[House Report 117-60]
[From the U.S. Government Publishing Office]


117th Congress    }                                    {       Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                    {       117-60

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



 
             EQUAL ACCESS TO CONTRACEPTION FOR VETERANS ACT

                                _______
                                

 June 14, 2021.--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. 239]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 239) 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, report favorably thereon 
and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Text of Reported Bill............................................     2
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     3
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     4
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..............................     6
Statement on Duplication of Federal Programs.....................     6
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     6

                         Text of Reported Bill

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

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 U.S.C. 300gg-13(a)(4)).''.

                          Purpose and Summary

    H.R. 239 was introduced by Representative Julia Brownley of 
California on January 11, 2021. H.R. 239 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 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 over-the-counter methods including 
emergency contraception. In addition, the committee expects 
that this will also apply to eliminating co-pays for placement 
of long-acting reversible contraceptives (LARCs), including 
intra-uterine devices (IUDs) and implants that the Veterans 
Health Administration (VHA) classifies as prosthetics.

                                Hearings

    No hearing was held on H.R. 239.

                       Subcommittee Consideration

    There was no Subcommittee markup of H.R. 239.

                        Committee Consideration

    On May 4, 2021, the full Committee met in an open markup 
session, a quorum being present, and ordered H.R. 239, 
favorably reported to the House of Representatives by roll call 
vote.

                            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. The results of the record vote on the motion to 
transmit, together with the names of those voting for and 
against, are printed below.

Veterans' Affairs Committee record vote No. 3

    A motion to favorably report the en bloc bills to the U.S. 
House of Representatives was agreed to by roll call vote. 
Passed: 22-6. The vote was as follows:

------------------------------------------------------------------------
        Majority Members            Vote     Minority Members     Vote
------------------------------------------------------------------------
Mr. Takano......................      Aye   Mr. Bost..........      Aye
Ms. Brownley....................      Aye   Ms. Radewagen.....  ........
Mr. Lamb........................      Aye   Mr. Bergman.......  ........
Mr. Levin.......................      Aye   Mr. Banks.........      Nay
Mr. Pappas......................      Aye   Mr. Roy...........      Nay
Ms. Luria.......................      Aye   Mr. Murphy........      Aye
Mr. Mrvan.......................      Aye   Mr. Mann..........      Nay
Mr. Sablan......................      Aye   Mr. Moore.........      Nay
Ms. Underwood...................      Aye   Ms. Mace..........      Aye
Mr. Allred......................      Aye   Mr. Cawthorn......      Aye
Ms. Frankel.....................      Aye   Mr. Nehls.........      Nay
Mr. Brown.......................      Aye   Mr. Rosendale.....      Nay
Ms. Slotkin.....................      Aye   Ms. Miller-Meeks..      Aye
Mr. Trone.......................      Aye
Ms. Kaptur......................      Aye
Mr. Ruiz........................      Aye
Mr. Gallego.....................      Aye
------------------------------------------------------------------------

                      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. 239 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. 
239, 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. 239 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 25, 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. 239, the Equal 
Access to Contraception for Veterans 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. 239 would eliminate copayments that the Department of 
Veterans Affairs (VA) charges to veterans who receive 
contraceptive items from the Veterans Health Administration. 
Those copayments are deposited in the Medical Care Collections 
Fund. VA spends those collections, subject to appropriation, to 
partially offset the cost of medical care for veterans.
    Using historical information from VA on copayments, CBO 
estimates that collections would decline by $400,000 each year. 
CBO estimates that lower out-of-pocket costs would lead to a 10 
percent increase in the number of contraceptive prescriptions 
that veterans fill through VA and would increase department 
spending by $700,000 each year. Over the 2021-2026 period, CBO 
estimates that the change would cost $5 million. Such spending 
would be subject to the availability of appropriated funds.
    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. 239, 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. 
239.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 239 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. 239 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. 239 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. 239 contains no directed rule making 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




           *       *       *       *       *       *       *
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 U.S.C. 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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