[Congressional Record Volume 145, Number 68 (Wednesday, May 12, 1999)]
[Senate]
[Pages S5164-S5165]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DORGAN (for himself, Mr. Conrad, and Mr. Wellstone):
  S. 1022. A bill to authorize the appropriation of an additional 
$1,700,000,000 for fiscal year 2000 for health care for veterans; to 
the Committee on Veterans' Affairs.


               veterans emergency health care act of 1999

  Mr. DORGAN. Mr. President, this country made a promise years ago to 
the men and women who risked their lives in defense of this nation. 
They were promised that their health care needs would be provided for 
by a grateful nation. That promise is not being kept, and it is time to 
stop paying lip service to those who served this country so well.
  The current state of veterans' health care funding is shameful. 
Spending on veterans' health care has seen no significant increase for 
three consecutive years, at the very time that more and more of our 
World War II and Korean war veterans are relying on the VA health care 
system.
  In a memo to VA Secretary Togo West, Under Secretary for Health Dr. 
Kenneth Kizer expressed concern that a fourth year with a stagnant 
health care budget ``poses very serious financial challenges which can 
only be met if decisive and timely actions are taken.'' If increased 
funding is not secured even deeper cuts will be required such as 
``mandatory employee furloughs, severe curtailment of services or 
elimination of programs, and possible unnecessary facility closures.''
  Today, veterans' health care facilities are laying off care-givers 
and other critical staff.
  It is unlikely that the Senate will increase normal appropriations 
for veterans health care funding enough to correct three years of 
neglect. That is why Senator Conrad and I are proposing an additional 
$1.7 billion in emergency spending to address the health care needs of 
our country's veterans. We need to keep our promises to those who have 
served our country and risked their lives to preserve our freedoms. 
This bill is a step in the right direction.
  This legislation will help the Veterans' Administration keep up with 
medical inflation, provide cost of living adjustments for VA employees, 
allow new medical initiatives that the VA wants to begin (Hepatitis C 
screenings and emergency care services), address long-term health care 
costs, provide funding for homeless veterans, and aid compliance with 
the Patients Bill of Rights.
  In light of other emergency measures this Congress is considering, it 
is our opinion that preventing a health care catastrophe for our 
veterans is of equal, if not greater, importance than funding items 
like the NATO infrastructure fund and overseas military construction 
projects. Congress is debating right now, many new emergencies, new 
programs, and new initiatives. I'm not passing judgment on those 
decisions.
  What I am saying, is that because of insufficient funding, and 
unforeseen health care needs, we have an emergency right now, in our 
ability to honor our commitment to this nation's veterans. We must not 
break our promise.
  Mr. President, I urge my colleagues to swiftly approve this 
legislation. The veterans who proudly served their country deserve no 
less.
  Mr. CONRAD. Mr. President, I am very pleased to join my distinguished 
colleague from North Dakota, in introducing legislation to authorize 
$1.7 billion in emergency funding for FY 2000 Veterans Health 
Administration programs. Since the release of the Administration's FY 
2000 budget for the Department of Veterans Affairs, I have been deeply 
concerned by the level of funding--$17.3 billion--for the Veterans 
Health Administration.
  This concerned was heightened by comments in an internal memo by Dr. 
Kenneth Kizer, VA Undersecretary for Health, in February, regarding the 
FY 2000 veterans health care budget. In that memo, Dr. Kizer warned VA 
Secretary Togo West that the Administration budget for FY 2000 ``poses 
very serious challenges which can only be met if decisive and timely 
actions are taken.''
  Dr. Kizer went on the say that unless the VA acts soon, ``* * * we 
face the very real prospect of far more problematic decisions, e.g. 
mandatory employee furloughs, severe curtailment of services or 
elimination of programs and possible unnecessary facility closures''
  Indeed, Mr. President, I can confirm, that concern over VA health 
care funding in FY 2000, and the possibility of severe curtailment of 
services, and the furlough VA employees is a very real concern for 
North Dakota veterans and DVA officials at the Fargo VA Medical Center 
in North Dakota. Veterans health care funding in FY 2000, and the hope 
that funding can be authorized this year to under take critical 
environmental improvements at the Fargo DVA Medical Center are high 
priorities for North Dakota veterans. These key priorities were 
discussed during a visit

[[Page S5165]]

to the Fargo DVA Medical Center earlier this year, at my request, by 
Deputy Secretary Hershel Gober. In fact, so concerned are members of 
the Disabled American Veterans nationwide, including North Dakota 
members, about funding for VA medical programs, that a rally has been 
scheduled on May 30th at the Fargo DVA Medical Center to heighten 
public awareness of the FY 2000 budget for veterans medical care and to 
press for additional funds.
  Mr. President, over the past few months, Members of the Senate 
Committee on Veterans' Affairs and many of my colleagues have been 
working hard to increase funding for veterans medical care in FY 2000. 
I have strongly supported these efforts. During consideration of the FY 
2000 budget resolution in committee, and when the resolution was 
reported to the Senate for consideration, I voted to increase funding 
for VA medical care by $3 billion, the figure recommended in the FY 
2000 Independent Budget supported by the AMVETS, Disabled American 
Veterans, the Veterans of Foreign Wars, and the Paralyzed Veterans of 
America. House and Senate conferees eventually agreed to increase 
veterans health care funding by $1.66 billion in FY 2000. Most 
recently, I cosigned a letter to Members of the Senate Appropriations 
Committee urging the committee to provide $1.7 billion above the 
administration's request for the Veterans Health Administration. 
Although Senate appropriators have not made a decision on how much to 
increase funding for veterans medical care, initial reports for a 
significant increase are not encouraging.
  Because of concerns that the FY 2000 appropriations for veterans 
health are not expected to be adequate, and may result in unnecessary 
furloughs and disruptions of health care services for veterans, Senator 
Dorgan and I are introducing legislation to provide an emergency 
authorization of $1.7 billion in funding above the administration's 
request for $17.3 billion for the Veterans Health Administration. This 
figure also represents the level of additional health care funding 
recommended for the VA to Senate appropriators by Senate Veterans' 
Committee Chairman Arlen Specter and Ranking Member John D. 
Rockefeller. We must make every effort to find these emergency FY 2000 
funds for veterans medical care, and to include them in appropriate 
legislation to avoid disruptions in critical health care. We can do no 
less for our veterans.
  Mr. President, I ask unanimous consent that additional material be 
printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:


                               Department of Veterans Affairs,

     Date: Feb. 8, 1999
     From: Under Secretary for Health (10)
     Subj: FY 99/2000 VHA Budget
     To: Secretary (00)
       1. As you know, current VHA program projections indicate 
     that the FY 99 budget is adequate to meet demands. However, 
     the President's FY 2000 requested budget, and especially the 
     1.4 billion of management efficiencies, pose very serious 
     financial challenges which can be met only if decisive and 
     timely actions are taken.
       2. Strategic planning initiatives undertaken by VHA 
     networks over the past year are culminating in 
     recommendations for a variety of program adjustments, 
     including facility integrations, bed reductions, program 
     consolidations and mission changes, which reflect necessary 
     shifts in patient care service delivery and practices.
       3. In most cases, these changes are, or will be, 
     accompanied by requests for reductions-in-force and staffing 
     adjustments which will better configure our workforce to meet 
     the changing needs of our patients and programs. While 
     difficult, these changes are absolutely essential if we are 
     to prepare ourselves for the limitations inherent in the 
     proposed FY 2000 budget.
       4. Please know that I believe we are in a serious and 
     precarious situation and that if we do not institute these 
     difficult changes in a timely manner, then we face the very 
     real prospect or far more problematic decisions, e.g., 
     mandatory employee furloughs, severe curtailment of services 
     or elimination of programs, and possible unnecessary facility 
     closures.
       5. In short, the earlier we act in this fiscal year to take 
     the necessary steps to position ourselves for next year's 
     budget, the less likely we will be to face far more drastic 
     and untenable actions in FY 2000.
       6. I therefore request that we quickly establish a protocol 
     for rapidly processing requests for actions to right-size the 
     VHA healthcare system. Such a process should identify 
     specific steps and associated timelines for assessing such 
     requests, ensuring proper Congressional notification and 
     issuing approval so that implementation actions can begin.
       7. Again, I cannot overstate the need for timely action so 
     as to avoid far more severe actions in the next fiscal year. 
     I am prepared to discuss this with you at your convenience.
     Kenneth W. Kizer, MD., M.P.H.
                                  ____


              Administrators Warn of VA Hospital Closings

       (By Katherine Rizzo, Associated Press, February 25, 1999)

       Washington (AP)--Veterans' hospitals may have to reduce 
     staff and services next year unless Congress comes up with 
     more money than the president has proposed, say 
     administrators and interest groups.
       ``When your drug costs go up 15 percent a year and employee 
     salaries go up 4 percent a year and our employees are 70 
     percent of our budget, at some point there are choices that 
     have to be made,'' said Laura Miller, who oversees hospitals 
     in Ohio and northern Kentucky.
       ``Administering this budget would be like trying to build a 
     house of cards in an Oklahoma tornado,'' added recently 
     retired Veterans Health Administration official Tom Trujillo.
       Trujillo, Miller and other administrators appeared before 
     the House Veterans' Affairs subcommittee on health Wednesday 
     to answer lawmakers' questions about a spending request that 
     all present deemed was insufficient.
       Miller said the no-growth budget proposal has her bracing 
     for a cut of 200 positions next year, most likely achieved by 
     closing hospital wards and suspending plans for new 
     outpatient clinics.
       Other administrators said they either expected to reduce 
     staff in 2000 or had requests pending to start reducing staff 
     this year.
       James Farsetta, director of the VA region that operates 
     seven medical centers in New Jersey and southern New York, 
     said he has already submitted a request to eliminate 400 
     jobs.
       William Galey, who oversees services in Alaska, Washington, 
     Oregon and Idaho, told the subcommittee he's considering 
     staff reductions of anywhere from 300 to 800.
       Veterans groups offered their own denunciations.
       ``It is unfair that in the presence of the largest budget 
     surplus in recent history, while other federal agencies will 
     have double-digit increases, veterans are being asked to once 
     again sacrifice,'' said the Veterans of Foreign Wars.
       The Paralyzed Veterans of America accused the Clinton 
     administration of crafting a budget that kills the VA health 
     system ``through intentional budget strangulation.''
       ``Nobody on either side of the aisle likes this budget,'' 
     said Rep. Mike Doyle, D-Pa. ``I don't know how we can flat-
     line a budget from 1997 to 2002 and not expect the system to 
     collapse.''
       Deputy Under Secretary for Health Thomas Garthwaite said 
     the administration was aware of ``significant financial 
     challenges ahead'' but that plans still was being made to 
     prepare for the possibility that Congress might not add money 
     to the administration's spending request.
       The veterans' organizations made public an internal 
     Department of Veterans Affairs memo written by Under 
     Secretary Kenneth Kizer, who heads the hospital system.
       ``I believe we are in a serious and precarious situation 
     and that if we do not institute these difficult changes in a 
     timely manner, then we face the very real prospect of far 
     more problematic decisions, e.g. mandatory employee 
     furloughs, severe curtailment of services or elimination of 
     programs, and possible unnecessary facility closures,'' Kizer 
     wrote.
       The veterans' groups did not say how they obtained the 
     memo, but Garthwaite did not dispute its authenticity. He 
     said he believed it was intended to outline the importance of 
     moving quickly because ``it will cost more later if we don't 
     take the administrative actions early.''
                                 ______