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110th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 110-645
SPINA BIFIDA HEALTH CARE PROGRAM EXPANSION ACT
May 15, 2008.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
Mr. Filner, from the Committee on Veterans' Affairs, submitted the
R E P O R T
[To accompany H.R. 5729]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 5729) to amend title 38, United States Code, to
direct the Secretary of Veterans Affairs to provide
comprehensive health care to children of Vietnam veterans born
with Spina Bifida, and for other purposes, having considered
the same, report favorably thereon with an amendment and
recommend that the bill as amended do pass.
Purpose and Summary.............................................. 2
Background and Discussion........................................ 2
Committee Consideration.......................................... 3
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
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....................................... 6
Advisory Committee Statement..................................... 6
Constitutional Authority Statement............................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill as Reported............. 6
The amendment is as follows:
Strike all after the enacting clause and insert the
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Spina Bifida Health Care Program
SEC. 2. PROVISION OF COMPREHENSIVE HEALTH CARE BY SECRETARY OF VETERANS
AFFAIRS TO CHILDREN OF VIETNAM VETERANS BORN WITH
(a) Provision of Comprehensive Health Care.--Section 1803(a) of title
38, United States Code, is amended by striking ``such health care as
the Secretary determines is needed by the child for the spina bifida or
any disability that is associated with such condition'' and inserting
``health care under this section''.
(b) Effective Date.--The amendment made by subsection (a) shall apply
with respect to care furnished after the date of the enactment of this
Purpose and Summary
H.R. 5729 was introduced by Representative Brad Ellsworth
of Indiana on April 8, 2008. The legislation would expand the
Department of Veterans Affairs Spina Bifida Health Care Program
to provide a comprehensive health benefit to beneficiaries.
The Spina Bifida Health Care Program is a federal health
benefit administered by the Department of Veterans Affairs
(VA). The program was established to provide appropriate health
care benefits to children who were born with Spina Bifida and
whose birth parent is a veteran of Vietnam or Korea. The
current program is fee-for-service and provides payment for
medical services and supplies related to Spina Bifida and
conditions associated with Spina Bifida. H.R. 5729 expands the
current benefit to provide comprehensive health care to
children of Vietnam and Korean War veterans born with Spina
Background and Discussion
Spina Bifida is a developmental birth defect in which the
embryonic neural tube does not completely close, resulting in
an incompletely formed spinal cord. The vertebrae overlying the
open portion of the spinal cord do not fully form and remain
unfused and open. Spina Bifida can cause varying degrees of
sensory, motor and/or cognitive impairment. Other conditions
associated with Spina Bifida include latex allergy, obesity,
skin breakdown, gastrointestinal disorders, learning
disabilities, depression, and social and sexual issues.
The ``Agent Orange Benefits Act,'' Public Law 104-204
established a benefits package for children of Vietnam veterans
born with Spina Bifida, possibly as a result of one or both
parents' exposure to herbicides during active service in the
Republic of Vietnam during the Vietnam era. Benefits include
lifetime health services for Spina Bifida and ``any disability
associated'' with Spina Bifida, a monthly monetary allowance,
and VA vocational training and rehabilitation services.
The ``Veterans Benefits Act of 2003,'' Public Law 108-183,
mandated that benefits of the Spina Bifida Health Care Program
be extended to the natural children of those who served in
Korea during the period of September 1, 1967, to August 31,
1971. In order to be eligible for this benefit, the veteran
must have served in the active military, naval or air service
and must have been exposed to an herbicide agent during such
service in or near the Korean demilitarized zone.
The Spina Bifida Health Care Program currently has
approximately 1,200 beneficiaries and this number is not
expected to grow in the future. As currently administered, this
program puts a significant administrative burden on
beneficiaries and their families. Because current law requires
that care provided under the Spina Bifida Health Care Program
be for medical services for Spina Bifida or related conditions,
beneficiaries must provide documentation that the care received
was related to Spina Bifida. This requirement is often
burdensome and difficult, as Spina Bifida has numerous
secondary conditions, and it is oftentimes difficult or
impossible to ascertain if a condition is secondary to Spina
H.R. 5729 would provide Spina Bifida Health Care Program
beneficiaries with a comprehensive health benefit. Because
there is no requirement that health care provided under this
program be related to Spina Bifida, it will decrease the
administrative burden on the beneficiaries by allowing them to
access a comprehensive health benefit. Additionally, many
program beneficiaries' parents are their primary caretaker. As
these parents age, and are no longer able to provide the level
of care that their children require, this bill ensures they
will receive the services they need when their caretakers are
no longer able to care for them.
On April 15, 2008, the Subcommittee on Health held a
legislative hearing on a number of bills introduced in the
110th Congress, including H.R. 5729. The following witnesses
testified: The Honorable Bob Filner of California; The
Honorable Michael H. Michaud of Maine; The Honorable Ginny
Brown-Waite of Florida; The Honorable Ed Perlmutter of
Colorado; The Honorable Christopher P. Carney of Pennsylvania;
The Honorable Brad Ellsworth of Indiana; Mr. Joseph L. Wilson,
Deputy Director, Veterans Affairs and Rehabilitation
Commission, The American Legion; Ms. Joy J. Ilem, Assistant
National Legislative Director, Disabled American Veterans; Mr.
Christopher Needham, Senior Legislative Associate, National
Legislative Services, Veterans of Foreign Wars of the United
States; Mr. Richard F. Weidman, Executive Director for Policy
and Government Affairs, Vietnam Veterans of America; Mr. Bernie
Edelman, Deputy Director, Vietnam Veterans of America; Gerald
M. Cross, MD, FAAFP, Principal Deputy Under Secretary for
Health, Veterans Health Administration, U.S. Department of
Veterans Affairs accompanied by Mr. Walter Hall, Assistant
General Counsel, U.S. Department of Veterans Affairs. Those
submitting statements for the record included: American
Veterans (AMVETS) and the Paralyzed Veterans of America.
On April 23, 2008, the Subcommittee on Health met in open
markup session and ordered favorably forwarded to the full
Committee H.R. 5729, without amendment, by voice vote.
On April 30, 2008, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 5729, as
amended, favorably reported to the House of Representatives, by
voice vote. During consideration of the bill the following
amendment was considered:
An amendment by Mr. Buyer of Indiana to strike the
authority to provide domiciliary care, was agreed to by voice
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report the legislation and amendments thereto.
There were no record votes taken on amendments or in connection
with ordering H.R. 5729 reported to the House. A motion by Mr.
Buyer of Indiana to order H.R. 5729, as amended, reported
favorably to the House of Representatives was agreed to by
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
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 reflected in the descriptive portions
of this report.
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. 5729 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e), or 9(f) 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.
5729 prepared by the Director of the Congressional Budget
Office pursuant to section 402 of the Congressional Budget Act
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. 5729 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
Congressional Budget Office,
Washington, DC, May 12, 2008.
Hon. Bob Filner,
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. 5729, the Spina
Bifida Health Care Program Expansion Act.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Sunita
Robert A. Sunshine
(For Peter R. Orszag, Director).
H.R. 5729--Spina Bifida Health Care Program Expansion Act
H.R. 5729 would authorize the Department of Veterans
Affairs (VA) to expand the health care benefits provided to the
children, born with spina bifida, of certain veterans. CBO
estimates that implementing the bill would cost $11 million
over the 2009-2013 period, assuming appropriation of the
estimated amounts. Enacting the bill would have no effect on
direct spending or revenues.
Spina bifida is a congenital condition in which the spine
fails to close completely and can lead to severe neurological
damage and mobility impairments. Under two sections of current
law (38 U.S.C. 1803 and 38 U.S.C. 1821), the children of
Vietnam and Korean war veterans who were born with spina bifida
are eligible for VA health care related to that condition. H.R.
5729 would expand that benefit and allow them to receive
comprehensive health care through VA. (The bill amends 38
U.S.C. 1803, which addresses children of Vietnam veterans.
However, 38 U.S.C. 1821 requires that the same benefits be
provided to eligible children of veterans of the Korean war.)
In 2007, VA provided health care related to spina bifida to
about 745 beneficiaries at an average cost of $22,000 per
person; that population has remained fairly stable in recent
years. Based on information from VA about the population and
the wide range and complexity of conditions related to spina
bifida, CBO estimates that VA currently provides about 90
percent of the comprehensive health care needs of this
population. CBO expects that the expansion of benefits under
H.R. 5729 would not significantly increase the number of
individuals seeking care for spina bifida from VA. We expect
that people who do not currently use VA's services under this
program would prefer to maintain continuity of care with their
current health care providers.
CBO estimates that under the bill, VA would provide
comprehensive care to beneficiaries it already serves at an
added cost of $2,500 per person in 2009, for a total of $2
million, assuming appropriation of the necessary amounts. After
adjusting for inflation, CBO estimates those costs would rise
to $3,400 per person by 2013, for a total of $3 million,
assuming appropriation of the necessary amounts.
H.R. 5729 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would not affect the budgets of state, local, or tribal
The CBO staff contact for this estimate is Sunita D'Monte.
This estimate was approved by Theresa Gullo, Deputy Assistant
Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 5729 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.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
Constitutional authority for H.R. 5729 is provided by Article
I, section 8 of the Constitution of the United States.
Applicability to Legislative Branch
The Committee finds that the legislation 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.
Section-by-Section Analysis of the Legislation
Section 1. Short title
This section would provide the short title of H.R. 5729 as
the ``Spina Bifida Health Care Program Expansion Act.''
Section 2. Provision of comprehensive health care by Secretary of
Veterans Affairs to children of Vietnam veterans born with
This section amends section 1803 of title 38, United States
Code, to provide a comprehensive health benefit to the children
of Vietnam veterans born with Spina Bifida.
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 italic, existing law in which no change is
proposed is shown in roman):
SECTION 1803 OF TITLE 38, UNITED STATES CODE
Sec. 1803. Health care
(a) In accordance with regulations which the Secretary shall
prescribe, the Secretary shall provide a child of a Vietnam
veteran who is suffering from spina bifida with [such health
care as the Secretary determines is needed by the child for the
spina bifida or any disability that is associated with such
condition] health care under this section.
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