[Congressional Record Volume 147, Number 103 (Monday, July 23, 2001)]
[Senate]
[Pages S8067-S8068]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER:
  S. 1221. A bill to amend title 38, United States Code, to establish 
an additional basis for establishing the inability of veterans to 
defray expenses of necessary medical care, and for other purposes; to 
the Committee on Veterans' Affairs.
  Mr. SPECTER. Madam President, I have sought recognition at this time 
to comment briefly on legislation that I have introduced today to 
address an injustice now contained in statutory formulas which define 
which veterans will, and will not, be allowed priority access to free 
Department of Veterans Affairs, VA, health care services. To simplify, 
VA currently provides access to health care under the following 
priority scheme: veterans who have suffered service-connected 
disabilities have first opportunity to enroll for VA care; then, 
veterans who are former prisoners of war, those who are 
catastrophically disabled, and those who have no where else to turn for 
health care because of financial constraints may enroll for VA care; 
and, finally, veterans who simply choose to seek VA care even though 
they can afford care elsewhere, and, in testimony to the quality of 
care VA provides, many do, are invited to enroll. Currently, VA

[[Page S8068]]

welcomes all veterans to enroll for care, and VA generally turns away 
no veteran who seeks hospital or clinical care. But lower priority 
patients are required to make copayments for the care and the 
medications they receive from VA.
  As I have noted, poor veterans, technically, those who are classified 
as being ``unable to defray the expenses of necessary care,'' have 
priority over veterans who have nonservice-connected illnesses or 
disabilities. In order to determine who is, in fact, ``unable to 
defray,'' VA uses a single, national ``means test.'' In effect, a 
veteran without dependents who has an annual income of less than 
$23,688 has priority access to VA care at no charge; a veteran with a 
higher annual income who does not otherwise qualify for priority status 
is required to make a copayment to receive the same care. In addition, 
that patient is placed in the pool of ``discretionary'' patients who 
face the risk of disenrollment should VA budget shortfalls ever require 
limiting enrollment.
  A single, national ``means test'' applies irrespective of cost-of-
living variations among geographic localities. In many other Federal 
pay and benefits systems, by contrast, geographic cost-of-living 
variations are taken into consideration. For example, the housing 
allowance paid to active duty service members is based on the average 
housing costs in the area they are assigned; salary and wage payments 
to Federal employees, while utilizing national pay scales, also contain 
locality adjustments; and, benefits afforded to low income families by 
the Department of Housing and Urban Development, HUD, are based on 
median family income in the area in which the applicant resides. VA's 
``means test'' should also take such local cost-of-living variations 
into account. Today, I introduce legislation which would require VA to 
do so.
  My legislation would adjust VA's current ``means test'' to allow 
veterans who live in high-cost areas, such as Philadelphia, to qualify 
for priority status in VA hospitals even if their incomes are slightly 
higher than VA's single, national threshold amount. My bill would 
provide for an additional formula to measure a veteran's ``unable to 
defray'' status, the ``Low Income index'' established by HUD under the 
U.S. Housing Act of 1937. That index defines ``low income'' by 
reference to the median family income in the Metropolitan Statistical 
Area in which the applicant lives. Clearly, a formula which takes into 
account local variations in income, and, thus, the local cost of 
living, more fairly measures a veteran's actual ability to assist in 
defraying the cost of his or her medical care. I note, however, that 
the current VA formula would also be retained lest veteran-patients who 
live in relatively low cost areas lose priority status they might 
currently have under that formula. It is not my intention to shrink the 
pool of priority patients; it is my intention to expand it by allowing 
more low income persons, particularly the urban poor, to qualify.
  I ask my colleagues to join with me in improving VA's medical care 
priority ``means test'' so that it more accurately accomplishes its 
true purpose of measuring whether a veteran can, or cannot, be expected 
to assist in defraying the cost of his or her necessary medical care. 
Such a test, clearly, must take into account variations in the cost-of-
living in the locality in which the veteran resides.
  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. 1221

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

     SECTION 1. ADDITIONAL BASIS FOR ESTABLISHMENT OF INABILITY TO 
                   DEFRAY EXPENSES OF NECESSARY CARE.

       (a) Additional Basis.--Section 1722(a) of title 38, United 
     States Code, is amended--
       (1) in paragraph (2), by striking ``or'' at the end;
       (2) in paragraph (3), by striking the period at the end and 
     inserting ``; or''; and
       (3) by adding at the end the following new paragraph:
       ``(4) the veteran (including any applicable part of the 
     veteran's family) is eligible for treatment as a low-income 
     family under section 3 of the United States Housing Act of 
     1937 (42 U.S.C. 1437a) for the area in which the veteran 
     resides.''.
       (b) Applicability.--The amendments made by subsection (a) 
     shall take effect on January 1, 2002, and shall apply with 
     respect to years beginning after December 31, 2001.

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