[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.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                      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.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    

    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]