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105th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES

 1st Session                                                    105-291
_______________________________________________________________________


 
   AUTHORIZING MAJOR MEDICAL CONSTRUCTION PROJECTS AND MAJOR MEDICAL 
FACILITY LEASES FOR THE DEPARTMENT OF VETERANS AFFAIRS FOR FISCAL YEAR 
                      1998, AND FOR OTHER PURPOSES

_______________________________________________________________________


October 2, 1997.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 2571]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Veterans' Affairs, to whom was referred the 
bill (H.R. 2571) to authorize major medical facility projects 
and major medical facility leases for the Department of 
Veterans Affairs for fiscal year 1998, and for other purposes, 
having considered the same, reports favorably thereon without 
amendment and recommends that the bill do pass.

                              Introduction

    On February 13, 1997, the Committee received testimony on 
the fiscal year 1998 Department of Veterans Affairs (VA) 
budget, including major construction plans. The Honorable Jesse 
Brown, Secretary of Veterans Affairs, testified for the VA. 
Among those accompanying him were General Counsel Mary Lou 
Keener; Mr. Mark Catlett, Assistant Secretary for Management; 
and Dr. Thomas Garthwaite, Deputy Under Secretary for Health.
    A second hearing on the FY 1998 Department of Veterans 
Affairs budget was conducted on February 27, 1997. Those 
testifying included Mr. David W. Gorman, Executive Director of 
the Disabled American Veterans; Mr. Kenneth A. Steadman, 
Executive Director of the Veterans of Foreign Wars of the 
United States; Mr. Michael E. Naylon, National Executive 
Director of AMVETS; Mr. John C. Bollinger, Deputy Executive 
Director of the Paralyzed Veterans of America; Mr. John R. 
Vitikacs, Assistant Director, National Veterans Affairs and 
Rehabilitation Commission of The American Legion; Mr. Larry D. 
Rhea, Deputy Director of Legislative Affairs, Non Commissioned 
Officers Association; and Ms. Kelli Willard West, Director of 
Government Relations, Vietnam Veterans of America.
    The full Committee met on September 30, 1997 and ordered 
H.R. 2571 reported favorably to the House by unanimous voice 
vote.

                      Summary of the Reported Bill

    H.R. 2571 would:

    1. Authorize the following major medical construction 
projects:
          a) seismic corrections at the Department of Veterans 
        Affairs Medical Center in Memphis, Tennessee;
          b) seismic corrections and clinical and other 
        improvements at the McClellan Hospital at Mather Field, 
        Sacramento, California (which will be transferred to VA 
        before any construction commences); and
          c) outpatient improvements at Mare Island, Vallejo, 
        California, and Martinez, California.

    2. Authorize major medical facility leases of information 
resources management field offices in Birmingham, Alabama, and 
Salt Lake City, Utah; and satellite outpatient clinics in 
Jacksonville, Florida; Boston, Massachusetts; Canton, Ohio; 
Portland, Oregon; and Tulsa, Oklahoma.
    3. Authorize $34.6 million for the Construction, Major 
Projects account for the Memphis project and $15.703 million 
for the Medical Care account for the leases.
    4. Specify that the California projects must be carried out 
using previously appropriated funds.

                       Background and Discussion

                      Major Construction Projects

    Section 1 of H.R. 2571 would authorize major construction 
projects for fiscal year 1998. The Committee proposes that 
$34.6 million be authorized to complete seismic corrections at 
the Memphis VA Medical Center. The facility, which does not 
conform to current seismic standards, lies on the New Madrid 
fault line, which has a high probability of considerable 
seismic activity. The VAMC could not sustain an earthquake of 
the proportion predicted and there is no VA medical center in 
the vicinity which could assume Memphis's mission in the case 
of such a calamity. This second phase of the project--Phase I 
has already been completed--would remove the upper nine floors 
of the main hospital building and provide seismic reinforcement 
to the remaining five floors.
    The bill also would authorize up to $48 million in 
previously appropriated funds to make seismic corrections and 
to provide clinical improvements to the McClellan Hospital at 
Mather Field in Sacramento, California. VA anticipates that the 
McClellan facility will be transferred at no cost from the Air 
Force under the Base Realignment and Closure (BRAC) process. 
The bill would also authorize up to $7 million for outpatient 
improvements at the facilities in Mare Island, Vallejo, 
California and Martinez, California. The bill specifies that 
the funding for these projects be taken from already-
appropriated Major Construction funds that remain available for 
obligation.
    This project is being authorized in lieu of previous VA 
plans to construct a 234-bed replacement inpatient facility at 
Travis Air Force Base to replace the Martinez VA Medical 
Center, which closed due to seismic damage in 1991. VA long 
supported such a project, and had secured partial funding for a 
$211 million replacement hospital at Travis, which lies midway 
between Sacramento and the closed Martinez site. The General 
Accounting Office concluded that the construction project was 
ill-advised and that lower cost alternatives should be 
explored. At the direction of the appropriations committees, VA 
contracted for a study on the health care needs of veterans in 
northern California. That study recommended that the inpatient 
needs of these veterans be met through a model which relies on 
care being furnished at several sites rather than a single 
replacement facility. The single-site option was considered 
undesirable in terms of both access and cost. The study 
recommended that in the Sacramento area, VA concentrate its 
provision of care at Mather Air Force Base, where the Air 
Force-operated McClellan Hospital is being closed under the 
BRAC process. With seismic and other renovations and 
improvements, the former McClellan facility would provide up to 
90 inpatient beds; additionally, VA projects that it would have 
the capacity to provide 110,000 outpatient visits annually.
    The Martinez project provides for the replacement of 
temporary buildings at the site, which includes a recently 
constructed outpatient clinic and nursing home. The replacement 
space would be used for home-based primary care, day treatment 
programs, and educational programs. The bill would also provide 
for construction work to upgrade an existing outpatient clinic 
at the former Mare Island Naval Shipyard in Vallejo, which VA 
anticipates will provide primary care, mental health care, and 
limited specialty care to veterans. VA projects a workload at 
the clinic of 30,000 outpatient visits.

                     Major Medical Facility Leases

    The Committee recognizes the need for the VA to enter into 
lease agreements to serve veterans' communities across the 
nation. The bill authorizes VA to enter into seven major 
medical leases and authorizes funding for sums representing the 
estimated annual rent and one-time cost of converting space for 
medical use. Specifically, H.R. 2571 would authorize funds for 
the lease of an information resources management field office 
in Birmingham, Alabama for up to $595,000; a satellite 
outpatient clinic in Jacksonville, Florida for up to $3.095 
million; a satellite outpatient clinic in Boston, Massachusetts 
for up to $5.215 million; a satellite outpatient clinic in 
Canton, Ohio for up to $2.115 million; a satellite outpatient 
clinic in Portland, Oregon for up to $1.919 million; a 
satellite outpatient clinic in Tulsa, Oklahoma for up to $2.112 
million; and an information resources management field office 
in Salt Lake City, Utah for up to $652,000.

                    Authorization of Appropriations

    H.R. 2571 would authorize the appropriation of $34.6 
million for the Construction, Major Projects account for the 
seismic correction project at the Memphis VA Medical Center. 
This authorization would provide for completing the second and 
final phase of this $107 million project.
    The bill would also authorize appropriations in the amount 
of $15.703 million for the Medical Care account for the seven 
leases.
    H.R. 2571 would specify that the $48 million authorized for 
the McClellan project and the $7 million authorized for the 
Mare Island and Martinez projects be taken from already-
appropriated funds. Congress had previously appropriated $79.7 
million toward construction of a replacement medical center 
(and has previously authorized construction of an outpatient 
clinic at Travis Air Force Base). To date, VHA has spent about 
$10 million of that amount on design work, site preparation and 
construction. The remainder is unobligated and would be the 
source of this funding.

                      Section-by-Section Analysis

    Section 1(1) would authorize seismic corrections at the 
Memphis VA Medical Center in an amount not to exceed $34.6 
million.

    Section 1(2) would authorize in already-appropriated funds 
seismic corrections and other improvements at the McClellan 
Hospital in Sacramento, California in an amount not to exceed 
$48 million.

    Section 1(3) would authorize in already-appropriated funds 
outpatient improvements at facilities in Mare Island, Vallejo, 
California and Martinez, California in an amount not to exceed 
$7 million.

    Section 2(1) would authorize the lease of an information 
resources management field office in Birmingham, Alabama in an 
amount not to exceed $595,000.

    Section 2(2) would authorize the lease of a satellite 
outpatient clinic in Jacksonville, Florida in an amount not to 
exceed $3.095 million.

    Section 2(3) would authorize the lease of a satellite 
outpatient clinic in Boston, Massachusetts in an amount not to 
exceed $5.215 million.

    Section 2(4) would authorize the lease of a satellite 
outpatient clinic in Canton, Ohio in an amount not to exceed 
$2.115 million.

    Section 2(5) would authorize the lease of a satellite 
outpatient clinic in Portland, Oregon in an amount not to 
exceed $1.919 million.

    Section 2(6) would authorize the lease of a satellite 
outpatient clinic in Tulsa, Oklahoma in an amount not to exceed 
$2.112 million.

    Section 2(7) would authorize the lease of an information 
resources management field office in Salt Lake City, Utah in an 
amount not to exceed $652,000.

    Section 3(a)(1) would authorize $34.6 million for the 
Construction, Major Projects account for Fiscal Year 1998.

    Section 3(a)(2) would authorize $15.703 million for the 
Medical Care account for Fiscal Year 1998.

    Section 3(b) specifies that the projects in section 1 may 
only be carried out using funds appropriated in section 1(a); 
already-appropriated, non-obligated Construction, Major 
Projects funds; and unspecified Fiscal Year 1998 Construction, 
Major Projects funds.

                           Oversight Findings

    No oversight findings have been submitted to the Committee 
by the Committee on Government Reform and Oversight.

               Congressional Budget Office Cost Estimate

    The following letter was received from the Congressional 
Budget Office concerning the cost of the reported bill:

                                     U.S. Congress,
                               Congressional Budget Office,
                                   Washington, DC, October 1, 1997.
Hon. Bob Stump,
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. 2571, a bill to 
authorize major medical facility projects and major medical 
facility leases for the Department of Veterans Affairs for 
fiscal year 1998, and for other purposes.
    If you wish further details on this estimate, we will be 
pleased to provide them.
    The CBO staff contact is Shawn Bishop, who can be reached 
at 226-2840.
            Sincerely,
                                           June E. O'Neill,
                                                           Director

    Enclosure

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

  H.R. 2571--A bill to authorize major medical facility projects and 
 major medical facility leases for the Department of Veterans Affairs 
              for fiscal year 1998, and for other purposes

As ordered reported by the House Committee on Veterans' Affairs 
on September 30, 1997

    Summary. --H.R. 2571 would authorize appropriations for 
construction projects and leases at medical facilities of the 
Department of Veterans Affairs (VA). CBO estimates that 
enacting the bill would result outlays of about $14 million in 
1997 and $48 million over the 1998-2002 period, assuming 
appropriation of the authorized amounts. Because the bill would 
not affect direct spending or receipts, pay-as-you-go 
procedures would not apply. The bill contains no 
intergovernmental or private-sector mandates defined in the 
Unfunded Mandates Reform Act (UMRA) and would not affect the 
budgets of State, local, or tribal governments.

    Estimated cost to the Federal Government. --The bill would 
authorize appropriations of $34.6 million to complete seismic 
corrections at VA's medical facility in Memphis, Tennessee, and 
appropriations of $15.7 million for several specific leasing 
agreements. The following table shows CBO's estimate of the 
budgetary impact of the bill over the 1998-2002 period, 
assuming appropriation of the authorized amounts.

                                                                                                                                                                                                
                                                                            [By fiscal year, in millions of dollars]                                                                            
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                              1997                 1998                        1999                        2000                        2001                        2002         
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                                                                                
                                                                                SPENDING SUBJECT TO APPROPRIATION                                                                               
Spending Under Current Level for Major                                                                                                                                                          
 Construction:                                                                                                                                                                                  
    Estimated authorization level 1 ...          219                   32                           0                           0                           0                           0       
    Estimated outlays..................          559                  243                         126                          53                          20                           9       
Proposed Changes:                                                                                                                                                                               
  Estimated authorization level........            0                   50                           0                           0                           0                           0       
  Estimated outlays....................            0                   14                           7                          11                          10                           6       
Spending Under H.R. 2571 for Major                                                                                                                                                              
 Construction:                                                                                                                                                                                  
    Estimated authorization level......          219                   82                           0                           0                           0                           0       
    Estimated outlays..................          559                  258                         133                          64                          30                          15       
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1 The 1997 and 1998 levels are the amounts appropriated for those years as of September 30, 1997.                                                                                               


    The bill would also authorize VA to use $55 million 
unobligated balances for two projects. The funding would be 
derived from amounts appropriated for fiscal years beginning 
before 1998 and that remain available for obligation. CBO 
estimates that this authorization would have no budgetary 
impact because the annual spending for the two newly authorized 
projects would not differ significantly from spending for the 
project that was funded originally.

    Pay-as-you-go considerations. --None.

    Intergovernmental and private-sector impact. --The bill 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would not affect the budgets of State, 
local, or tribal governments.

    Estimate prepared by:
          Federal cost: Shawn Bishop
          Impact on State, local, and tribal governments: Marc 
        Nicole
          Impact on the private sector: Rachel Schmidt

    Estimate approved by:
          Robert A. Sunshine, Deputy Assistant Director for 
        Budget Analysis

                     Inflationary Impact Statement

    The enactment of the reported bill would have no 
inflationary impact.

                  Applicability to Legislative Branch

    The reported bill would not be applicable to the 
legislative branch under the Congressional Accountability Act, 
Public Law 104-1, because it would apply only to certain 
Department of Veterans Affairs programs and facilities.

                 Statement of Constitutional Authority

    Pursuant to Article I, section 8 of the United States 
Constitution, the reported bill would be authorized by 
Congress' power to ``provide for the common Defence and general 
Welfare of the United States.''

                     Statement of Federal Mandates

    The reported bill would not establish a federal mandate 
under the Unfunded Mandates Reform Act, Public Law 104-4.

                                   -