[Congressional Record Volume 155, Number 27 (Tuesday, February 10, 2009)]
[Senate]
[Pages S2080-S2081]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. AKAKA (for himself and Mr. Burris):
  S. 404. A bill to amend title 38, United States Code, to expand 
veteran eligibility for reimbursement by the Secretary of Veterans 
Affairs for emergency treatment furnished in a non-Department facility, 
and for other purposes; to the Committee on Veterans' Affairs.
  Mr. AKAKA. Mr. President, today I introduce legislation to correct a 
deficiency in the law governing health care for veterans. Under current 
law, originally enacted on November 30, 1999, a veteran who is enrolled 
in VA's health care system can be reimbursed for emergency treatment 
received at a non-VA hospital. However, the statute only permits such 
VA reimbursement if the veteran has no other outside health insurance, 
no matter how limited that other coverage might be.
  This sole payor provision means that a veteran who has any insurance 
is not entitled to reimbursement from VA for emergency medical 
treatment received at a non-VA facility. This is true even if the 
veteran's insurance policy does not cover the full amount owed.
  The bill I am introducing would amend current law so that a veteran 
who has outside insurance would be eligible for reimbursement in the 
event that any outside insurance does not cover the full amount of the 
emergency care. VA would be authorized to cover the difference between 
the amount the veteran's insurance will pay and the total cost of care. 
In essence, VA would become the payor of last resort in such cases. 
This would keep the veteran from being burdened by exorbitant medical 
fees with no insurance with which to pay them.
  In addition to amending current law in a prospective manner, this 
legislation would also allow the Secretary of Veterans Affairs to 
retroactively apply this law to emergency treatment received between 
the effective date of the current law and the date of enactment of the 
legislation I am introducing today.
  One example of the sort of case to which this discretionary authority 
might apply is one that came to the Committee's attention involving a 
disabled Vietnam veteran who was in a serious motorcycle accident which 
led to a medical bill for emergency room care of over $100,000. This 
veteran, who lived in Illinois, had state mandated auto insurance which 
included a medical benefit of $10,000. Since he had this other 
insurance, VA was precluded from paying for his care and the veteran 
was personally responsible for the difference between the amount 
covered by his state-required policy and the total charge for his care. 
Had this veteran

[[Page S2081]]

had no insurance at all, VA would have paid the entire amount.
  I urge our colleagues to cosponsor this legislation and to work with 
me and the other members of the Veterans' Affairs Committee to address 
this gap in VA benefits.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 404

       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' Emergency Care 
     Fairness Act of 2009''.

     SEC. 2. EXPANSION OF VETERAN ELIGIBILITY FOR REIMBURSEMENT BY 
                   SECRETARY OF VETERANS AFFAIRS FOR EMERGENCY 
                   TREATMENT FURNISHED IN A NON-DEPARTMENT 
                   FACILITY.

       (a) Expansion of Eligibility.--Subsection (b)(3)(C) of 
     section 1725 of title 38, United States Code, is amended by 
     striking ``, in whole or in part,''.
       (b) Limitations on Reimbursement.--Such section 1725 is 
     further amended--
       (1) in subsection (c), by adding at the end the following 
     new paragraph:
       ``(4)(A) If the veteran has contractual or legal recourse 
     against a third party that would, in part, extinguish the 
     veteran's liability to the provider of the emergency 
     treatment and payment for the treatment may be made both 
     under subsection (a) and by the third party, the amount 
     payable for such treatment under such subsection shall be the 
     amount by which the costs for the emergency treatment exceed 
     the amount payable or paid by the third party, except that 
     the amount payable may not exceed the maximum amount payable 
     established under paragraph (1)(A).
       ``(B) In any case in which a third party is financially 
     responsible for part of the veteran's emergency treatment 
     expenses, the Secretary shall be the secondary payer.
       ``(C) A payment in the amount payable under subparagraph 
     (A) shall be considered payment in full and shall extinguish 
     the veteran's liability to the provider.
       ``(D) The Secretary may not reimburse a veteran under this 
     section for any copayment or similar payment that the veteran 
     owes the third party or for which the veteran is responsible 
     under a health-plan contract.''; and
       (2) in subsection (f)(3)--
       (A) in subparagraph (A), by inserting before the period at 
     the end the following: ``, including the Secretary of Health 
     and Human Services with respect to the Medicare program under 
     title XVIII of the Social Security Act (42 U.S.C. 1395 et 
     seq.) and the Medicaid program under title XIX of such Act 
     (42 U.S.C. 1396 et seq.)''; and
       (B) in subparagraph (B), by inserting before the period at 
     the end the following: ``, including a State Medicaid agency 
     with respect to payments made under a State plan for medical 
     assistance approved under title XIX of such Act (42 U.S.C. 
     1396 et seq.)''.
       (c) Effective Date.--
       (1) In general.--The amendments made by subsections (a) and 
     (b) shall take effect on the date of the enactment of this 
     Act, and shall apply with respect to emergency treatment 
     furnished on or after the date of the enactment of this Act.
       (2) Reimbursement for treatment before effective date.--The 
     Secretary may provide reimbursement under section 1725 of 
     title 38, United States Code, as amended by subsection (a) 
     and (b) for emergency treatment furnished before the date of 
     the enactment of this Act if the Secretary determines that, 
     under the circumstances applicable with respect to the 
     veteran, it is appropriate to do so.
                                 ______