[House Report 117-223]
[From the U.S. Government Publishing Office]
117th Congress} { Report
2d Session } HOUSE OF REPRESENTATIVES { 117-223
======================================================================
ENSURING VETERANS' SMOOTH TRANSITION ACT
_______
January 6, 2022.--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
together with
DISSENTING VIEWS
[To accompany H.R. 4673]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 4673) to amend title 38, United States Code, to
provide for the automatic enrollment of eligible veterans in
patient enrollment system of Department of Veterans Affairs,
and for other purposes, having considered the same, reports
favorably thereon without amendment and recommends that the
bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
Hearings......................................................... 3
Subcommittee Consideration....................................... 5
Committee Consideration.......................................... 5
Committee Votes.................................................. 5
Committee Oversight Findings..................................... 7
Statement of General Performance Goals and Objectives............ 7
New Budget Authority, Entitlement Authority, and Tax Expenditures 7
Earmarks and Tax and Tariff Benefits............................. 7
Committee Cost Estimate.......................................... 7
Congressional Budget Office Estimate............................. 7
Federal Mandates Statement....................................... 9
Advisory Committee Statement..................................... 9
Constitutional Authority Statement............................... 9
Applicability to Legislative Branch.............................. 9
Statement on Duplication of Federal Programs..................... 9
Disclosure of Directed Rulemaking................................ 9
Section-by-Section Analysis of the Legislation................... 10
Changes in Existing Law Made by the Bill as Reported............. 10
Minority Views................................................... 12
Dissenting Views................................................. 13
Purpose and Summary
H.R. 4673, the Ensuring Veterans' Smooth Transition Act or
the EVEST Act, was introduced by Chairman Mark Takano on July
22, 2021. H.R. 4673 would become effective upon passage into
law and would provide for improvements to servicemembers'
transitions to civilian life by automatically enrolling all
eligible veterans into the Department of Veterans Affairs (VA)
patient enrollment system.
Background and Need for Legislation
H.R. 4673 automatically enrolls eligible service members
into VA healthcare during the transition process and gives
service members an opt-out should they wish to not enroll. This
is accomplished by the Department of Defense (DOD) providing
information from the Defense Manpower Data Center (DMDC) to VA
for purposes of enrollment. Veterans are provided notice within
60 days of enrollment and given instructions for how they may
opt out.
Currently, veterans eligible for VA health care must
proactively decide to enroll with VA using online, phone, or in
person services. However, veterans often are unclear about
their eligibility status, meaning that some attempt to enroll
when they are not eligible, and many more fail to enroll due to
a lack of understanding that they are eligible for care. For
example, many of the 175,000 veterans who served in Operation
Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and
Operation New Dawn (OND) are unaware of their eligibility for
five years of VA health care upon separation. These veterans
would no longer have to guess their status--they would simply
be enrolled, made aware of their enrollment, and be given an
option of opt-out of care should they wish.
Providing care immediately upon separation is crucial for
veterans, as the first few months after transitioning out of
the military are a time of stress and place veterans at high
risk for mental health challenges, including suicide. The
Committee believes strongly that no veteran should have to
struggle with navigating the VA bureaucracy to enroll in care.
By ensuring a smooth care transition, this legislation will
lower new veterans' risks for problems and promote easier
access to care. Care that is offered sooner is more effective
and likely to lower costs for VA and taxpayers. In addition,
providing care when needed can reduce the likelihood of
veterans becoming homeless or seriously ill.
This legislation has the support of many Veteran Service
Organizations and health organizations such as Paralyzed
Veterans of American, Disabled American Veterans, the Nurses
Organization of Veterans Affairs, and the Veterans Healthcare
Policy Institute (VHPI). VHPI noted that
a disproportionate number of veterans' suicide
attempts occur during the period following separation
from military service. That fact was the impetus
underlying Executive Order 13822 granting VA mental
health care for veterans during the transitional first
year. Veterans are more likely to utilize these life-
saving mental health services if all their care is in
one place. . . . The EVEST Act in turn would foster
quicker access of VA health care that is critical in an
acute crisis.
H.R. 4673 uses DoD systems that are already in place
through DMDC and the Transition Assistance Program, as well as
VA's existing patient enrollment system, to enable a warm
handoff from DOD to VA.
Hearings
Pursuant to clause 3(c)(6) of rule XIII of the Rules of the
House of Representatives, the Committee held the following
hearings which were used to develop H.R. 4673:
On April 29, 2019, the House Veterans' Affairs
Committee held a hearing titled ``Tragic Trends:
Suicide Prevention Among Veterans.'' The following
witnesses testified: Dr. Shelli Avenevoli, Deputy
Director, National Institutes of Mental Health, Dr.
Keita Franklin, National Director of Suicide
Prevention, Department of Veterans Affairs, Dr. Richard
McKeon, Chief, Suicide Prevention Branch, Substance
Abuse and Mental Health Services Administration, Dr.
Richard Stone, Executive in Charge, Veterans Health
Administration, Department of Veterans Affairs.
On May 21, 2019, the House Veterans' Affairs
Committee held a joint hearing with the House Armed
Services Committee titled ``Military and Veteran
Suicide: Understanding the Problem and Preparing for
the Future.'' The following witnesses testified: Dr.
Elizabeth Van Winkle, Executive Director, Force
Resiliency, Office of the Under Secretary for Personnel
and Readiness, U.S. Department of Defense, Captain Mike
Colston, M.D., Director, Mental Health Policy and
Oversight, U.S. Department of Defense, Dr. Keita
Franklin, National Director of Suicide Prevention, U.S.
Department of Veterans Affairs, Michael Fischer, Chief
Readjustment Counseling Officer, U.S. Department of
Veterans Affairs.
On January 29, 2020, the House Veterans' Affairs
Committee held a hearing titled ``Caring for Veterans
in Crisis: Ensuring a Comprehensive Health System
Approach.'' The following witnesses testified: Ms.
Renee Oshinski, Deputy Under Secretary for Health for
Operations and Management, Veterans Health
Administration, U.S. Department of Veterans Affairs,
Dr. David Carroll, Executive Director, Office of Mental
Health and Suicide Prevention, Veterans Health
Administration, U.S. Department of Veterans Affairs,
Mr. Frederick Jackson, Senior Executive Director,
Office of Security and Law Enforcement, U.S. Department
of Veterans Affairs, Dr. Julie Kroviak, Deputy
Assistant Inspector General for Healthcare Inspections,
VA Office of Inspector General, U.S. Department of
Veterans Affairs, Dr. C. Edward Coffey, Affiliate
Professor of Psychiatry and Behavioral Sciences,
Medical University of South Carolina Charleston, SC.
On September 9, 2020, the House Veterans' Affairs
Committee held a legislative hearing on various bills
introduced during the 116th Congress, including a
discussion draft of H.R. 4673 which was included at
that time in the Veterans Comprehensive Prevention,
Access to Care, and Treatment (Veterans COMPACT) Act of
2020. The following witnesses testified: Ms. Lindsay
Church, Executive Director, Minority Veterans of
America (MVA); Ms. Maureen Elias, Associate Legislative
Director, Government Relations, Paralyzed Veterans of
America (PVA); Ms. Joy Ilem, National Legislative
Director, Disabled American Veterans (DAV); Mr. Patrick
Murray, Director, National Legislative Service,
Veterans of Foreign Wars (VFW); Dr. Russell Lemle,
Veterans Healthcare Policy Institute (VHPI); and Mr.
Jim Lorraine, Lt. Col., USAF, (Ret.), President & CEO,
America's Warrior Partnership.
On May 12, 2020, the House Veterans' Affairs
Committee Economic Opportunity Subcommittee held a
hearing titled ``Military Transition During the COVID-
19 Pandemic.'' There were two witness panels for this
hearing. The first panel saw the following witnesses
testify: Vivian Richards, Program Manager, Minority
Veterans of America, Dr. J. Michael Haynie, PhD., Vice
Chancellor for Strategic Initiatives and Innovations,
Institute for Veteran and Military Families, Syracuse
University, Jennifer Dane Executive Director, Modern
Military Association of America, Matt Stevens, Chief
Executive Officer, The Honor Foundation, Carolyn Lee,
Executive Director, The Manufacturing Institute,
Patrick Murray, Legislative Director, Veterans of
Foreign Wars. The second panel saw the following
witnesses testify: William Mansell, Director, Defense
Support Services, Department of Defense, James
Rodriguez, Acting Assistant Secretary, Veterans'
Employment & Training Service, Department of Labor,
Cheryl Rawls, Executive Director, Outreach, Transition
and Economic Development Service (OTED), Veterans
Benefits Administration, Dr. Lawrencia Pierce, Deputy
Director, Outreach, Transition and Economic Development
Service (OTED), Veterans Benefits Administration,
Joshua Lashbrook, Assistant Director of Operations
Support and Digital GI Bill Program Lead, Education
Service, Veterans Benefits Administration.
On September 22, 2021, the House Veterans' Affairs
Committee held a hearing titled ``Veterans Suicide
Prevention: Innovative Research and Expanded Public
Health Efforts.'' There were two witness panels for
this hearing where the following witnesses testified.
On the first panel: Kameron Matthews, MD, JD, Assistant
Under Secretary for Health--Clinical Services, Matthew
Miller, PhD, MPH, Executive Director, Suicide
Prevention Program, Lisa Brenner, PhD, Director, Rocky
Mountain Mental Illness Research Education and Clinical
Center (MIRECC) for Suicide Prevention. On the second
panel: Tammy Barlet, Deputy Legislative Director,
Veterans of Foreign Wars (VFW), Kaitlynne Hetrick,
Associate, Government Affairs Iraq and Afghanistan
Veterans of America (IAVA), Jennifer Silva, Chief
Program Officer Wounded Warrior Project (WWP), Chief
William (``Bill'') Smith, Chairman, National Indian
Health Board (NIHB), Nick Armendariz, Veteran, Rajeev
Ramchand, PhD, Co-Director, RAND Epstein Family
Veterans Policy Research Institute, Senior Behavioral
Scientist, RAND Corporation.
On October 27, 2021, the House Veterans Affairs
Committee held a hearing titled ``Lessons Learned?
Building a Culture of Patient Safety Withing the
Veterans Health Administration.'' There was one witness
panel where the following witnesses testified: Dr.
Julie Kroviak, Deputy Assistant Inspector General for
Healthcare Inspections, Office of Inspector General,
U.S. Department of Veterans Affairs, Ms. Sharon Silas,
Director, Health Care Team, U.S. Government
Accountability Office, Ms. Renee Oshinski, Assistant
Under Secretary for Health for Operations, Veterans
Health Administration, U.S. Department of Veterans
Affairs, Dr. Gerard Cox, Assistant Under Secretary for
Health for Quality and Patient Safety, Veterans Health
Administration, U.S. Department of Veterans Affairs,
Dr. Teresa Boyd, Network Director VA Northwest Health
Network (VISN 20), Veterans Health Administration, U.S.
Department of Veterans Affairs.
Subcommittee Consideration
H.R. 4673 was not considered in Subcommittee.
Committee Consideration
On July 28, 2021, the Full Committee met in an open markup
session, a quorum being present, and ordered H.R. 4673 reported
favorably to the House of Representatives by a roll call vote
of 16-10.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the recorded
votes on the motion to report the legislation and amendments
thereto.
There was one amendment offered by Ranking Member Bost to
H.R. 4673, which was not agreed to by a voice vote.
There was one recorded vote on a motion by Congressman Mike
Levin of California to favorably report H.R. 4673, as
introduced, to the U.S. House of Representatives, which was
agreed to by a roll call vote of 16-10.
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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 establishes the
following performance goals and objectives for this
legislation: effective upon passage into law,
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. 4673 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.
4673 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. 4673 provided by the Director of the Congressional
Budget Office pursuant to section 402 of the Congressional
Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, December 13, 2021.
Hon. Mark Takano,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4673, the Ensuring
Veterans' Smooth Transition Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Etaf Khan.
Sincerely,
Phillip L. Swagel,
Director.
Enclosure.
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H.R. 4673 would require the Department of Veterans Affairs
(VA) to automatically enroll eligible veterans in the
department's patient enrollment system for VA health care
benefits and services. That requirement would only apply to
veterans who leave the armed forces after enactment. The bill
also would require VA to provide veterans with an electronic
mechanism for disenrolling from the VA health care system.
CBO expects that most newly separated and eligible veterans
will enroll in VA health care under current law. Using data
from VA, CBO estimates that under the bill about 58,000
additional veterans would be automatically enrolled in 2022,
and a similar number of veterans would be enrolled in each
subsequent year. After accounting for the voluntary
disenrollment of some veterans, CBO estimates that about
250,000 of those who would be automatically enrolled would
remain enrolled by 2026. Accounting for a gradual increase in
the use of VA health care by automatically enrolled veterans,
CBO estimates that those veterans would receive care that costs
on average $3,900 each year. In total, implementing that
requirement would cost $3.1 billion over the 2022-2026 period.
Such spending would be subject to the appropriation of the
estimated amounts.
The bill also would require VA to provide veterans with
digital certificates of enrollment and an electronic method to
opt out of the system. Using costs for similar information
technology efforts, CBO estimates that satisfying those
requirements would cost $2 million over the 2022-2026 period.
Such spending would be subject to the availability of
appropriated funds.
The costs of the legislation, detailed in Table 1, fall
within budget function 700 (veterans benefits and services).
TABLE 1.--ESTIMATED INCREASES IN SPENDING SUBJECT TO APPROPRIATION UNDER H.R. 4673
----------------------------------------------------------------------------------------------------------------
By fiscal year, millions of dollars--
-------------------------------------------------------
2022 2023 2024 2025 2026 2022-2026
----------------------------------------------------------------------------------------------------------------
Health Care (Auto-enroll):
Estimated Authorization............................. 42 130 411 960 1,745 3,288
Estimated Outlays................................... 37 119 376 889 1,637 3,058
System Requirements:
Estimated Authorization............................. 1 * * * * 2
Estimated Outlays................................... 1 * * * * 2
Total Changes:
Estimated Authorization............................. 43 130 411 960 1,746 3,290
Estimated Outlays................................... 38 119 376 889 1,638 3,060
----------------------------------------------------------------------------------------------------------------
Components may not sum to totals because of rounding. * = between zero and $500,000.
The CBO staff contact for this estimate is Etaf Khan. 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. 4673 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.
4673.
Constitutional Authority Statement
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 4673 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. 4673 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the legislative branch.
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. 5545 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. 4673 contains no directed rule making that
would require the Secretary to prescribe regulations.
Section-by-Section Analysis of the Legislation
Section 1: Short Title: This Act may be cited as the
``Ensuring Veterans' Smooth Transition Act'' or the ``EVEST
Act''.
Section 2: Directs the Secretary of VA to use the DoD's
DMDC to automatically enroll veterans in the patient enrollment
system. The Secretary is instructed to then provide all
veterans enrolled under this act a notice within 60 days of
veterans' enrollment status and instructions for how veterans
may opt out of such enrollment.
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, 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 (new matter is
printed in italics and existing law in which no change is
proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
* * * * * * *
Sec. 1705. Management of health care: patient enrollment system
(a) In managing the provision of hospital care and medical
services under section 1710(a) of this title, the Secretary, in
accordance with regulations the Secretary shall prescribe,
shall establish and operate a system of annual patient
enrollment. The Secretary shall manage the enrollment of
veterans in accordance with the following priorities, in the
order listed:
(1) Veterans with service-connected disabilities
rated 50 percent or greater and veterans who were
awarded the medal of honor under section 7271, 8291, or
9271 of title 10 or section 491 of title 14.
(2) Veterans with service-connected disabilities
rated 30 percent or 40 percent.
(3) Veterans who are former prisoners of war or who
were awarded the Purple Heart, veterans with service-
connected disabilities rated 10 percent or 20 percent,
and veterans described in subparagraphs (B) and (C) of
section 1710(a)(2) of this title.
(4) Veterans who are in receipt of increased pension
based on a need of regular aid and attendance or by
reason of being permanently housebound and other
veterans who are catastrophically disabled.
(5) Veterans not covered by paragraphs (1) through
(4) who are unable to defray the expenses of necessary
care as determined under section 1722(a) of this title.
(6) All other veterans eligible for hospital care,
medical services, and nursing home care under section
1710(a)(2) of this title.
(7) Veterans described in section 1710(a)(3) of this
title who are eligible for treatment as a low-income
family under section 3(b) of the United States Housing
Act of 1937 (42 U.S.C. 1437a(b)) for the area in which
such veterans reside, regardless of whether such
veterans are treated as single person families under
paragraph (3)(A) of such section 3(b) or as families
under paragraph (3)(B) of such section 3(b).
(8) Veterans described in section 1710(a)(3) of this
title who are not covered by paragraph (7).
(b) In the design of an enrollment system under subsection
(a), the Secretary--
(1) shall ensure that the system will be managed in a
manner to ensure that the provision of care to
enrollees is timely and acceptable in quality;
(2) may establish additional priorities within each
priority group specified in subsection (a), as the
Secretary determines necessary; and
(3) may provide for exceptions to the specified
priorities where dictated by compelling medical
reasons.
(c)(1) The Secretary may not provide hospital care or medical
services to a veteran under paragraph (2) or (3) of section
1710(a) of this title unless the veteran enrolls in the system
of patient enrollment established by the Secretary under
subsection (a).
(2) The Secretary shall provide hospital care and medical
services under section 1710(a)(1) of this title, and under
subparagraph (B) of section 1710(a)(2) of this title, for the
12-month period following such veteran's discharge or release
from service, to any veteran referred to in such sections for a
disability specified in the applicable subparagraph of such
section, notwithstanding the failure of the veteran to enroll
in the system of patient enrollment referred to in subsection
(a) of this section.
(d)(1) The Secretary shall enroll each veteran described in
subsection (a) in the patient enrollment system under this
section by not later than 60 days after receiving the
information described in paragraph (3) with respect to the
veteran.
(2) Not later than 60 days after enrolling a veteran under
paragraph (1), the Secretary shall provide to the veteran--
(A) notice of the veteran's enrollment; and
(B) instructions for how the veteran may opt out of
such enrollment, at the election of the veteran.
(3) The information described in this paragraph is the
appropriate information concerning eligibility for enrollment
in the patient enrollment system under this section, as
provided by the Defense Manpower Data Center of the Department
of Defense, or such successor entity of the Department.
* * * * * * *
Minority Views
Clause 2(c) of rule XIII of the Rules of the House of
Representatives requires each report by a committee on a public
matter to include any additional, minority, supplemental, or
dissenting views submitted pursuant to clause 2(1) of rule XI
of the Rules of the House of Representatives by one or more
members of the committee. The minority views of members of the
Committee are as follows:
DISSENTING VIEWS
The Minority offers the following dissenting views
regarding H.R. 4673.
H.R. 4673, the ``Ensuring Veterans' Smooth Transition Act''
or ``EVEST Act'' is a bill introduced by Chairman Mark Takano
July 22, 2021. This bill has no other co-sponsors, nor does it
have a companion bill in the Senate. The bill directs the
Secretary of the Department of Veterans Affairs (VA) to use
information concerning eligibility for enrollment as provided
by the Defense Manpower Data Center of Department of Defense to
automatically enroll veterans in the patient enrollment system.
All veterans enrolled under this act must receive notice within
60 days as to their enrollment status via an electronic version
of the certificate of eligibility along with an electronic
mechanism by which the veteran may opt out of such enrollment.
The Minority appreciates the intent of this bill, which is
to support transitioning servicemembers by helping to connect
them seamlessly with VA hospital care and medical services.
Currently servicemembers are encouraged to enroll for VA
healthcare and coached through the application process while
attending mandatory Transition Assistance Program sessions
prior to discharge or retirement. While in theory an automatic
enrollment may appear less onerous, there are simply too many
unknowns to proceed with this bill as written and without
appropriate review.
First, the Majority has failed to exercise legislative due
diligence. The Majority's report of H.R. 4673, cites a
September 9, 2020 House Veterans' Affairs Full Committee a
legislative hearing on various bills introduced during the
116th Congress, including a discussion draft of H.R. 4673 which
was included at that time as a provision within in the Veterans
Comprehensive Prevention, Access to Care, and Treatment
(Veterans COMPACT) Act of 2020. VA did not testify at that
hearing and its statement for the record did not address this
specific language. Rather, the language considered at this
hearing was limited to requiring the provision of hospital care
and medical services to veterans during the one-year period
following discharge or release from active service regardless
of enrollment status. Here, the language in H.R. 4673 is
extremely dissimilar in that it would create an automatic
lifetime of eligibility for VA health care. The reliance on a
dissimilar bill from a previous Congress is misplaced.
Moreover, current stakeholders have not had the opportunity
to provide input into this legislation. Over half of the
members of the Committee are new in the 117th Congress. Also,
we have a new Administration. As such, Congress has not had the
benefit of receiving testimony on this proposal. Many of the
concerns posed below could have been addressed if the Majority
had included this bill in one of number of legislative hearings
held by the Subcommittee on Health or the Subcommittee on
Economic Opportunity in the last year.
Second, the Majority failed to consider the serious policy
concerns regarding the potential impact on the VA healthcare
system should this bill be enacted. No views have been provided
by VA, VSOs, or any other stakeholders on the scope of this
language. According to VA 2022 Budget documents, 9.2 million
veterans are enrolled for hospital care and medical services.
Of that number, 7.1 million veterans actually received
treatment at a VA or community care facility. Budgets are
determined by historical enrollment versus utilization. To
increase enrollment without insight as to associated increases
in utilization or other requirements would create a potential
imbalance between budgetary needs and reality.
Third, to proceed with an expansion at this time is
premature. Last Congress passed Public Law 116-171, the
``Commander John Scott Hannon Veterans Mental Health Care
Improvement Act of 2019.'' A provision in that law required VA
to submit a strategic plan for the provision of health care to
any veteran during the one-year period following the discharge
or release of the veteran from active service. The plan has
been delayed beyond its October 2021 required date due to
coordination issues with the Department of Defense. This
language recognized the need for, as well as the challenges of,
offering blanket access to healthcare during the critical one-
year transition period after leaving military service. This
strategic plan is now expected to be released in early 2022.
Fourth, the Majority failed to consider the disparity among
the veteran populations that this bill will create. The
Majority rightly asserts in their report, that providing care
immediately upon separation is crucial for veterans as the
first few months after transitioning out of the military can be
a time of stress and high risk for mental health challenges.
The Minority joins in strongly believing that no veteran should
have to struggle with navigating VA bureaucracy to enroll in
care. The Minority also recognizes that the current priority
group system that governs eligibility for care in the V.A.
healthcare system is outdated and in need of reform.
Unfortunately, automatic enrollment offered to only those who
separate or retire on or after the date of bill enactment, that
is only newly separating servicemembers, does not address the
larger issue.
As we saw with the veteran demand for vaccinations among a
population that is not eligible for VA healthcare due to income
levels or lack of a service connection rating, a disparity will
result from this bill which will certainly result in similar
issues of equity. The Caregiver Program of Comprehensive
Assistance for Family Caregivers is another example of the
problems generated by inequitable treatment of one era of
veterans versus another. The Majority's report cites as an
example that many of the 175,000 veterans who served in
Operation Enduring Freedom (OEF), Operation Iraqi Freedom
(OIF), and Operation New Dawn (OND) are unaware of their
eligibility for five years of VA health care upon separation.
Ironically, this bill will likely not help many of these
veterans who have most likely already separated.
Finally, there are serious concerns as to the cost of this
legislation and, given the lack of any VA testimony or formal
views presented on this language, are equally unsure as to the
true costs for this bill. The Congressional Budget Office (CBO)
states that this bill will have a significant discretionary
cost of $3.1 billion over five years due to an influx of new
veteran enrollees. In addition to the cost, Congress has no
idea how significant the impact of an automatic enrollment will
be on the VA healthcare system. This uncertainty includes
potential impacts on access to care for other veterans with
potentially greater needs, VA staffing and facility
requirements, or impact on budgetary projections. Furthermore,
there is no proposed offset for this discretionary spending.
Since the beginning of the 117th Congress, the members of the
Majority and Minority have joined in a pledge to address the
needs of toxic-exposed servicemembers and veterans as a top
priority. CBO has concluded that the cost to expand these
benefits to toxic-exposed veterans will be in the hundreds of
billions of dollars in both mandatory and discretionary costs.
While the mechanics of addressing the needs of toxic-exposed
veterans still a matter of debate, the Majority believes that
committing to significant cost outside of this priority, and in
a manner that may not impact this population, is premature.
During the Full Committee markup of the bill, I offered an
amendment intended to address the Minority's grave concerns
with Chairman Takano's language. The amendment would have
replaced the underlying bill with the text from H.R. 1216, the
Modernizing Veterans Health Care Eligibility Act, creating a
bipartisan commission to evaluate eligibility for care and to
recommend a path to improving eligibility for not only
transitioning servicemembers but also for other groups of
veterans who are, arguably, not well-served today. This
amendment was voted down by the Majority. Not only would this
amendment have provided a more measured, fiscally responsible,
and frankly more veteran-focused approach to enrollment
eligibility for VA healthcare, it would have included all
veterans not just those separating or retiring after passage of
H.R. 4673. This amendment would have given the Committee the
information, data, and time needed to consider expanding
responsibly, an opportunity to understand the true cost and
implications of enrolling more veterans in VA healthcare, and
most importantly to gather the views of not only VA but
numerous other stakeholders in the process. In failing to
address the larger issue of enrollment, and equity in
eligibility, I am unable to support H.R. 4673.
Mike Bost,
Ranking Member.
[all]