[Congressional Record Volume 148, Number 118 (Wednesday, September 18, 2002)]
[Senate]
[Pages S8747-S8749]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
NEW ADMINISTRATION REGULATIONS TO CUT SERVICES TO VETERANS
Mr. ROCKEFELLER. Mr. President, I rise today to speak about the
latest action by the Administration to cut services to veterans.
For years when we looked at the health care budget, we focused on the
declining veteran population and declining demand. We are in a totally
different predicament today. More veterans are turning to the VA health
care system, and that is a success story. In recent months, however,
unacceptably long waiting times for care have materialized. Cutting
services to veterans who now depend more upon VA, is a perverse
reaction to the problem.
In 1996, Congress enacted eligibility reform which allowed all
veterans to come to the VA health care system. At the time, I spoke
about the dilemma that we would face in opening up the doors and
providing a rich benefit package and how, down the road, we would have
to face the consequences.
In my view, the administration has a choice: Either own up to the
demand for health care services and provide funding--my preference--or
manage enrollment. The administration has chosen a completely different
course.
In its budget request, the administration proposed charging a $1,500
deductible to higher-income veterans as a means to ``reduce demand.''
In July, VA issued a mandate prohibiting all enrollment-generating
activities, such as health fairs. Yesterday, regulations
[[Page S8748]]
were issued to require VA to give priority for health care services to
veterans with service-connected conditions. No veteran who is enrolled
with VA for health care should have to endure long waiting times for
care.
The administration's latest action changes the way veterans access
health care services, and in doing so, not only circumvents current law
regarding eligibility for care, but will also create serious hardship
for hundreds of thousands of veterans who depend upon VA. These
regulations should be rescinded. Today, several other Senators and I
wrote to the President and asked that he do so.
These regulations will almost certainly increase--rather than
decrease--the waiting times facing hundreds of thousands of veterans.
Let me repeat that: The recent regulations will do nothing for the more
than 300,000 veterans waiting to be seen by VA clinicians, and in fact,
the new priority system could more than double the time they are forced
to wait for care. I ask unanimous consent that VA's list of waiting
times be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Survey conducted July 1, 2002.
Data was gathered from multiple clinics at all VA
facilities. The data sources included Excel spreadsheets and
manual lists as well as the scheduling package for those
waiting 6 months or greater for an appointment. Because the
survey was derived primarily from manual data collection,
patients waiting at more than one site may be counted more
than once; the data could also reflect the same patient
waiting for multiple clinics at one specific site. Therefore,
the data should be viewed as an indicator of an overall
problem. We are working on automating the wait list to ensure
more accurate reporting.
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B Number of established
patients waiting to be
scheduled for follow-up
A Number of new enrollees primary care or specialty
Veterans integrated service network waiting for first clinic care clinic appointments and
appointment to be scheduled new and established patients
with appointments scheduled
electronically, although the
wait is 6 months or greater
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1................................................... 9,891 12,130
2................................................... 460 1,844
3................................................... 82 2,448
4................................................... 18,535 8,061
5................................................... 0 217
6................................................... 0 29,124
7................................................... 4,662 3,299
8................................................... 31,469 22,474
9................................................... 11,093 7,887
10.................................................. 13 1,239
11.................................................. 1,172 2,562
12.................................................. 8,922 9,424
15.................................................. 1,283 6,616
16.................................................. 5,490 8,126
17.................................................. 1,874 17,444
18.................................................. 0 4,471
19.................................................. 8,230 9,342
20.................................................. 8,891 15,702
21.................................................. 1,013 5,015
22.................................................. 0 3,810
23.................................................. 19,198 6,471
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Totals........................................ 132,278 177,976
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Col A: Number of new enrollees waiting for first
appointment where an appointment has not been scheduled.
Represents a manual count of Veterans who have enrolled and
requested an appointment but the Veteran's preferred site of
care cannot schedule the appointment within six months.
Therefore, the veteran is placed on a wait list. An
electronic wait list is being developed that will allow for
more accurate data collection.
Col B: Number of established patients on a wait list or new
and established patients scheduled for appointments requiring
a wait of 6 months or more. Includes: (1) a manual count of
established patients (patients have been seen at least once)
who are on a wait list (cannot be scheduled within 6 months)
for follow-up care for a Primary Care Clinic or Specialty
Care Clinic visit. (Examples would include veterans waiting
for reassignment to a new Primary Care Provider, or patients
waiting for consults in Specialty Care Clinics.) Also
includes (2) a count of Veterans scheduled electronically for
appointments, however the wait time meets or exceeds six
months. (This also includes those patients who have either
voluntarily canceled their appointments or had their
appointment canceled by the VA.)
Note: This data includes approximately 80 percent of VHA's
workload. All Primary Care Clinics are included and 5 major
Specialty Care Clinics (eye, urology, cardiology,
orthopedics, audiology). The electronic wait list capability
will allow for additional clinics to be included.
Mr. ROCKEFELLER. The Paralyzed Veterans of America, too, is very
concerned about these new regulations, as the new system ``completely
ignore[s] the other key missions of the VA health care system to care
for the poor and medically indigent and those veterans with special
disabilities such as spinal cord dysfunction, blindness, and mental
illness.'' I ask unanimous consent that the full text of PVA's letter
be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Paralyzed Veterans of America,
Washington, DC, September 13, 2002.
Hon. John D. Rockefeller, IV,
Chairman, Committee on Veterans' Affairs, U.S. Senate,
Washington, DC.
Dear Chairman Rockefeller: On behalf of the Paralyzed
Veterans of America (PVA), I am writing to express our grave
concerns over the attempts by the Department of Veterans
Affairs (VA) to move forward with an interim final rule that
has insufficient statutory grounding.
VA Secretary Anthony Principi has proposed an interim final
rule dispensing with notice-and-comment requirements under
the Administrative Procedures Act. These fast track
regulations dramatically alter existing eligibility for VA
health care services. Faced with woefully inadequate funding
requests from the Bush Administration and the Congress for
the veterans' health care system, the new regulations would
give hospital administrators the authority to ration care by
establishing a priority for treatment for certain veterans
with service connected disabilities. Veterans with service
connected disabilities rated 50 percent and above and
veterans seeking care for their service connected
disabilities would get access to treatment before any other
veteran is served. No one can argue that service-connected
disabled veterans do not deserve the highest priority for
veterans benefits and services. However, by allowing
admitting clerks to give them front-of-the-line access, the
regulations inherently give these same clerks the authority
to deny care to veterans in other categories when budgets
remain tight. This is the real intent of the proposed
regulations, and we believe, contrary to VA opinions, that
the VA lacks the statutory authority to deny care to higher-
priority veterans in lieu of the Secretary's granted
authority to disenroll lower-priority veterans.
PVA, along with every other major veterans service
organization worked for nearly a decade to enact legislation
that would standardize veterans' eligibility for health care
services. Prior to enactment of eligibility reform
legislation in 1996, access to health care services was
governed by a fragmented bureaucratic tangle of regulations
governed primarily by fiscal considerations. Some veterans
could get some services; some veterans could get others but
only under certain circumstances and under certain conditions
governed in part by veteran status, not health care need. The
veterans organizations argued that such a system was unfair,
did not provide the optimal health care services needed by
veterans, was a bureaucratic nightmare and, more importantly,
was medically unethical.
Eligibility reform legislation brought simplicity to the
process. Veterans would be enrolled in the system based on
veterans status and economic need in seven categories. Once
enrolled, each veteran was entitled to the complete VA health
benefits package on an
[[Page S8749]]
equal basis. This was not only good policy; it was good
medicine. Veterans with service-connected disabilities were
included in the highest enrollment categories to ensure
complete and speedy access to the system. In fact, because of
their service-connected disabilities they were even exempted
from enrollment requirements. If these high-priority veterans
are having difficulty accessing VA health care now, as the
Secretary has stated, then the problem lies in the inability
of the Administration to fund the VA properly and the
incompetence of VA admitting clerks who ignore current
eligibility law and the high priority these veterans already
have. Both of these problems should be rectified without the
institution of new regulations. The $275 million in emergency
supplemental funding that the White House refused to allocate
to the VA last month could have gone a long way to ease the
burden on the system. The re-characterization of health care
access in the proposed regulations is a major step backward
toward the chaos that existed in the pre-eligibility reform
days.
There is no question that the VA is grossly overburdened. A
product of its own success, the system, because of the
quality and accessibility of the health care services it
provides, has attracted unprecedented numbers of new veteran
users. While eligibility reform has been blamed for opening
the gates to the system, the real cause of this influx of
patients are the new health care markets VA has established
by opening 800 outpatient clinics across the country. Among
other factors are a private health insurance system that is
pricing itself out of reach of most Americans and a Medicare
plan that ignores the need for a quality prescription drug
benefit for seniors and people with disabilities.
VA is pulling in the reins, attempting to ration care and
dissuade veterans from coming into the system. These new
regulations are only one attempt. We are certain to see other
proposals in the months ahead. But if we go down the road of
pitting one group of veterans in the health care queue
against other groups of veterans where does it stop? These
regulations completely ignore the other key missions of the
VA health care system to care for the poor and medically
indigent and those veterans with special disabilities such as
spinal cord dysfunction, blindness and mental illness. With
these regulations in place a hospital administrator could
logically ignore these responsibilities as well in
contravention of direct statutory requirements.
Finally, we seriously question the VA's opinion that is has
sufficient authority under existing statutes to move forward
with these interim final rules. The VA's sophistical argument
ignores the plain language of the statute providing the VA
limited flexibility in managing the enrollment system
established by Congress in 1996.
All in all, we do not see why veterans should be denied an
accessible, quality health care product just because it is
unattainable or unaffordable elsewhere, and the
Administration and the Congress do not want to come up with
the dollars to fund it adequately.
Sincerely,
Delatorro L. McNeil,
Executive Director.
Mr. ROCKEFELLER. Finally, Mr. President, we have seen a rush by the
Administration to implement these new regulations, without the normal
comment period for Congress, veterans, or veterans advocates to make
their views known. I believe VA's finding, that it has ``good cause''
to dispense with a normal notice-and-comment period, is without factual
merit. If an emergency situation exists, the Administration could have
surely provided the $270 million in additional funds which Congress
already appropriated to deal with the unacceptably long waiting times.
We must work together to find a better solution for veterans and
these regulations must be rescinded to protect access to care for all
veterans.
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