[Congressional Record Volume 145, Number 78 (Thursday, May 27, 1999)]
[Senate]
[Pages S6289-S6291]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DASCHLE (for himself and Mr. Rockefeller):
  S. 1146. 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 care act of 1999

  Mr. DASCHLE. Mr. President, the American people continue to say they 
want a comprehensive, enforceable Patients' Bill of Rights. Toward that 
goal, several of my Democratic colleagues and I introduced S. 6, the 
Patients' Bill of Rights Act of 1999, earlier this year. That 
legislation, which we first introduced in the 105th Congress, addresses 
the growing concerns among Americans about the quality of care 
delivered by health maintenance organizations. I am disappointed that 
some of my colleagues on the other side of the aisle prevented the 
Senate from considering managed care reform legislation last year. But 
I remain hopeful that the Republican leadership will allow an open and 
honest debate on this important issue this year.
  I am hopeful that my colleagues will also take a moment to listen to 
veterans in this country who are raising legitimate concerns about the 
medical care they receive from the Department of Veterans Affairs (VA). 
Many veterans are understandably concerned that the Administration 
requested approximately $18 billion for VA health care in FY00--almost 
the same amount it requested last year. They fear that if this flat-
lined budget is enacted, the VA would be forced to make significant 
reductions in personnel, health care services and facilities. I share 
their concerns and agree that we simply cannot allow that to happen. On 
the contrary, Congress and the Administration need to work together to 
provide the funds necessary to improve the health care that veterans 
receive.
  Toward that end, and as we prepare to celebrate Memorial Day, I am 
reintroducing the Veterans' Access to Emergency Care Act of 1999. I am 
pleased that Senator Rockefeller, the distinguished Ranking Member of 
the Senate Veterans' Affairs Committee, is joining me in this effort. 
This legislation, which was S. 2619 last year, calls for veterans to be 
reimbursed for emergency care they receive at non-VA facilities.
  The problem addressed in the bill stems from the fact that veterans 
who rely on the 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 country, 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 to be taken to a VA 
facility, VA officials advised him to seek care elsewhere. He was then 
transported by ambulance to the 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-conscious, 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 Care Act of 1999 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 introduced

[[Page S6290]]

similar legislation in the House of Representatives earlier this year. 
I am encouraged that the Administration's FY00 budget request includes 
a proposal to allow veterans with service-connected disabilities to be 
reimbursed by the VA for emergency care they receive at non-VA 
facilities. This is a step in the right direction, but I think that all 
veterans enrolled in the VA's health care system--whether or not they 
have a service-connected disability--should be able to receive 
emergency care at non-VA facilities. I look forward to continuing to 
work with Senator Rockefeller and 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. 1146

       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 1999''.

     SEC. 2. EMERGENCY HEALTH CARE IN NON-DEPARTMENT OF VETERANS 
                   AFFAIRS FACILITIES FOR ENROLLED VETERANS.

       (a) Definitions.--Section 1701 of title 38, United States 
     Code, is amended--
       (1) in paragraph (6)--
       (A) by striking ``and'' at the end of subparagraph (A);
       (B) by striking the period at the end of subparagraph (B) 
     and inserting ``; and''; and
       (C) 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.''; and
       (2) by adding at the end the following new paragraph:
       ``(10) The term `emergency medical condition' means a 
     medical condition manifesting itself by acute symptoms of 
     sufficient severity (including severe pain) such that a 
     prudent layperson, who possesses an average knowledge of 
     health and medicine, could reasonably expect the absence of 
     immediate medical attention to result in--
       ``(A) placing the health of the individual (or, with 
     respect to a pregnant woman, the health of the woman or her 
     unborn child) in serious jeopardy;
       ``(B) serious impairment to bodily functions; or
       ``(C) serious dysfunction of any bodily organ or part.''.
       (b) Contract Care.--Section 1703(a)(3) of such title is 
     amended by striking ``medical emergencies'' and all that 
     follows through ``health of a veteran'' and inserting ``an 
     emergency medical condition of a veteran who is enrolled 
     under section 1705 of this title or who is''.
       (c) Reimbursement of Expenses for Emergency Care.--Section 
     1728(a)(2) of such title is amended--
       (1) by striking ``or'' before ``(D)''; and
       (2) by inserting before the semicolon at the end the 
     following: ``, or (E) for any emergency medical condition of 
     a veteran enrolled under section 1705 of this title''.
       (d) Payment Priority.--Section 1705 of such title is 
     amended by adding at the end the following new subsection:
       ``(d) 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.

  Mr. ROCKEFELLER. Mr. President, I am pleased to offer my support to 
the Veterans' Access to Emergency Care Act of 1999. This bill will 
authorize VA to cover emergency care at non-Department of Veterans 
Affairs (VA) facilities for those veterans who have enrolled with VA 
for their health care. I join my colleague, Senator Daschle, in 
cosponsoring this valuable initiative and thank him for his leadership.
  Currently, VA is restricted by law from authorizing payment of 
comprehensive emergency care services in non-VA facilities except to 
veterans with special eligibility. Most veterans must rely on other 
insurance or pay out of pocket for emergency services.
  I remind my colleagues that VA provides a standard benefits package 
for all veterans who are enrolled with the VA for their health care. In 
many ways, this is a very generous package, which includes such things 
as pharmaceuticals. Enrolled veterans are, however, missing out on one 
essential part of health care coverage: the standard benefits package 
does not allow for comprehensive emergency care. So, in effect, we are 
asking veterans to choose VA health care, but leaving them out in the 
cold when it comes to emergency care.
  Mr. President, we have left too many veterans out in the cold 
already. When veterans call their VA health care provider in the middle 
of the night, many reach a telephone recording. This recording likely 
urges that veterans who have emergencies dial ``911.'' Veterans who 
call for help are then transported to non-VA facilities. After the 
emergency is over, veterans are presented with huge bills. These are 
bills which VA cannot, in most cases, pay and which are, therefore, 
potentially financially crushing. We cannot abandon these veterans in 
their time of need.
  Let me tell my colleagues about some of the problems that veterans 
face because of the restriction on emergency care. In January of this 
year, a low income, non-service-connected, World War II veteran with a 
history of heart problems, from my State of West Virginia, presented to 
the nearest non-VA hospital with severe chest pain. In an attempt to 
get the veteran admitted to the VA medical center, the private 
physician placed calls to the Clarksburg VA Medical Center, where the 
veteran was enrolled, on three separate occasions, over the course of 
three days. The response was always the same--``no beds available.''
  Ultimately, a different VA medical center, from outside the veteran's 
service area, accepted the patient, and two days later transferred him 
back to the Clarksburg VA Medical Center where he underwent an 
emergency surgical procedure to resolve the problem. By this time, 
however, complications had set in, and the veteran was critically ill.
  The veteran's wife told me that ``no one should have to endure the 
pain and suffering'' they had to endure over a five-day period to get 
the emergency care her husband needed. But in addition to that 
emotional distress, the veteran now also faces a medical bill of almost 
$800 at the private hospital, the net amount due after Medicare paid 
its portion. This is an incredible burden for a veteran and his wife 
whose sole income are their small Social Security checks.
  In another example from my state, in February 1998, a 100 percent 
service-connected veteran with post-traumatic stress disorder suffered 
an acute onset of mid-sternal chest pain, and an ambulance was called. 
The ambulance took him to the nearest hospital, a non-VA facility. 
Staff at the private facility contacted the Clarksburg VA Medical 
Center and was told there were no ICU beds available and advised 
transferring the patient to the Pittsburgh VA Medical Center.
  When contacted, Pittsburgh refused the patient because of the length 
of necessary transport. A call to the Beckley VAMC was also fruitless. 
The doctor was advised by VA staff that the trip to Beckley would be 
``too risky for the three hour ambulance travel.''
  The veteran was kept overnight at the private hospital for 
observation, and then was billed for the care--$900, after Medicare 
paid its share.
  Two more West Virginia cases quickly come to mind involving 100 
percent service-connected combat veterans, both of whom had to turn to 
the private sector in emergency situations.
  One veteran had a heart attack and as I recall, his heart stopped 
twice before the ambulance got him to the closest non-VA hospital. The 
Huntington VA Medical Center was his health care provider and it was 
more than an hour away from the veteran's home. This veteran had 
Medicare, but he was still left with a sizeable medical bill for the 
emergency services that saved his life.
  The other veteran suffered a fall that rendered him unconscious and 
caused considerable physical damage. He also was taken to the closest 
non-VA hospital--and was left with a $4,000 bill after Medicare paid 
its share.
  Both contacted me to complain about the unfairness of these bills. As 
100 percent service-connected veterans, they rely totally on VA for 
their health care. I can assure you that neither of them, nor the other 
two West Virginia veterans I referred to, ever expected to be in the 
situation in which they all

[[Page S6291]]

suddenly found themselves--strapped with large health care bills 
because they needed emergency treatment in life-threatening situations, 
when they were miles and miles from the nearest VA medical center.
  Coverage of emergency care services for all veterans is supported by 
the consortium of veterans services organizations that authored the 
Independent Budget for Fiscal Year 2000--AMVETS, the Disabled American 
Veterans, the Paralyzed Veterans of America, and the Veterans of 
Foreign Wars. The concept is also included in the Administration's FY 
2000 budget request for VA and the Consumer Bill of Rights, which 
President Clinton has directed every federal agency engaged in managing 
or delivering health care to adopt.
  To quote from the Consumer Bill of Rights, ``Consumers have the right 
to access emergency health care services when and where the need 
arises. Health plans should provide payment when a consumer presents to 
an emergency department with acute symptoms of sufficient severity--
including severe pain--such that a 'prudent layperson' could reasonably 
expect the absence of medical attention to result in placing their 
health in serious jeopardy, serious impairment to bodily functions, or 
serious dysfunction of any bodily organ or part.'' This ``prudent 
layperson'' standard is included in the Veterans' Access to Emergency 
Care Services Act of 1999 and is intended to protect both the veteran 
and the VA.
  To my colleagues who would argue that this expansion of benefits is 
something which the VA cannot afford, I would say that denying veterans 
access to care should not be the way to balance our budget. The Budget 
Resolution includes an additional $1.7 billion for VA. I call on the 
appropriators to ensure that this funding makes its way to VA hospitals 
and clinics across the country.
  Truly, approval of the Veterans' Access to Emergency Services Act of 
1999 would ensure appropriate access to emergency medical services. 
Thus, we would be providing our nation's veterans greater continuity of 
care.
  Mr. President, veterans currently have the opportunity to come to VA 
facilities for their care, but they lack coverage for the one of the 
most important health care services. I look forward to working with my 
colleagues on the House and Senate Committees on Veterans' Affairs to 
make this proposal a reality.
                                 ______