[Congressional Record (Bound Edition), Volume 145 (1999), Part 1]
[Extensions of Remarks]
[Pages 300-301]
[From the U.S. Government Publishing Office, www.gpo.gov]



     VETERANS HEALTH CARE ALLOCATION FAIRNESS ACT OF 1999, H.R. 24

                                 ______
                                 

                        HON. BENJAMIN A. GILMAN

                              of new york

                    in the house of representatives

                       Wednesday, January 6, 1999

  Mr. GILMAN. Mr. Speaker, I rise today to introduce H.R. 24 the 
Veterans Health Care Allocation Fairness Act of 1999.
  In 1996, the Veterans Administration was mandated by Congress to 
develop and implement a more equitable method for allocating health 
care resources. In response, the VA devised the veterans equity 
resource allocation (VERA) model.
  While VERA was a noble effort, it is based on a flawed model. As a 
research method, VERA is unfairly biased against older veterans in 
major metropolitan areas. These veterans are those in need of 
inpatient, comprehensive health care, and they will suffer if VERA is 
allowed to go forward as planned.
  This legislation is designed to correct these inherent flaws within 
VERA. Specifically, it does this in three ways:
  First, the bill would raise the income level in the means test by 20% 
for any veteran who lives in a standard metropolitan statistical area 
(SMSA) as defined by the Bureau of the Census. This would make the VA 
more accessible to veterans who live in high-cost areas, thus 
increasing the number of veterans who use VA in those regions.
  Second, the bill would move veterans with catastrophic health care 
expenses from category ``C'' (those who must meet the means test for 
non-service connected care) to category ``A'' (those eligible for free 
non-service connected care). These veterans are defined as those 
individuals whose medical expenses for the previous year exceeded 7.5% 
of their adjusted gross income.
  Third, the bill would level the playing field between the northeast 
and southwest by removing the high-cost, ``inefficient'' speciality 
care programs from those funds which can be

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considered in reallocation calculations under VERA. The programs 
removed would include: Readjustment counseling and treatment, 
counseling and psychiatric care for the mentally ill, drug and alcohol 
related programs, programs for the homeless, PTSD programs, spinal cord 
injury programs, AIDS programs and geriatric and extended care 
programs.
  In a memorandum prepared for me by the Congressional Research Service 
on this legislation, it estimates that this bill would result in an 
additional 5-6% of veterans in the northeast becoming eligible for free 
health care. That translates to approximately 75,000 additional 
veterans for New York alone. CRS also estimates that if 20% of these 
veterans seek to use VA services, a conservative assumption, it would 
result in an increased caseload for both VISN #2 and #3 of 15-20%. This 
would force a recomputation of VERA distributions, and result in more 
VA health care funds remaining in northern urban areas.
  Accordingly, I urge my colleagues to support this legislation which 
will help ensure that all veterans receive equal opportunity to the 
health care which they have earned, regardless of where they have 
chosen to live.

                                H.R. 24

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. CRITERIA FOR REQUIRED COPAYMENT FOR MEDICAL CARE 
                   PROVIDED BY THE DEPARTMENT OF VETERANS AFFAIRS.

       (a) Exception Based on Prior Catastrophic Health Care 
     Expenses.--Subsection (a) of section 1722 of title 38, United 
     States Code, is amended--
       (1) by striking ``or'' at the end of paragraph (2);
       (2) by striking the period at the end of paragraph (3) and 
     inserting ``; or''; and
       (3) by adding at the end the following new paragraph:
       ``(4) the veteran's expenses for medical care (as defined 
     in section 213 of the Internal Revenue Code of 1986) for the 
     previous year are in excess of 7\1/2\ percent of the 
     veteran's adjusted gross income for the previous year (as 
     determined for purposes of the personal income tax under the 
     Internal Revenue Code of 1986).''.
       (b) Adjustment in Income Thresholds for Veterans Residing 
     in SMSAs.--Subsection (b) of such section is amended by 
     adding at the end the following new paragraph:
       ``(3) The amounts in effect for purposes of this subsection 
     for any calendar year shall be increased by 20 percent for 
     any veteran who resides in a Standard Metropolitan 
     Statistical Area (SMSA), as defined by the Bureau of the 
     Census.''.
       (c) Amendments Within Existing Resources.--The Secretary of 
     Veterans Affairs shall carry out the amendments made by this 
     section for fiscal years 2000 and 2001 within the amount of 
     funds otherwise available (or programmed to be available) for 
     medical care for the Department of Veterans Affairs for those 
     fiscal years.
       (d) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2000.

     SEC. 2. SERVICES FOR MENTALLY ILL VETERANS.

       (a) Membership of Committee on Care of Severely Chronically 
     Mentally Ill Veterans.--Section 7321 of title 38, United 
     States Code, is amended--
       (1) in subsection (a), by inserting ``and members of the 
     general public with expertise in the care of the chronically 
     mentally ill'' in the second sentence after ``chronically 
     mentally ill''; and
       (2) by adding at the end the following new subsection:
       ``(e) The Secretary shall determine the terms of service 
     and (for members appointed from the general public) the pay 
     and allowances of the members of the committee, except that a 
     term of service may not exceed five years. The Secretary may 
     reappoint any member for additional terms of service.''.
       (b) Centers for Mental Illness Research, Education, and 
     Clinical Activities.--Paragraph (3) of section 7320(b) of 
     such title is amended to read as follows:
       ``(3) The Secretary shall designate at least one center 
     under this section in each service network region of the 
     Veterans Health Association.''.

     SEC. 3. ALLOCATION OF MEDICAL CARE RESOURCES FOR THE 
                   DEPARTMENT.

       (a) In General.--(1) Chapter 81 of title 38, United States 
     Code, is amended by inserting after section 8116 the 
     following new section:

     ``Sec. 8117. Allocation of medical care resources

       ``In applying the plan for the allocation of health care 
     resources (including personnel and funds) known as the 
     Veterans Equitable Resource Allocation system, developed by 
     the Secretary pursuant to the requirements of section 429 of 
     Public Law 104-204 (110 Stat. 2929) and submitted to Congress 
     in March 1997, the Secretary shall exclude from consideration 
     in the determination of the allocation of such resources the 
     following (resources for which shall be allocated in such 
     manner as the Secretary determines to be appropriate):
       ``(1) Programs to provide readjustment counseling and 
     treatment.
       ``(2) Programs to provide counseling and treatment 
     (including psychiatric care) for the mentally ill.
       ``(3) Programs relating to drug and alcohol abuse and 
     dependence.
       ``(4) Programs for the homeless.
       ``(5) Programs relating to post-traumatic stress disorder.
       ``(6) Programs relating to spinal cord dysfunction.
       ``(7) Programs relating to AIDS.
       ``(8) Programs relating to geriatric and extended care.''.
       (2) The table of sections at the beginning of such chapter 
     is amended by inserting after the item relating to section 
     8116 the following new item:
       ``8117.  Allocation of medical care resources.''.
       (b) Effective Date.--Section 8117 of title 38, United 
     States Code, as added by subsection (a), shall apply with 
     respect to the allocation of resources for each fiscal year 
     after fiscal year 1999.

     

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