[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regulations should be rescinded.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.

----------------------------------------------------------------------------------------------------------------
                                                                                       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
----------------------------------------------------------------------------------------------------------------
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
                                                     -----------------------------------------------------------
      Totals........................................                       132,278                       177,976
----------------------------------------------------------------------------------------------------------------

       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.

                          ____________________