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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 
                               following

                              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.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     2
Background and Discussion........................................     2
Hearings.........................................................     3
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

                               Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Spina Bifida Health Care Program 
Expansion Act''.

SEC. 2. PROVISION OF COMPREHENSIVE HEALTH CARE BY SECRETARY OF VETERANS 
                    AFFAIRS TO CHILDREN OF VIETNAM VETERANS BORN WITH 
                    SPINA BIFIDA.

  (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 
Act.

                          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 
Bifida.

                       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 
Bifida.
    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.

                                Hearings

    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.

                        Committee Consideration

    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 
vote.

                            Committee Votes

    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 
voice vote.

                      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 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 
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. 5729 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 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 
D'Monte.
            Sincerely,
                                         Robert A. Sunshine
                                   (For Peter R. Orszag, Director).
    Enclosure.

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 
governments.
    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. 
5729.

                   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 
        Spina Bifida.

    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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