[Extensions of Remarks]
[Pages E17-E18]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

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

______

HON. BENJAMIN A. GILMAN

of new york

in the house of representatives

Wednesday, January 6, 1999

Mr. GILMAN. Mr. Speaker, I rise today to introduce H.R. 24 the
Veterans Health Care Allocation Fairness Act of 1999.
In 1996, the Veterans Administration was mandated by Congress to
develop and implement a more equitable method for allocating health
care resources. In response, the VA devised the veterans equity
resource allocation (VERA) model.
While VERA was a noble effort, it is based on a flawed model. As a
research method, VERA is unfairly biased against older veterans in
major metropolitan areas. These veterans are those in need of
inpatient, comprehensive health care, and they will suffer if VERA is
allowed to go forward as planned.
This legislation is designed to correct these inherent flaws within
VERA. Specifically, it does this in three ways:
First, the bill would raise the income level in the means test by 20%
for any veteran who lives in a standard metropolitan statistical area
(SMSA) as defined by the Bureau of the Census. This would make the VA
more accessible to veterans who live in high-cost areas, thus
increasing the number of veterans who use VA in those regions.
Second, the bill would move veterans with catastrophic health care
expenses from category ``C'' (those who must meet the means test for
non-service connected care) to category ``A'' (those eligible for free
non-service connected care). These veterans are defined as those
individuals whose medical expenses for the previous year exceeded 7.5%
of their adjusted gross income.
Third, the bill would level the playing field between the northeast
and southwest by removing the high-cost, ``inefficient'' speciality
care programs from those funds which can be considered in reallocation
calculations under VERA. The programs removed would include:
Readjustment counseling and treatment, counseling and psychiatric care
for the mentally ill, drug and alcohol related programs, programs for
the homeless, PTSD programs, spinal cord injury programs, AIDS programs
and geriatric and extended care programs.
In a memorandum prepared for me by the Congressional Research Service
on this legislation, it estimates that this bill would result in an
additional 5-6% of veterans in the northeast becoming eligible for free
health care. That translates to approximately 75,000 additional
veterans for New York alone. CRS also estimates that if 20% of these
veterans seek to use VA services, a conservative assumption, it would
result in an increased caseload for both VISN #2 and #3 of 15-20%. This
would force a recomputation of VERA distributions, and result in more
VA health care funds remaining in northern urban areas.
Accordingly, I urge my colleagues to support this legislation which
will help ensure that all veterans receive equal opportunity to the
health care which they have earned, regardless of where they have
chosen to live.

H.R. 24

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

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

(a) Exception Based on Prior Catastrophic Health Care
Expenses.--Subsection (a) of section 1722 of title 38, United
States Code, is amended--
(1) by striking ``or'' at the end of paragraph (2);
(2) by striking the period at the end of paragraph (3) and
inserting ``; or''; and
(3) by adding at the end the following new paragraph:
``(4) the veteran's expenses for medical care (as defined
in section 213 of the Internal

[[Page E18]]

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

SEC. 2. SERVICES FOR MENTALLY ILL VETERANS.

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

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

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

``Sec. 8117. Allocation of medical care resources

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

____________________