veterans.
  Madam Speaker, other key aspects of this legislation reflect the high 
priority this committee has given during the 105th Congress to 
oversight and particularly to oversight of VA care and provisions of 
benefits to Persian Gulf veterans. The full committee and its 
subcommittees have held four oversight hearings this year devoted 
exclusively to Persian Gulf war issues. That record has certainly sent 
a strong, clear message to veterans as well as to the Department of 
Veterans Affairs that this committee will do everything in its power to 
ensure that the VA fulfill its obligation to these veterans.
  In fact, the National Commander of the American Legion commended the 
committee last month for ``Convening the most comprehensive and 
important hearings on Gulf War veterans since the end of the Gulf 
War.''
  Central to our concerns has been the large number of veterans with 
unexplained and ill-defined health problems. What has become apparent 
to our committee is not only that these problems have been difficult to 
diagnose but they have been difficult to treat. We are encouraged that 
VA officials have recognized the need for different approaches to 
treating some of these chronically ill veterans who suffer from poorly 
understood health problems.
  Accordingly, this legislation requires the VA to establish and fund a 
competitive grant program under which participating VA facilities would 
develop and operate demonstration programs aimed at improving care to 
Persian Gulf war veterans with undiagnosed illnesses. Medical science 
has still not provided the answers so many gulf war veterans seek in 
understanding the nature and cause of their illness. This legislation, 
however, would make it clear that regardless of the nature of the cause 
or causes, and regardless of whether the problem can be linked to 
exposure to a toxic substance or environmental hazard, these veterans 
are eligible for VA health care.
  Finally, Madam Speaker, I would like to express my regret that a 
provision of this bill, based upon H.R. 1687 relating to physician and 
dentist retirements, was dropped due to disagreements with the 
Congressional Budget Office regarding its cost implications.
  Nevertheless, Madam Speaker, this is an excellent bill and I urge my 
colleagues to join with me in passing this most important piece of 
legislation.
  Mr. EVANS. Madam Speaker, I yield 3 minutes to the gentleman from 
California [Mr. Filner], a member of the committee.
  Mr. FILNER. Madam Speaker, I thank the gentleman from Arizona [Mr. 
Stump] and the ranking member of the committee, the gentleman from 
Illinois [Mr. Evans] for bringing this to the floor in such a rapid 
fashion; and also thanks to the gentleman from Florida [Mr. Stearns], 
the chairman of the subcommittee, and the gentleman from Illinois [Mr. 
Gutierrez], its ranking member, for their leadership on these issues.
  Madam Speaker, homelessness among our Nation's veterans continues to 
be a significant and troubling problem across the country. Informal 
surveys indicate that up to 275,000 former members of our Armed Forces 
sleep on America's streets or in homeless shelters every night. H.R. 
2206, as has been described, provides for the extension and improvement 
of programs administered by the Department of Veterans Affairs which 
have assisted thousands of these men and women.
  I am proud to say that my city of San Diego was one of the first to 
reach out to its homeless veterans, originating the creative program of 
``Stand Down.'' Also, the Vietnam vets of San Diego run an incredibly 
effective housing program. But no city has the resources to address the 
crisis without Federal assistance and cooperation.
  The programs which are being extended under H.R. 2206 will enable the 
good and caring citizens of San Diego and every other American city to 
continue to provide shelter, transitional housing and other support 
critical to the survival and rehabilitation of homeless veterans.
  Madam Speaker, I urge my colleagues to support this measure.
  Mr. EVANS. Madam Speaker, I yield 5 minutes to the gentleman from 
Ohio [Mr. Dennis Kucinich].

[[Page H8366]]

  Mr. KUCINICH. I want to congratulate, first of all, Madam Speaker, 
the gentleman from Illinois [Mr. Evans] and his counterpart on the 
other side of the aisle, the gentleman from Arizona [Mr. Stump], for 
the concern which they have shown for homeless veterans and for 
veterans of all kinds across this country.
  My father fought in World War II. I had a brother who fought in 
Vietnam, and he is in a veterans home today as a result of that 
service. I am familiar firsthand with the effect that service to a 
government can have on a family, and I appreciate very much the work 
that all the men and women have done in this country in serving 
America. That is why to stand here at this moment is very difficult.
  I want to point out a provision in H.R. 2206, the Veterans Health 
Programs Improvement Act of 1997, which was put in there, and for some 
reason this provision, which really has nothing to do with veterans at 
all, this provision would punish rural and urban public hospitals and 
health clinics in districts across the country and be tantamount to a 
local tax increase. It makes a bill, which everyone should agree on, 
quite controversial.
  Section 10 of this bill would prohibit State, county, and municipal 
health givers from getting lower prices for lifesaving pharmaceuticals 
which their patients need. Nursing homes and public hospitals would 
suffer, since they must purchase equipment, medical devices and 
lifesaving drugs for elderly citizens and the ill, especially people 
with AIDS.
  Local public health institutions will not be allowed to operate more 
efficiently and less expensively, since they will be forbidden by law 
from purchasing many products and services at discounted prices, which 
would otherwise enable the taxpayers to save billions of dollars at a 
State and local level.
  At the request of the National Performance Review and Vice President 
Gore, the 104th Congress intended to bring efficient practices to local 
and State government without onerous regulations or government 
mandates. The bottom line savings would be realized by local taxpayers 
who pay the bill of local government.
  Although saving money for local taxpayers is a good idea, there are 
those who oppose it, and certain industry groups which benefit from 
Government inefficiency, would like nothing more than to have Congress 
pass this particular provision which is in H.R. 2206. These industry 
groups are trying to, in effect, interject their interest into a bill 
which should be, first and foremost, to support the interests of 
veterans but, instead, the bill has a provision which attacks public 
hospitals.
  The pharmaceutical industry wants to see H.R. 2206 pass because they 
do not want public hospitals and AIDS clinics to benefit from 
significant savings or significant discounts on lifesaving drugs. Why 
sell AIDS drugs at a lifesaving discount when they can be sold at full 
price?
  Therefore, this provision makes H.R. 2206 a tax increase on local 
taxpayers because it would deny State, county, and municipal hospitals 
and clinics from purchasing pharmaceuticals and medical equipment at 
the discounted prices the Federal Government negotiates.
  The provision in this bill is objectionable, unfair, and 
controversial, and I would suggest that this provision is emblematic of 
what is wrong with Government. Here we all agree that our veterans need 
access to low cost drugs for their health, particularly those who are 
least able to care for themselves. And all of us could agree, I would 
hope, that our public hospitals and clinics need access to the lowest 
possible cost for pharmaceuticals. But this bill puts us in a conflict 
where it makes us have to separate those interests, which ought to be 
interests we agree on.
  So we are asked to choose between those interests. I say that is a 
false choice; that we in the Congress should be supporting veterans and 
we should be supporting public hospitals in our districts. And for that 
reason, until we can clean up this particular provision, I am urging a 
``no'' vote on this particular bill, and I do so only with the greatest 
reluctance because of the terrific respect that I have for my 
colleagues on both sides of the aisle who are dedicated to veterans, 
and I know they really care about veterans' concerns.
  Mr. STUMP. Madam Speaker, I yield 2 minutes to the gentleman from 
Florida [Mr. Stearns].
  Mr. STEARNS. Madam Speaker, I thank the chairman for yielding me this 
time and, Madam Speaker, this is a stretch of circuitous logic to say 
that this bill is a tax increase.
  As I recollect, this bill, and the ranking member, the gentleman from 
Illinois [Mr. Evans] can point out, as I remember, this passed by 
unanimous consent, all the Democrats and Republicans. This has nothing 
to do with what the gentleman from Ohio is talking about.
  In fact, there is nothing in this bill that prevents worthy 
institutions from negotiating favorable prices for themselves, 
individually or collectively. We simply say that this institution 
should not piggyback on the Federal supply schedule.
  Remember, now, if we open up the Federal supply schedule and make it 
for everybody, then the price is going to go up for veterans, and that 
is why I think many of us in the committee were worried about. In fact, 
the General Accounting Office, I tell my colleague from Ohio, came to 
the committee and testified that the VA and other Federal agencies 
could experience price increases on almost 81 percent of all the drugs 
in the Federal supply schedule.
  And what would that mean for veterans? Let us talk about that, 
because this is what we are talking about. We are talking about the 
Veterans Administration. We are talking about a bill that would benefit 
veterans. The result, the VA Administration, the Clinton 
administration, not Republicans in the House, not our committee, the VA 
Administration told us that about 50,000 veterans would lose access to 
care. So with that in mind, both the Democrats and Republicans 
unanimously passed this bill.
  I think we have to remember that what we are trying to do is allow 
veterans, through the Committee on Veterans' Affairs, to have access 
and have discounted prices. If we want to have discounted programs for 
veterans hospitals and veterans, let us keep it there and not open it 
up so that they are in the final analysis hurt.
  Mr. EVANS. Madam Speaker, I yield 2 minutes to the gentleman from 
Ohio [Mr. Kucinich].

                              {time}  1430

  Mr. KUCINICH. Madam Speaker, the gentleman from Florida [Mr. Stearns] 
and I are in agreement on the need to lower the cost of pharmaceuticals 
for veterans. To me, there is no question that this Congress ought to 
be doing more for our veterans.
  Where we are in disagreement is that we should accept a provision in 
this bill which stops public hospitals from taking advantage of the 
lowest possible prices that might be available to them. When I say that 
it means a tax increase if this bill passes, here is what I mean, so we 
can understand this.
  If public hospitals are able to get the lowest possible price for 
goods that they buy and for services, since they run on tax dollars, 
the longer they can carry that tax dollar, the more they can stretch 
it, the more value that is given for the tax dollar. But if the goods 
cost more, that means people have to pay more taxes to support it.
  So that would qualify the statement that I made.
  But I can see, it is difficult to be able to at once stand very 
firmly for veterans, as my colleague has done, for which I congratulate 
him, and at the same time take a stand which says, well, we cannot 
regard the interest of public hospitals.
  So, Madam Speaker, I am very concerned that we need to let people 
know the effect this could have on public hospitals.
  Mr. EVANS. Madam Speaker, I yield back the balance of my time.
  Mr. STUMP. Madam Speaker, I yield myself such time as I may consume.
  Let me mention one or two things about the Committee on Veterans' 
Affairs' efforts to address the concerns of Persian Gulf war veterans. 
We have had four separate hearings on this subject this year. We have 
heard from veterans' organizations, scientists, officials from VA, DOD, 
and CIA, and from the Presidential Advisory Commission.
  At our request, the General Accounting Office has reviewed how VA 
cares

[[Page H8367]]

for veterans with undiagnosed illnesses and is undertaking additional 
reviews of how well VA is responding to our benefits. I also want all 
Members to know that we continue to press for answers to these 
veterans' questions.
  One word about what the gentleman from Ohio [Mr. Kucinich] is 
speaking of. There is nothing to prevent health organizations from 
negotiating with pharmaceutical companies today. Our responsibility is 
to protect the veterans, and if in fact we did that, or did not try to 
protect them, we could lose up to $250 million a year.
  The VA procures about $1 billion dollars in pharmaceuticals every 
year, and that is why we are so interested in protecting this 
provision. I would like to thank the gentleman from Florida [Mr. 
Stearns] and the gentleman from Illinois [Mr. Gutierrez], the chairman 
and ranking member of the Subcommittee on Health, as well as the 
gentleman from Illinois [Mr. Evans], the ranking member of the full 
committee, for their contributions on this bill and for their 
continuing efforts to improve veterans' health care administration.
  Mr. GUTIERREZ. Mr. Speaker, I would like to thank Ranking Member 
Evans and Chairman Stump for their work on this important bill.
  I would also like to thank Chairman Stearns for his efforts to get 
this legislation reported out of the Veterans' Affairs Committee, 
Subcommittee on Health in a timely manner.
  Today, Mr. Speaker, we reauthorize a number of vital programs that 
provide treatment and rehabilitation services for homeless and mentally 
ill veterans.
  I am sure many of you are aware of the numbers of homeless veterans 
in our Nation. The National Coalition for Homeless Veterans [NCHV] 
estimates that nearly 40 percent of homeless men are veterans.
  The percentage of homeless women who are veterans has also increased 
during the past decade.
  Thousands of these men and women who served our Nation and risked 
their lives for our defense have not been offered the respect and care 
they earned and deserve.
  By reauthorizing the provision of vital health and rehabilitative 
care to this vulnerable but deserving population we pay off a small 
portion of the debt we owe these courageous Americans.
  The bill before us today would consolidate, clarify, and I believe 
improve the Department of Veterans Affairs [VA] programs for homeless 
and mentally ill veterans by enabling the VA to deal more effectively 
and directly with many of the ailments afflicting these brave 
individuals.
  Homeless veterans suffer from substance abuse at disproportionate 
levels. Approximately 70 percent of homeless veterans currently treated 
by the VA suffer from substance abuse problems.
  Community-based residential care, which this bill authorizes for 
homeless veterans, has been proven to help these men and women restore 
their lives and I am pleased that we have reinstated these programs in 
this bill.
  Compensated work therapy is similarly vital to the rehabilitative 
needs of homeless and mentally ill veterans. Work therapy is 
inextricably linked to the success of patients in their fight against 
substance abuse.
  The consolidated work therapy program reauthorized in H.R. 2206 
should continue to provide this crucial link for veterans who are 
fighting addiction while rebuilding their lives and careers.
  H.R. 2206 is important also because it gives the VA authority to 
create new and innovative treatments and services for Persian Gulf 
veterans.
  We don't have all the answers regarding the illnesses afflicting the 
veterans of the Persian Gulf war.
  Yet evidence that indicates that the symptoms Persian Gulf veterans 
are experiencing as a result of their service are real and not figments 
of their imagination continues to mount.
  What we do know, is that these veterans have been suffering for too 
long without health care programs specifically geared to their needs.
  So I am pleased that this bill creates a new program to fund 
demonstration projects at the VA that may lead to the development of 
new treatments for gulf war veterans with undiagnosed or ill-defined 
medical conditions.
  This is a positive and long-overdue step toward addressing their 
unique needs.
  Once again, I thank the leadership of the House Veterans' Affairs 
Committee for their thoughtful work on this important legislation.
  I ask my colleagues to recognize this work and the importance of this 
bill for our veterans by voting your support for this measure.
  Mr. GILMAN. Mr. Speaker, I rise today in strong support of H.R. 2206, 
the Veterans Health Programs Improvement Act of 1997.
  This bill modifies several laws, that are set to expire, which 
authorize programs to assist and rehabilitate homeless veterans and 
those with chronic mental illness. It also moves to address some of the 
critical needs relating to Gulf War illnesses.
  It is estimated that one-third of all homeless adults and 40 percent 
of homeless men are veterans. According to research conducted by the 
VA, most homeless veterans suffer from serious psychiatric or substance 
abuse disorders. This legislation require the VA to create at least 
eight centers to provide comprehensive services to homeless veterans 
and to coordinate such services with other agencies and departments. It 
also extends the Homeless Veterans Comprehensive Service Grant Program 
through fiscal year 1999 and eliminates current law limitations on the 
number of specified projects for which grants may be awarded.
  Equally important, Mr. Speaker, is the VA's responsibility to its 
veterans from the Persian Gulf war. With recent evidence pointing more 
and more towards troops having been exposed to chemical or biological 
agents, we are morally obligated to provide our veterans with the best 
medical care available for the injuries they incurred in service to 
their country.
  In addition, the Presidential Advisory Committee is expected to 
release its final recommendations to the administration in the near 
future. Among the recommendations is one that would extend general 
health care for those veterans with undiagnosed or difficult-to-
diagnose conditions. While such a provision would be an enormous help 
to our Persian Gulf veterans suffering from mysterious ailments, many 
of them also would like to know the exact cause of their condition.
  This bill establishes a $5 million grant program for 10 VA facilities 
to establish demonstration projects aimed at improving health care for 
Gulf War veterans with the aforementioned conditions that are difficult 
to diagnose or categorize. It also makes clear that Gulf War veterans 
are eligible for care for any health problem, and not just those 
related to exposure to toxic agents.
  Accordingly, I ask my colleagues to join in supporting this worthy 
legislation.
  Mrs. KENNELLY of Connecticut. Mr. Speaker, I rise as a strong 
supporter of the Randolph-Sheppard Act which provides important work 
opportunities for the blind. I want to thank Mr. Stump and Mr. Evans 
for removing Section 8 from the Veterans' Health Programs Improvement 
Act of 1997, which would have weakened the Randolph-Sheppard Act. 
Section 8 of this bill would have granted the Veterans' Canteen Service 
sole authority to establish canteens, including vending facilities and 
vending machines at VA medical facilities. This provision would have 
negatively impacted the Randolph-Sheppard Act and I am pleased that it 
has been removed.
  The Randolph-Sheppard Act, which was enacted in 1936, gives blind 
individuals a priority over other businesses in the operation of 
vending facilities and vending machine services on federal property. In 
1995, I led a successful bipartisan effort which eliminated a provision 
to exempt the National Park Service, Bureau of Land Management and 
Bureau of Reclamation from the Randolph-Sheppard Act. Across the United 
States this program has provided employment opportunities for over 
3,500 blind individuals, including over 30 blind men and women in my 
home state of Connecticut. In fact, it is the nation's most successful 
program to provide independence and work opportunities for blind 
people.
  Blindness is often associated with adverse social and economic 
consequences. It is often difficult for blind individuals to find 
sustained employment or for that matter employment at all. The 
Randolph-Sheppard Act was created to eliminate dependence and its 
resultant cost to the taxpayer, and it remains successful in doing 
that. Perhaps most important, it creates entrepreneurial opportunities 
for blind people and promotes this nation's tradition of pride in self-
reliance.
  Mr. STUMP. Madam Speaker, I yield back the balance of my time.
  Mr. EVANS. Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mrs. Emerson). The question is on the motion 
offered by the gentleman from Arizona [Mr. Stump] that the House 
suspend the rules and pass the bill, H.R. 2206, as amended.
  The question was taken.
  Mr. STEARNS. Madam Speaker, I object to the vote on the ground that a 
quorum is not present and make the point of order that a quorum is not 
present.
  The SPEAKER pro tempore. Pursuant to clause 5 of rule I and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.
  The point of no quorum is considered withdrawn.




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