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116th Congress  }                                        {  Rept. 116-166
                        HOUSE OF REPRESENTATIVES
 1st Session    }                                        {  Part 1

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



 
  HELPING EXPAND AND LAUNCH TRANSITIONAL HEALTH FOR WOMEN VETERANS ACT

                                _______
                                

 July 23, 2019.--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

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 2942]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 2942) to direct the Secretary of Veterans 
Affairs to carry out the Women's Health Transition Training 
pilot program through at least fiscal year 2020, and for other 
purposes, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.
    The Committee on Veterans' Affairs, to which was referred 
the bill (H.R. 2942) to direct the Secretary of Veterans 
Affairs to carry out the Women's Health Transition Training 
pilot program through at least fiscal year 2020, and for other 
purposes.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     3
Hearings.........................................................     3
Subcommittee Consideration.......................................     4
Committee Consideration..........................................     4
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.............................     5
Committee Cost Estimate..........................................     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Advisory Committee Statement.....................................     6
Constitutional Authority Statement...............................     6
Applicability to Legislative Branch..............................     6
Statement on Duplication of Federal Programs.....................     7
Disclosure of Directed Rulemaking................................     7
Section-by-Section Analysis of the Legislation...................     7
Changes in Existing Law Made by the Bill as Reported.............     7
Minority Views...................................................     8

    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 ``Helping Expand and Launch Transitional 
Health for Women Veterans Act'' or ``HEALTH Act''.

SEC. 2. ENCOURAGEMENT OF PARTICIPATION IN WOMEN'S HEALTH TRANSITION 
                    TRAINING PILOT PROGRAM.

  (a) Duration.--The Secretary of Veterans Affairs shall carry out the 
Women's Health Transition Training pilot program (in this section 
referred to as the ``pilot program'') until at least September 30, 
2020.
  (b) Report.--Not later than September 30, 2020, the Secretary of 
Defense and the Secretary of Veterans Affairs shall jointly submit to 
the appropriate congressional committees a report on the pilot program 
that includes the following:
          (1) For the period since the commencement of the pilot 
        program--
                  (A) the number of women members by military 
                department (with respect to Department of the Navy, 
                separately for the Navy and Marine Corps) who 
                participated in the pilot program;
                  (B) the number of courses held under the pilot 
                program; and
                  (C) the locations at which such courses were held, 
                and the number of seats available and the number of 
                participants at each such location.
          (2) With respect to the number of members who participated in 
        the pilot program as specified under paragraph (1)--
                  (A) the number who enrolled in the health care system 
                established under section 1705(a) of title 38, United 
                States Code; and
                  (B) the number who attended at least one health care 
                appointment at a medical facility of the Department of 
                Veterans Affairs.
          (3) Data relating to--
                  (A) satisfaction with courses held under the pilot 
                program;
                  (B) improved awareness of health care services 
                administered by the Secretary of Veterans Affairs; and
                  (C) any other available statistics regarding the 
                pilot program.
          (4) A discussion of regulatory, legal, or resource barriers 
        to--
                  (A) making the pilot program permanent to enable 
                access by a greater number of women members at 
                locations throughout the United States;
                  (B) offering the pilot program online for women 
                members who are unable to attend courses held under the 
                pilot program in person; and
                  (C) the feasibility of automatically enrolling pilot 
                program participants in the health care system 
                established under section 1705(a) of title 38, United 
                States Code.
  (c) Appropriate Congressional Committees Defined.--In this section, 
the term ``appropriate congressional committees'' means the Committees 
on Veterans' Affairs and the Committees on Armed Services of the House 
of Representatives and the Senate.

                          PURPOSE AND SUMMARY

    H.R. 2942, ``To direct the Secretary of Veterans Affairs to 
carry out the Women's Health Transition Training pilot program 
through at least fiscal year 2020, and for other purposes,'' 
was introduced by Representative Gil Cisneros, along with 
Representative Chrissy Houlahan, on May 23, 2019. H.R. 2942 
would require the Department of Veterans Affairs (VA) to extend 
an ongoing pilot program run by the U.S. Air Force (USAF) under 
VA's Transition Assistance Program that educates transitioning 
servicewomen about women's healthcare at VA.

                  BACKGROUND AND NEED FOR LEGISLATION

    Women veterans are the fastest growing demographic within 
the veteran population yet underutilize VA healthcare 
resources. This is primarily due to misperceptions about 
eligibility and available resources. Many women leaving the 
service may not realize they are eligible to use VA services, 
nor that VA offers extensive gender-specific care such as 
mammography, prenatal and maternity care, infertility, and 
mental health care that addresses complex trauma, including 
military sexual trauma (MST) and combat-related Post-Traumatic 
Stress Disorder (PTSD).
    VA's Air Force Women's Health Transition Training pilot 
works to combat issues commonly experienced by women veterans 
when accessing VA care by building on a highly successful pilot 
program jointly run by the USAF and VA that educates 
servicewomen on the comprehensive women's healthcare services 
available at VA to ensure a ``warm handoff'' between DoD and 
VA. Specifically, the bill would authorize an extension of the 
program across all service branches. According to the 
Department of Defense, participants of the pilot program have 
shown higher rates of confidence in how to access services and 
benefits at VA and report an increased likelihood of actually 
using them.
    In addition, this bill requires reporting on the 
feasibility of making the program permanent, creating an online 
version of the course, and on the feasibility of automatically 
enrolling program participants in VA's healthcare system.

                                HEARINGS

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress--the following hearings and meetings were used 
to develop or consider H.R. 2942.
    On June 20, 2019, the Committee on Veterans' Affairs 
conducted a legislative hearing on various bills introduced 
during the 116th Congress, including H.R. 2942.
    The following witnesses testified:
          The Honorable Gilbert Cisneros, Member of Congress. 
        The Honorable Seth Moulton, Member of Congress. The 
        Honorable Luis Correa, Member of Congress. The 
        Honorable Earl Blumenauer, Member of Congress. The 
        Honorable Phil Roe, Member of Congress. The Honorable 
        Scott Tipton, Member of Congress. Mr. Adrian Atizado, 
        Deputy National Legislative Director, Disabled American 
        Veterans. Mr. Travis Horr, Director, Government 
        Affairs, Iraq and Afghanistan Veterans of America. Dr. 
        Igor Grant, M.D., F.R.C.P.(C), Director, Center for 
        Medicinal Cannabis Research, University of California. 
        Mr. Carlos Fuentes, Director, National Legislative 
        Service, Veterans of Foreign Wars. Mr. Derek 
        Fronabarger, Director, Government Affairs, Wounded 
        Warrior Project. Mr. Larry Mole, BA, PharmD, Chief 
        Consultant, Population Health Services, Patient Care 
        Services, Veterans Health Administration.
    Statements for the record were submitted by:
          Ms. Thelma Roach-Serry, BSN, RN, NE-BC, President, 
        Nurses Organization of Veterans Affairs (NOVA). Mr. 
        Eric Goepel, Founder & CEO, Veterans Cannabis Coalition 
        (VCC). Mr. Morgan D. Brown, National Legislative 
        Director, Paralyzed Veterans of America (PVA). Mr. J. 
        David Cox, Sr., National President, American Federation 
        of Government Employees (AFGE). Mr. Randy Erwin, 
        National President, National Federation of Federal 
        Employees (NFFE). Mr. William Attig, Executive 
        Director, Union Veterans Council, AFL-CIO. Mr. Brett W. 
        Copeland, Executive Director, Veterans Healthcare 
        Policy Institute. Mr. David J. Holway, National 
        Association of Government Employees (NAGE). Mr. Justin 
        Strekal, Political Director, National Organization for 
        the Reform of Marijuana Laws--(NORML).

                       SUBCOMMITTEE CONSIDERATION

    H.R. 2942 was not considered in subcommittee.

                        COMMITTEE CONSIDERATION

    On July 11, 2019, the Committee on Veterans' Affairs met in 
an open markup session, a quorum being present, and ordered 
H.R. 2942, as amended, reported favorably to the House of 
Representatives by voice vote. During the July 11, 2019 
consideration, the Committee considered H.R. 2942 as 
introduced. The Committee adopted an amendment from Rep. 
Cisneros of California to add a short title to the bill 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 recorded 
votes on the motion to report the legislation and amendments 
thereto. Mr. Cisneros's amendment to H.R. 2942 to add a short 
title was agreed to by voice vote. A motion by Ranking Member 
Phil Roe of Tennessee to report H.R. 2942, as amended favorably 
to the House of Representatives was agreed to by voice vote. 
There were no recorded votes on the consideration of amendments 
or on reporting H.R. 2942 as amended to the House.

                      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 continue to study and understand 
the issues surrounding transition of military service members 
and promote transition programs that have been shown to improve 
veteran outcomes.

   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. 2942, as amended 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. 
2942, as amended 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. 2942 provided by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974:
    According to the Congressional Budget Office estimate, H.R. 
2942, as amended would increase the number of beneficiaries who 
would be eligible to receive the funds but would not change the 
total amount of scholarships awarded; thus, enacting the bill 
would not affect direct spending or spending subject to 
appropriation.

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, July 17, 2019.
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. 2942, the Helping 
Expand and Launch Transitional Health for Women Veterans Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                         Phillip L. Swagel,
                                                          Director.
    Enclosure.

    
    

    H.R. 2942 would require the Department of Veterans Affairs 
(VA) to continue, through fiscal year 2020, a pilot program 
that provides information about VA health care to women who are 
separating from the U.S. Armed Forces. The bill also would 
require VA to submit a report to the Congress on the results of 
the program by September 30, 2020.
    VA has conducted the pilot program since July 2018 and 
plans to conclude it at the end of 2020. It also plans to 
submit the report to the Congress at the conclusion of the 
program. Because the bill would codify VA's existing plans, CBO 
estimates that implementing H.R. 2942 would not affect the 
federal budget.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was reviewed by Leo Lex, Deputy Assistant Director 
for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own estimate of Federal 
mandates regarding H.R. 2942, as amended 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. 
2942, as amended.

                   CONSTITUTIONAL AUTHORITY STATEMENT

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 2942, as amended 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. 2942, as amended does not 
relate to the terms and conditions of employment or access to 
public services or accommodations within the legislative 
branch.

              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. 2942, as amended 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. 2942, as amended contains no directed rule 
making that would require the Secretary to prescribe 
regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1: Short title

Section 2:

    Requires VA to continue carrying out the Women's Health 
Transition Training pilot program at least through Fiscal Year 
2020. By September 30, 2020, the Secretaries of Defense and 
Veterans Affairs shall jointly submit a report to Congress on 
the pilot program regarding the number and location of courses 
provided, outcomes and data related to participants of the 
courses, and recommendations for improving the transition for 
women veterans and service members.

         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, existing law in which no change 
is proposed is shown in roman):
    No changes were made to existing law.

                             MINORITY VIEWS

    The Minority offers the following Minority views regarding 
H.R. 2942, as amended.
    The Minority supports H.R. 2942, as amended, but believes 
that it could have been stronger if the Majority had considered 
and accepted an amendment offered by Representative Andy Barr 
of Kentucky to protect the children of our nation's veterans 
being cared for through the Department of Veterans Affairs (VA) 
child care program.
    H.R. 2942, as amended, the Helping Expand and Launch 
Transitional Health for Women Veterans (HEALTH) Act, would 
extend the Women's Health Transition Training Pilot (the pilot) 
through fiscal year 2020 and require a report from the 
Department of Defense (DOD) and VA on the pilot. The pilot 
began as a partnership between VA's Office of Women's Health 
Services and DOD's Air Force Women's Initiative Team.\1\ The 
purpose of the pilot is to increase utilization of the VA 
healthcare system among women veterans by raising awareness of 
the VA health care services available for women during 
servicewomen's transition out of the military.\2\
---------------------------------------------------------------------------
    \1\Veterans Affairs--Air Force Women's Health Transition Training 
Pilot. June 11, 2019. Presentation for Committee on Veterans' Affairs 
Minority staff by VA Office of Women's Health Services and Air Force 
Women's Initiative Team staff.
    \2\Ibid.
---------------------------------------------------------------------------
    The lack of child care services at many VA medical 
facilities is frequently cited as a barrier to care for 
veterans, in general, and for women veterans, in particular. A 
2015 independent study required by the Caregivers and Veterans 
Omnibus Health Services Act of 2010 (Public Law 111-163; 124 
Stat. 1130) on the barriers to comprehensive health care 
experienced by women veterans found that 42 percent of women 
who use the VA healthcare system considered finding childcare 
to attend medical appointments either ``somewhat hard'' or 
``very hard.''\3\ Furthermore, 42 percent of the women veterans 
surveyed had dependents 17 years or younger living at home and 
62 percent indicated that they would find on-site childcare at 
a VA medical center ``very helpful.''\4\
---------------------------------------------------------------------------
    \3\Study of Barriers for Women Veterans to VA Health Care. U.S. 
Department of Veterans Affairs. April 2015. https://
www.womenshealth.va.gov/docs/Womens%20Health%20Services_ 
Barriers%20to%20Care%20Final%20Report_April2015.pdf
    \4\Ibid.
---------------------------------------------------------------------------
    On February 8, 2019, the House passed H.R. 840, as amended, 
the Veterans' Access to Child Care Act, to permanently extend a 
pilot program to provide child care assistance to veterans who 
are receiving mental health or certain other intensive 
healthcare services and expand it across the VA healthcare 
system. H.R. 840 was moved straight to the House Floor, 
bypassing regular order and any consideration or debate within 
the Committee. Upon House passage of that bill, Representative 
Julia Brownley of California, the bill's sponsor as well as the 
Chairwoman of the Subcommittee on Health and the Bipartisan 
Women Veterans Task Force, noted that, ``ensuring veterans have 
access to child care is especially important for our growing 
population of women veterans, who are more likely to be taking 
care of young children.''\5\ The Minority concurs with 
Representative Brownley's assessment of the importance of the 
VA child care program to women veterans. H.R. 840, as amended, 
passed the House by a recorded vote of 400-9.
---------------------------------------------------------------------------
    \5\House Passes Brownley Bill to Expand Child Care Program to 
Improve Veterans' Access to Healthcare. February 8, 2019. https://
juliabrownley.house.gov/house-passes-brownley-bill-to-expand-child-
care-program-to-improve-veterans-access-to-healthcare/. Accessed July 
14, 2019.
---------------------------------------------------------------------------
    During Floor consideration of H.R. 840, as amended, 
Representative Mikie Sherrill of New Jersey offered an 
amendment to prohibit a child care center, agency, or provider 
from caring for a veteran's child under the VA child care 
program if they employ an individual who has been convicted of 
a sex crime, a violent crime, a drug felony, or another offense 
VA considers appropriate. Representative Mark Takano of 
California, the Chairman of the Committee, noted during Floor 
debate regarding Representative Sherill's amendment that, ``at 
the very minimum, veterans who need childcare so they can see 
their healthcare providers must trust that those who are 
watching their children will keep their children safe.''\6\ The 
Minority concurs with Chairman Takano's assessment of the 
importance of ensuring that children in the VA child care 
program are safe. Representative Sherrill's amendment was 
agreed to by a recorded vote of 401-19.
---------------------------------------------------------------------------
    \6\Representative Mark Takano of California. ``Veterans' Access to 
Child Care Act.'' Congressional Record p. H1475. https://
www.congress.gov/116/crec/2019/02/08/CREC-2019-02-08-pt1-PgH1469-2.pdf. 
Accessed: July 14, 2019.
---------------------------------------------------------------------------
    Prior to the passage of H.R. 840, Representative Barr 
offered a Motion to Recommit (MTR). Representative Barr's MTR 
would affirmatively prohibit VA from paying a child care 
provider if they employ an individual who has been charged with 
a sex offense, an offense involving a child victim, a violent 
crime, a drug felony, or other offense that VA determines 
appropriate unless the child care provider has suspended the 
individual from having any contact with children while on the 
job until the case has been resolved. Current law allows, but 
does not require, a child care facility operated by or under 
contract with a federal agency to suspend a child care worker 
if they have been charged with a sex crime, an offense 
involving a child victim, a violent crime, or a drug felony but 
whose charge is still pending. The MTR failed by a recorded 
vote of 200-214.
    During the Full Committee markup of H.R. 2942, as amended, 
Representative Barr offered an amendment that was identical to 
the MTR he offered to H.R. 840, as amended. Both H.R. 2942, as 
amended, and the amendment that Representative Barr offered 
share a primary goal of increasing utilization of VA healthcare 
among women veterans. Despite this, Chairman Takano ruled the 
amendment non-germane. This is the first time in at least a 
decade that a Chairman of the Committee refused to consider an 
amendment due to germaneness. During debate regarding the 
germaneness of the amendment, Chairman Takano repeatedly 
gaveled down members of the Minority arguing in favor of the 
amendment's germaneness. Representative Barr moved to appeal 
Chairman Takano's ruling. However, Representative Conor Lamb of 
Pennsylvania successfully moved to table the appeal. 
Representative Lamb's motion was agreed to by a recorded vote 
of 14-13, with 14 members of the Majority voting to end debate 
on the germaneness of the amendment and 2 members of the 
Majority joining with 11 members of the Minority in voting to 
continue debating the germaneness of the amendment.
    The Minority believes that the willingness of women 
veterans with minor children to use the VA child care program--
and, therefore, access the services available to them through 
the VA healthcare system--is directly correlated to their 
assurance that their children will be safe in the child care 
facilities that VA provides, either in VA facilities or through 
contracts with other child care entities. Representative Barr's 
amendment would close a loophole that would allow an individual 
who has been charged with a serious crime--such as a sexual or 
physical assault of a child--from caring for a veteran's child 
under the VA child care program. While the amendment does not 
presuppose guilt for an individual charged with one of these 
offenses, it does recognize the considerable amount of time it 
takes for some cases to proceed through the criminal justice 
system and the pressing need to ensure the safety of veterans' 
children by preventing them from being preyed upon by potential 
predators.
    The Minority also believes that the procedural tactics 
Chairman Takano used in a partisan manner during the markup of 
H.R. 2942, as amended, do an immense disservice to the 
Committee and, more importantly, to our nation's veterans. 
Throughout its 73-year history, the Committee has prided itself 
on a shared spirit of bipartisanship and compromise on behalf 
of the men and women who have honorably served our country. 
Refusing to consider a constructive amendment offered by a 
Member of the Minority to protect the vulnerable children of 
those men and women is an unprecedented affront to that 
history.
                                   David P. Roe, M.D.,
                                           Ranking Member, Committee on 
                                               Veterans' Affairs, House 
                                               of Representatives.

                                  [all]