[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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