[House Report 116-529]
[From the U.S. Government Publishing Office]


116th Congress  }                                             {    Report
                          HOUSE OF REPRESENTATIVES
 2d Session     }                                             {   116-529

======================================================================



 
             EQUAL ACCESS TO CONTRACEPTION FOR VETERANS ACT

                                _______
                                

 September 22, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

  Mr. Takano, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 3798]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 3798) to amend title 38, United States Code, to 
provide for limitations on copayments for contraception 
furnished by the Department of Veterans Affairs, and for other 
purposes, having considered the same, reports favorably thereon 
with an amendment and recommends that the bill as amended do 
pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     3
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     5
Applicability to Legislative Branch..............................     5
Statement on Duplication of Federal Programs.....................     5
Disclosure of Directed Rulemaking................................     5
Section-by-Section Analysis of the Legislation...................     5
Changes in Existing Law Made by the Bill as Reported.............     6

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Equal Access to Contraception for 
Veterans Act''.

SEC. 2. LIMITATION ON COPAYMENTS FOR CONTRACEPTION.

  Section 1722A(a)(2) of title 38, United States Code, is amended--
          (1) by striking ``to pay'' and all that follows through the 
        period and inserting ``to pay--''; and
          (2) by adding at the end the following new subparagraphs:
          ``(A) an amount in excess of the cost to the Secretary for 
        medication described in paragraph (1); or
          ``(B) an amount for any contraceptive item for which coverage 
        under health insurance coverage is required without the 
        imposition of any cost-sharing requirement pursuant to section 
        2713(a)(4) of the Public Health Service Act (42 USC 300gg-
        13(a)(4)).''.

                          Purpose and Summary

    H.R. 3798 was introduced by Representative Julia Brownley 
of California on July 17, 2019. H.R. 3798, as amended, 
eliminates co-payments for contraceptives, so that veterans 
have the same access to birth control as required by the 
Affordable Care Act.

                  Background and Need for Legislation

    Access to contraception is part of providing comprehensive 
health services. However, cost sharing can be a barrier for 
some veterans who need health care services or treatment. 
Eliminating co-pays will ensure that cost is not a barrier to 
all veterans accessing preventative health care. Currently, 
only women veterans and the uninsured are required to pay co-
pays for their contraception. This bill brings parity with the 
Department of Defense and coverage for contraception under the 
Affordable Care Act. Access to affordable contraceptives is an 
essential component of comprehensive health care, and since VA 
patients tend to be sicker and poorer than non-veteran 
patients, eliminating this inequity will particularly help this 
population, especially women veterans.

          SEC. 2. LIMITATION ON COPAYMENTS FOR CONTRACEPTION.

    Women represent the fastest growing subpopulation of 
veterans in the nation, while the population of male veterans 
is growing smaller. The preventative health care needs of 
female veterans include access to contraceptives. This bill 
would exempt from copayment liability the provision of 
contraceptives by amending section 1772A of title 38, United 
States Code (USC).
    The committee expects that this will apply to all 
contraceptives available at the pharmacy, including both 
prescription methods and emergency contraception. In addition, 
the committee expects that this will also apply to eliminating 
co-pays for long-acting reversible contraceptives (LARCs), 
including intra-uterine devices (IUDs) and implants that the 
Veterans Health Administration (VHA) classifies as prosthetics.

                                Hearings

    On September 11, 2019, the Subcommittee on Health held a 
legislative hearing on H.R. 2645; H.R. 2681; H.R. 2752; H.R. 
2798; H.R. 2972; H.R. 2982; H.R. 3036; H.R. 3798; H.R. 3636; 
H.R. 3798; H.R. 3867; H.R. 4096; and a Draft bill, to establish 
in the Department of Veterans Affairs the Office of Women's 
Health, and for other purposes. The following witnesses 
testified: Dr. Teresa Boyd, Assistant Deputy Under Secretary 
for Health for Clinical Operations, U.S. Department of Veterans 
Affairs; Mr. Jeremy Butler, CEO, Iraq and Afghanistan Veterans 
of America; Ms. Joy Ilem, Disabled American Veterans, National 
Legislative Director; Mr. Roscoe Butler, Associate Legislative 
Director, Paralyzed Veterans of America. Representative(s) 
Bilirakis, Correa, Hartzler, Lee, Pappas, Rose, Stefanik, 
Velazquez, provided statements for the record. Statements were 
also given by The Veterans of Foreign Wars of the United 
States, National Association of State Women Veteran 
Coordinators, and Service Women's Action Network.

                       Subcommittee Consideration

    There was no Subcommittee markup of H.R. 3798.

                        Committee Consideration

    On March 12, 2020, the full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 3798, as 
amended, favorably reported to the House of Representatives by 
voice vote. During consideration of the bill, the following 
amendment was considered:
    An amendment offered by Representative Phil Roe of 
Tennessee. This amendment addressed a technical change 
requested by the Department of Veteran Affairs to strike the 
words ``or service.''

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 3798, 
as amended, reported to the House. A motion by Representative 
Mark Takano of California to report H.R. 3798, as amended, 
favorably to the House of Representatives was agreed to by 
voice vote.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         Statement of General Performance Goals and Objectives

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to improve resources and benefits for 
women veterans and other underserved veterans.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  Earmarks and Tax and Tariff Benefits

    H.R. 3798, as amended, does not contain any Congressional 
earmarks, limited tax benefits, or limited tariff benefits as 
defined in clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate on H.R. 
3798, as amended, prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

               Congressional Budget Office Cost Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 3798, as amended, provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974:

 


    The Department of Veterans Affairs (VA) charges copayments 
to veterans who receive contraceptive items from the Veterans 
Health Administration. H.R. 3798 would eliminate those 
copayments. Collections of copayments for contraceptive items, 
which totaled $420,000 in 2018, are deposited in the Medical 
Care Collections Fund and, subject to appropriation, are spent 
on medical care for veterans. CBO expects that any reduction in 
those collections would need to be replaced with additional 
funding in order to provide the same level of health care to 
veterans.
    Using historical information on copayments from VA and 
adjusting for an increase in the cost of VA-funded health care 
that veterans will receive from nonfederal providers, CBO 
estimates collections over the 2020-2025 period would be 
reduced by $5 million. Replacing those amounts and continuing 
to provide the same level of health care to veterans would cost 
$5 million over the 2020-2025 period, CBO estimates; that 
spending would be subject to the availability of 
appropriations.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Leo Lex, Deputy Director of Budget 
Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 3798, as amended, prepared by the 
Director of the Congressional Budget Office pursuant to section 
423 of the Unfunded Mandates Reform Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
3798, as amended.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 3798, as amended, is authorized by Congress' 
power to ``provide for the common Defense and general Welfare 
of the United States.''

                  Applicability to Legislative Branch

    The Committee finds that H.R. 3798, as amended, does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

              Statement on Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that no provision 
of H.R. 3798, as amended, establishes or reauthorizes a program 
of the Federal Government known to be duplicative of another 
Federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                   Disclosure of Directed Rulemaking

    Pursuant to clause 3(c)(5) of rule XIII, the Committee 
estimates that H.R. 3798 contains no directed rulemaking that 
would require the Secretary to prescribe regulations.

             Section-by-Section Analysis of the Legislation


Sec. 1. Short title

    Section 1 names the Act the ``Equal Access to Contraception 
for Veterans Act''.

Sec. 2. Limitation on copayments for contraception

    Section 2 amends section 1722A (a)(2) of title 38, United 
States Code to eliminate copayments on contraceptive items.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE



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PART II--GENERAL BENEFITS

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CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *


   SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND 
NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS

           *       *       *       *       *       *       *


Sec. 1722A. Copayment for medications

  (a)(1) Subject to paragraph (2), the Secretary shall require 
a veteran to pay the United States $2 for each 30-day supply of 
medication furnished such veteran under this chapter on an 
outpatient basis for the treatment of a non-service-connected 
disability or condition. If the amount supplied is less than a 
30-day supply, the amount of the charge may not be reduced.
  (2) The Secretary may not require a veteran [to pay an amount 
in excess of the cost to the Secretary for medication described 
in paragraph (1).] to pay--
          (A) an amount in excess of the cost to the Secretary 
        for medication described in paragraph (1); or
          (B) an amount for any contraceptive item for which 
        coverage under health insurance coverage is required 
        without the imposition of any cost-sharing requirement 
        pursuant to section 2713(a)(4) of the Public Health 
        Service Act (42 USC 300gg-13(a)(4)).
  (3) Paragraph (1) does not apply--
          (A) to a veteran with a service-connected disability 
        rated 50 percent or more;
          (B) to a veteran who is a former prisoner of war;
          (C) to a veteran whose annual income (as determined 
        under section 1503 of this title) does not exceed the 
        maximum annual rate of pension which would be payable 
        to such veteran if such veteran were eligible for 
        pension under section 1521 of this title; or
          (D) to a veteran who was awarded the medal of honor 
        under section 7271, 8291, or 9271 of title 10 or 
        section 491 of title 14.
  (4) Paragraph (1) does not apply to opioid antagonists 
furnished under this chapter to a veteran who is at high risk 
for overdose of a specific medication or substance in order to 
reverse the effect of such an overdose.
  (b) The Secretary, pursuant to regulations which the 
Secretary shall prescribe, may--
          (1) increase the copayment amount in effect under 
        subsection (a); and
          (2) establish a maximum monthly and a maximum annual 
        pharmaceutical copayment amount under subsection (a) 
        for veterans who have multiple outpatient 
        prescriptions.
  (c) Amounts collected under this section shall be deposited 
in the Department of Veterans Affairs Medical Care Collections 
Fund.

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