[Congressional Record Volume 144, Number 142 (Saturday, October 10, 1998)]
[Senate]
[Pages S12312-S12315]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DASCHLE:
  S. 2619. A bill to amend title 38, United States Code, to improve 
access of veterans to emergency medical care in non-Department of 
Veterans Affairs medical facilities; to the Committee on Veterans' 
Affairs.


       The Veterans' Access to Emergency Health Care Act of 1998

  Mr. DASCHLE. Mr. President, as we near the end of the 105th Congress, 
I would again like to voice my frustration about the fact that the 
United States Senate failed to consider and pass important legislation 
this year that could have greatly benefited the American people. 
Unfortunately, the highway leading to adjournment is littered with 
legislation that should have been considered, passed and enacted long 
ago, including efforts to prevent teen smoking, modernize our public 
schools, and increase the minimum wage.
  I am particularly disappointed that my colleagues on the other side 
of the aisle prevented the United States Senate from considering 
managed care reform legislation. Yesterday, Senate Republicans even 
prevented us from proceeding to their own HMO reform bill. Time and 
again, the American people have said they want a comprehensive, 
enforceable Patients' Bill of Rights. Toward that goal, several of my 
Democratic colleagues and I introduced the Patients' Bill of Rights Act 
of 1998. That legislation addressed a growing concern among the 
American people about the quality of care delivered by health 
maintenance organizations. Despite enormous public support for HMO 
reform, Democratic efforts to consider the Patients' Bill of Rights 
were stymied at every turn.
  For months, it has been my intention to offer an amendment to the HMO 
reform legislation regarding a serious deficiency in veterans' access 
to emergency health care. I was prepared to do so yesterday. Since the 
Senate was again precluded from debating managed care reform, however, 
I would like to call attention to this matter before the 105th Congress 
adjourns by introducing the Veterans' Access to Emergency Health Care 
Act of 1998 as a separate bill. I hope my colleagues will

[[Page S12315]]

support this legislation when I introduce it again in the 106th 
Congress, when I am confident the United States Senate will finally 
have the opportunity to consider meaningful HMO reform legislation.
  The problem addressed in this bill stems from the fact that veterans 
who rely on the Department of Veterans Affairs (VA) for health care 
often do not receive reimbursement for emergency medical care they 
receive at non-VA facilities. According to the VA, veterans may only be 
reimbursed by the VA for emergency care at a non-VA facility that was 
not pre-authorized if all of the following criteria are met:
  First, care must have been rendered for a medical emergency of such 
nature that any delay would have been life-threatening; second, the VA 
or other federal facilities must not have been feasibly available; and, 
third, the treatment must have been rendered for a service-connected 
disability, a condition associated with a service-connected disability, 
or for any disability of a veteran who has a 100-percent service-
connected disability.
  Many veterans who receive emergency health care at non-VA facilities 
are able to meet the first two criteria. Unless they are 100-percent 
disabled, however, they generally fail to meet the third criterion 
because they have suffered heart attacks or other medical emergencies 
that were unrelated to their service-connected disabilities. 
Considering the enormous costs associated with emergency health care, 
current law has been financially and emotionally devastating to 
countless veterans with limited income and no other health insurance. 
The bottom line is that veterans are forced to pay for emergency care 
out of their own pockets until they can be stabilized and transferred 
to VA facilities.
  During medical emergencies, veterans often do not have a say about 
whether they should be taken to a VA or non-VA medical center. Even 
when they specifically ask to be taken to a VA facility, emergency 
medical personnel often transport them to a nearby hospital instead 
because it is the closest facility. In many emergencies, that is the 
only sound medical decision to make. It is simply unfair to penalize 
veterans for receiving emergency medical care at non-VA facilities. 
Veterans were asked to make enormous sacrifices for this county, and we 
should not turn our backs on them during their time of need.
  There should be no misunderstanding. This is a widespread problem 
that affects countless veterans in South Dakota and throughout the 
country. I would like to cite just three examples of veterans being 
denied reimbursement for emergency care at non-VA facilities in western 
South Dakota.
  The first involves Edward Sanders, who is a World War II veteran from 
Custer, South Dakota. On March 6, 1994, Edward was taken to the 
hospital in Custer because he was suffering chest pains. He was 
monitored for several hours before a doctor at the hospital called the 
VA Medical Center in Hot Springs and indicated that Edward was in need 
of emergency services. Although Edward asked repeatedly to be taken to 
a VA facility, he was transported by ambulance to Rapid City Regional 
Hospital, where he underwent a cardiac catheterization and coronary 
artery bypass grafting. Because the emergency did not meet the criteria 
I mentioned previously, the VA did not reimburse Edward for the care he 
received at Rapid City Regional. His medical bills totaled more than 
$50,000.
  On May 17, 1997, John Lind suffered a heart attack while he was at 
work. John is a Vietnam veteran exposed to Agent Orange who served his 
country for 14 years until he was discharged in 1981. John lives in 
Rapid City, South Dakota, and he points out that he would have asked to 
be taken to the VA Medical Center in Fort Meade for care, but he was 
semi-unconscious, and emergency medical personnel transported him to 
Rapid City Regional. After 4 days in the non-VA facility, John incurred 
nearly $20,000 in medical bills. Although he filed a claim with the VA 
for reimbursement, he was turned down because the emergency was not 
related to his service-connected disability.
  Just over one month later, Delmer Paulson, a veteran from Quinn, 
South Dakota, suffered a heart attack on June 26, 1997. Since he had no 
other health care insurance, he asked to be taken to the VA Medical 
Center in Fort Meade. Again, despite his request, the emergency medical 
personnel transported him to Rapid City Regional. Even though Delmer 
was there for just over a day before being transferred to Fort Meade, 
he was charged with almost a $20,000 medical bill. Again, the VA 
refused to reimburse Delmer for the unauthorized medical care because 
the emergency did not meet VA criteria.
  The Veterans' Access to Emergency Health Care Act of 1998, which I am 
introducing today, would address this serious problem. It would 
authorize the VA to reimburse veterans enrolled in the VA health care 
system for the cost of emergency care or services received in non-VA 
facilities when there is ``a serious threat to the life or health of a 
veteran.'' Rep. Lane Evans has introduced identical legislation in 
House of Representatives.
  Although I am extremely disappointed that the United States Senate 
did not debate meaningful managed care reform legislation this year, I 
am hopeful the American people will continue to urge their elected 
representatives to pass a comprehensive, enforceable Patients' Bill of 
Rights early next year. I am equally hopeful that any meaningful HMO 
reform legislation will address this serious deficiency in veterans' 
access to emergency health care. I look forward to continuing to work 
with my colleagues on both sides of the aisle to ensure that veterans 
receive the health care they deserve.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 2619

       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' Access to 
     Emergency Care Act of 1998''.

     SEC. 2. DEPARTMENT OF VETERANS AFFAIRS ENROLLMENT SYSTEM 
                   DECLARED TO BE A HEALTH CARE PLAN.

       Section 1705 of title 38, United States Code, is amended by 
     adding at the end the following new subsection:
       ``(d) The enrollment system under subsection (a) is a 
     health care plan, and the veterans enrolled in that system 
     are enrollees and participants in a health care plan.''.

     SEC. 3. EMERGENCY HEALTH CARE IN NON-DEPARTMENT OF VETERANS 
                   AFFAIRS FACILITIES FOR ENROLLED VETERANS.

       (a) Contract Care.--Section 1703(a)(3) of title 38, United 
     States Code, is amended by inserting ``who is enrolled under 
     section 1705 of this title or who is'' after ``health of a 
     veteran''.
       (b) Definition of Medical Services.--Section 1701(6) of 
     such title is amended--
       (1) by striking out ``and'' at the end of subparagraph (A);
       (2) by striking out the period at the end of subparagraph 
     (B) and inserting in lieu thereof ``; and''; and
       (3) by inserting after subparagraph (B) the following new 
     subparagraph:
       ``(C) emergency care, or reimbursement for such care, as 
     described in sections 1703(a)(3) and 1728(a)(2)(E) of this 
     title.''.
       (c) Reimbursement of Expenses for Emergency Care.--Section 
     1728(a)(2) of such title is amended--
       (1) by striking out ``or'' before ``(D)''; and
       (2) by inserting before the semicolon at the end the 
     following: ``, or (E) for any medical emergency which poses a 
     serious threat to the life or health of a veteran enrolled 
     under section 1705 of this title''.
       (d) Payment Priority.--Section 1705 of such title, as 
     amended by section 2, is further amended by adding at the end 
     the following new subsection:
       ``(e) The Secretary shall require in a contract under 
     section 1703(a)(3) of this title, and as a condition of 
     payment under section 1728(a)(2) of this title, that payment 
     by the Secretary for treatment under such contract, or under 
     such section, of a veteran enrolled under this section shall 
     be made only after any payment that may be made with respect 
     to such treatment under part A or part B of the Medicare 
     program and after any payment that may be made with respect 
     to such treatment by a third-party insurance provider.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply with respect to care or services provided on or 
     after the date of the enactment of this Act.
                                 ______