[Congressional Record Volume 147, Number 115 (Thursday, September 6, 2001)]
[Senate]
[Pages S9198-S9199]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER:
  S. 1408. A bill to amend title 38, United States Code, to standardize 
the income threshold for copayment for outpatient medications with the 
income threshold for inability to defray necessary expense of care, and 
for other purposes; to the Committee on Veterans' Affairs.
  Mr. ROCKEFELLER. Mr. President, I am pleased to introduce today 
legislation that would exempt certain veterans from copayments for 
needed prescription drugs.
  Currently, veterans with incomes of less than $24,000 a year are 
exempt from copayments for most VA health care services. However, when 
it comes to prescription drugs, the income threshold for exemption is 
just $9,000 a

[[Page S9199]]

year. Veterans earning over $9,000, well below the poverty threshold 
established by the Census Bureau, are required to make copayments. 
These copayments place an undue burden on our poorest veterans. To 
compound the problem, the Department of Veterans Affairs recently 
proposed increasing the copayment for prescription drugs from $2 to $7 
per 30-day prescription.
  I have serious concerns about what this copayment increase will mean 
for veterans. Indeed, I have already heard from a number of veterans 
whose incomes hover just above the $9,000 threshold, who must make the 
required copayments for their pharmaceuticals. Many of them are on 
several different medications for multiple medical conditions, each 
requiring their own copay. There are many veterans like Steven Smith, 
formerly of Greenwood, WV, who has no health insurance except Medicare 
and depends upon the VA for his medications. With the lack of a 
Medicare drug benefit, he, and many veterans like him, are faced with a 
350 percent increase in what they must pay for life-sustaining 
medications.
  I am not alone in my concerns about the impact the copayment increase 
will have on veterans. In commenting on the proposed regulations, the 
VFW recently cited an example of a veteran who has an annual income of 
$10,500, just above the current exemption limit set by VA. The increase 
in the prescription copayment rate would force that veteran to allocate 
over 8 percent of his annual income just to prescription drugs. There 
is a grave danger that, faced with this situation, many veterans will 
stop seeking necessary medical care because they are priced out of the 
system.
  At a glance, the increase to $7 per prescription may seem reasonable 
enough and in keeping with industry standards. However, consider a 
veteran with an income of about $9,000 a year who currently pays $2 per 
prescription for 10 medications a month. He presently incurs out-of-
pocket costs of $240 a year. Under the new regulations, his costs would 
go up to $840 per year, an increase of $600. For someone living barely 
over the $9,000 annual income threshold, this is a substantial sum.
  I am also concerned about disparities in how VA defines who is 
``poor'' for the purpose of exemption from health care copayments. For 
prescription drugs, veterans with more than $9,000 annual income must 
make copayments, but for outpatient care, hospitalization, and extended 
care, the income threshold for copayments is $24,000 per year. My 
proposed legislation would raise the exemption level for prescription 
copays to make them the same as all other VA health care copays. It 
will be less confusing to veterans, easier to administer, and quite 
simply, it's the right thing to do.
  My legislation, the Veterans' Copayment Adjustment Act, would also 
require VA to delay implementing the increase in prescription 
copayments until we see an adjustment to copayments for other health 
care services. On July 24, I held a hearing on prescription drug issues 
in VA. At that hearing, we heard testimony from VA Secretary Anthony 
Principi who also believes that new drug copayments shouldn't be put 
into effect until we see a reduction in other health care copayments.
  As part of the Veterans Millennium Health Care and Benefits Act, 
Congress gave VA authority to adjust the different health care 
copayments. This was intended to make VA's copayments more rational. 
Currently, veterans must make a copayment of over $50 for outpatient 
care services. There is no doubt that $50 for a routine outpatient 
visit is unreasonable at best, and at worst, discourages veterans from 
getting the primary care they need. By delaying the increase in the 
medication copayment until VA implements its adjusted outpatient 
copayment, we will reduce the negative financial impact on our Nation's 
veterans. I am confident that VA will study this issue closely and will 
expeditiously set the outpatient copayment to be more in line with 
managed care plans.
  I urge my Senate colleagues to join me in seeking to provide 
affordable health care for our sick and disabled veterans. They have 
sacrificed for all of us, and deserve every effort we can make to keep 
them from having to choose between buying needed prescription drugs and 
putting food on the table.
  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. 1408

       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' Copyament 
     Adjustment Act''.

     SEC. 2. STANDARDIZATION OF INCOME THRESHOLDS FOR COPAYMENT 
                   FOR OUTPATIENT MEDICATIONS AND FOR INABILITY TO 
                   DEFRAY NECESSARY EXPENSES OF CARE.

       (a) Standardization.--Section 1722A(a)(3)(B) of title 38, 
     United States Code, is amended to read as follows:
         ``(B) to a veteran whose attributable income is not 
     greater than the amount provided for in subsection (b) of 
     section 1722 of this title, as adjusted from time to time 
     under subsection (c) of that section.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on January 1, 2002, and shall apply with 
     respect to calendar years beginning on or after that date.

     SEC. 3. LIMITATION ON IMPLEMENTATION OF INCREASE IN 
                   COPAYMENTS FOR OUTPATIENT MEDICATIONS PENDING 
                   COLLECTION OF COPAYMENTS FOR OUTPATIENT CARE.

       Notwithstanding any other provision of law, the Secretary 
     of Veterans Affairs may not implement under section 
     1722A(b)(1) of title 38, United States Code, an increase in 
     the copayment amount for medications furnished on an 
     outpatient basis under section 1722A(a) of that title until 
     the Secretary commences collection of amounts for outpatient 
     visits for medical services under section 1710(g) of that 
     title.
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