[Congressional Record Volume 162, Number 171 (Wednesday, November 30, 2016)]
[Senate]
[Pages S6609-S6610]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      EMERGENCY CARE FAIRNESS BILL

  Mr. ROUNDS. Mr. President, let me begin by thanking my colleagues who 
are here today, the Senator from Tennessee, the Senator from Louisiana, 
and the Senator from Connecticut, for the hard work they are doing to 
create new legislation that will improve the health care of Americans 
in the future, but I come today as well to speak about legislation 
which has already passed that was designed to improve the health care 
of veterans across the entire United States.
  I come to speak in favor and in support of the Emergency Care 
Fairness Act of 2009, which recently has come under attack by the VA 
and legislation introduced on this floor. In 2009, the 111th Congress 
passed the Emergency Care Fairness Act to fix a very big loophole in 
the law which hurt our Nation's veterans. Prior to 2009, the VA was not 
authorized to cover any costs of emergency room care at non-VA 
facilities for veterans who were covered by any type of third-party 
insurance. That meant that if a veteran had a limited insurance policy 
that covered even $1 of an emergency room bill, the VA would not pay a 
dime to cover costs that were not paid for by their insurance. 
Meanwhile, if a veteran had no insurance and was rushed to the 
emergency room, the VA was authorized to cover all of his or her costs. 
Clearly, this made no sense. Under the system,

[[Page S6610]]

the VA penalized veterans for owning third-party insurance, 
particularly Medicare.
  Leaders in both the House and the Senate got to work to fix this 
issue and introduced bills in both Chambers of Congress to allow the VA 
to pay the remaining balance of emergency care after a veteran's third-
party insurance was applied. This made good common sense. At the time, 
the chairman of the Senate Veterans' Affairs Committee, Senator Daniel 
Akaka of Hawaii, stated the following on this very floor: ``The bill I 
am introducing would amend current law so that a veteran who had 
outside insurance would be eligible for reimbursement in the event that 
any outside insurance does not cover the full amount of the emergency 
care.''
  Mr. President, congressional intent does not get any clearer than 
that.
  While the Emergency Care Fairness Act was being considered in 
committee, the VA is on the record as having supported the intent of 
the bill. Everything was going according to plan and the President 
signed the bill into law in February of 2010. The problem arose when 
after the law was passed, the VA implemented a new regulation which 
continued to deny veterans' legitimate emergency room claims. Despite 
having previously supported the Emergency Care Fairness Act, the VA 
reversed course and elected not to comply. This went on for 6 years, 
and hundreds of thousands of veterans had their emergency room claims 
denied by the VA.
  It was not until a veteran from Minnesota named Richard Staab had a 
heart attack in 2015 that the VA's illegal regulation was challenged in 
court. Mr. Staab was rushed to the emergency room following his heart 
attack and accrued $48,000 in medical expenses. Because he carried 
limited Medicare insurance, the VA denied his claim for reimbursement, 
as it had done for so many veterans, even though his Medicare didn't 
come close to covering the cost of his treatment.
  Mr. Staab sued the VA, and in April of this year, his case was heard 
by the U.S. Court of Appeals for Veterans Claims. After hearing the 
case, the court unanimously ruled in Mr. Staab's favor and ruled that 
the VA was in violation of the law by denying his claim and 
specifically ruled that the VA's regulation was in violation of 
congressional intent of the Emergency Care Fairness Act.
  Part of the Court's ruling stated: ``Therefore, it is clear from the 
plain language of the statute that Congress intended the VA to 
reimburse a veteran for that portion of expenses not covered by a 
health plan contract.''
  This was a huge win for veterans.
  Unfortunately, today the VA has appealed the decision of the U.S. 
Circuit Court of Appeals. This is an egregious dereliction of duty and 
a clear effort to avoid complying with the original intent of Congress 
back in 2009. Just since the VA's appeal of the ruling, over 100,000 
veterans' claims have been put in a pending status. That equates to 
thousands upon thousands of veterans who are waiting for the VA to help 
them pay their bills.
  It is a fact that those most affected by the VA's noncompliance with 
the Emergency Care Fairness Act are elderly veterans, many of whom are 
living on fixed incomes and have limited resources to pay medical 
bills. Often these veterans find themselves dealing with collection 
agencies as a result of emergency care received in their communities. 
In an era where we know that more than 20 veterans commit suicide every 
day, with 65 percent of those veterans aged 50 years or older, this is 
unacceptable.
  I want to tell a short story about a constituent of mine who was a 
veteran that was supposed to be covered by the Emergency Care Fairness 
Act. His name is Mr. Alfred Dymock. Mr. Dymock is 90 years old, and he 
served in the Army Air Corps during the Korean war. He flew over 100 
combat missions during the war and earned a Bronze Star and 
Distinguished Flying Cross for his heroic service. Mr. Dymock receives 
all his medical care at the VA as a disabled veteran but also carries 
his Medicare Part A, as does nearly every American over the age of 65.
  During a 1-month span earlier this year, Mr. Dymock collapsed twice 
in the middle of the night while he was in the bathroom. One time he 
hit his head and was bleeding. Because his 85-year-old wife was unable 
to pick him up, she appropriately called 911 each time. In both 
instances, the ambulance took him to Rapid City Regional Hospital, even 
though he requested to go to the Fort Meade VA hospital, the VA 
facility where he normally receives all of his care. The paramedics did 
not want to take him on the 25-mile drive to Fort Meade because they 
feared he was having a heart attack and may not survive even in that 
short of a drive. As a result of these two incidents, Mr. Dymock's 
emergency room bills totaled over $44,000.
  After Medicare Part A paid its share, Mr. Dymock still owes Rapid 
City Regional nearly $10,000. The VA has denied Mr. Dymock's claims to 
cover this amount because he, like nearly every other American, is 
eligible for Medicare Part A.
  The Dymocks do not own a home. They live in an apartment. They live 
solely on their Social Security and on Mr. Dymock's VA disability 
payments. If the VA continues to deny his claims, the Dymocks have no 
ability to pay these medical bills.
  Today, Mr. Dymock is in hospice care with Stage 4 kidney disease and 
liver disease. His daughter writes to me that even as frail and ill as 
Mr. Dymock is, he wants to know before he dies that his bills are 
covered so he can have peace.
  It was veterans like Mr. Dymock in Rapid City, SD, that Congress 
intended to help when it passed the Emergency Care Fairness Act in 
2009. Today I call on the VA to drop their appeal of the court's ruling 
and begin writing new regulations that comply with the law as Congress 
intended to properly reimburse our veterans for their emergency room 
care.
  I fully understand there is a cost associated with this course of 
action. Taking care of our veterans and complying with the law in this 
case is not a cost issue. I believe it is a moral issue, and in this 
case, it is also a legal issue. Complying with the intent of the 
Emergency Care Fairness Act is also simply the right thing to do.
  Should the VA agree, I stand ready to support them in their efforts 
to take care of our veterans and to give them medical care which they 
need, both from the VA and in the private sector.
  While we certainly have a long way to go to fix VA health care, I 
fully believe that implementing the Emergency Care Fairness Act as it 
was intended is a step in the right direction. I look forward to 
working with the Secretary of the VA and my colleagues on the Senate 
Veterans' Affairs Committee on a broad range of initiatives that 
continue to improve health care for our veterans.
  It is my goal to keep our veterans at the center of all we do. I urge 
my colleagues to join me in standing up for our veterans in supporting 
the Emergency Care Fairness Act of 2009.
  Thank you, Mr. President.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Georgia.

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