could be sited at medical or counseling facilities which serve the homeless, augmenting the range of services now provided. Finally, additional funding could support new grant programs aimed at solidifying the interrelated responsibilities of Federal, State, and local governments to help homeless veterans.

Reinstate half of the budget's “management initiative savings".The budget builds $20 million in "savings" into its calculations, based on the speculative notion that VA medical facilities will find ways to "streamline" certain operations. At least $10 million of these projected savings clearly lack any foundation or chance of being realized. Although the budget uses the phrase "management initiative", no specific initiative exists to save $10 million or any part thereof, none has been developed, and none is in sight. To rely on the budget reductions proposed is simply to erode further existing service levels. Accordingly, the Committee recommends the restoration of $10 million of these "savings".

Administration's legislative proposals.-The fiscal year 1993 budget proposes extensions of sunsetting provisions of OBRA 1990 and establishment of copayment obligations on certain service-connected veterans. The Committee cannot accept these legislative proposals or make permanent a series of provisions, which were adopted as short-lived emergency measures, without at the same time offering veterans improvements in service delivery is unsound. Accordingly, the Committee rejects the projected $131 million in savings associated with these Administration proposals.

The Administration also proposes legislation to limit beneficiary travel reimbursements to veterans who must travel at least 50 miles to receive care and who are at least 50 percent service-connected disabled, are receiving care for a service-connected condition, or meet an income test. The Committee rejects this proposal. It is insensitive to the cost and frequency of veterans' travel, and to the impact it could have on access to care of "rural" and other veterans whom it would disenfranchise.

Committee Legislative Proposals

The Committee proposes to report legislation that would revise eligibility for VA health care. The Committee will attempt to work with the Administration and veterans' service organizations in drafting an eligibility reform bill. Such legislation would establish a uniform system of eligibility and eliminate obstacles which now impede veterans from receiving the level of VA care clinically needed. In developing such a model the Committee will build on the work of a blue-ribbon advisory committee which studied the VA health care system over an 18-month period and recently published its report. That panel cited the need for Congress to reform VA health care eligibility.

In a previous session, the House passed legislation to expand eligibility for outpatient care so that those entitled to hospital care would also be entitled to receive needed outpatient care. Although that legislation was not enacted into law, the Committee seeks to expand its provisions to provide a continuum of care, and to foster a restructuring of VA health care over a period of years. Among its goals, such revision would help assure that veterans receive needed care at the least costly appropriate level. Preliminary estimates in

dicate that such changes, phased in over a five-year period, would entail costs totalling less than $2 billion over that period.

The Committee also proposes to report legislation to revise the system for allocation of funds collected under the Department's medical care cost recovery program. Under current law, third-party collections under 38 USC section 1729 are covered into the Treasury as miscellaneous receipts with the exception that VA may retain the cost of its collection effort. Although VA medical centers have in many cases achieved significant levels of cost recovery in recent years, an allocation system which provides a tangible reward-in new monies available for program enrichment-would provide all personnel with a real incentive to enhance recoveries. Accordingly, the proposed legislation would direct that funds in excess of those needed to defray the costs of collection would be allocated-one-third to the nursing home revolving fund, and twothirds to VA medical centers, in proportion to their respective individual collection records.

Finally, the Committee intends to report out legislation which would authorize extension and expansion of existing programs targeted at homeless veterans, and development of new programs to combat homelessness, subject to the availability of new appropriations.

MEDICAL AND PROSTHETIC RESEARCH

VA is requesting $242 million for medical and prosthetic research for fiscal year 1993. While this sum represents a $15 million increase over FY 92 levels, it would, nevertheless, set back the research program. Despite an increase in funding this budget would force VA to fund 93 fewer projects than currently underway, and would lead to a decline from 40 to 33 percent in the award rate— that is, the likelihood that a peer-reviewed project judged to merit funding would actually receive VA research support. Such declines, coupled with a proposed cut in employment of more than 100 positions reflect a level of inconsistency which would be very disruptive to a program whose successes rely heavily on multiyear projections. As the budget submission itself attests, VA research has proven itself as a high-quality program. The investment made in VA research yields not only long-term dividends but has been critical in attracting outstanding clinicians to VA employment. To countenance a decline in the real spending power underlying VA research would likely have adverse consequences far beyond the conduct of research itself.

The Committee on Veterans Affairs has on many occasions highlighted the enormous importance it attaches to the link between VA research and delivery of high quality health care. The VA's research programs have not only advanced medical science, prosthetic engineering, and health systems research, but have been critical elements in attracting high quality health professionals to VA employment. The ability to attract and retain outstanding clinicians through such incentives as the opportunity to compete for VA research funding has had a direct effect on the quality of clinical care delivered. Unfortunately, for more than a decade, the VA re

search budget has not received the levels of support received by other federal research programs.

In its fiscal year 1992 recommendation to the Budget Committee, the House Veterans Affairs Committee relied heavily upon the recommendations of a "blue ribbon" advisory committee established by the Secretary of Veterans Affairs to review the VA's research program. That Committee characterized VA's research program as being of exceptional quality, and recognized its linkage and importance to VA's clinical care mission. The VA, in this budget submission, cites the assessment of VA research conducted by the Secretary's Advisory Committee as justification for the proposed increase. What the VA submission fails to mention is the Advisory Committee's recommendation that the VA research budget receive a very substantial increase in funding ($280 million) for fiscal year 1992. Support for the Advisory Committee's recommendations was reinforced in a letter signed by 142 House Members and in a similar letter signed by 60 Senators to the President urging him to increase the funding level of VA's research program to the level recommended by the Secretary's Advisory Committee.

This Committee in conjunction with the Advisory Committee's recommendations, recommended an additional $43 million in fiscal year 1992 for VA research. This increase was intended to allow the VA to better support its research programs and to increase the award rates for research proposals deemed meritorious. However, the recommended level was not fully funded.

In view of the program erosion which would result from the Administration's proposed funding level, the Committee recommends an additional $20 million for medical and prosthetic research for fiscal year 1993. This additional amount would allow VA to maintain program stability and hold steady its current award rate and FTEE levels in its medical and prosthetic research programs.

CONSTRUCTION

For major construction, the Department has requested $382 million in fiscal year 1993. This represents a decrease of $32 million from 1992 levels. To put this reduction in perspective, though, it is important to note that fiscal year 1992 major construction funding was $166 million less than the fiscal year 1991 level. To adopt the proposed funding level for 1993 would result in a budget $198 million below the 1991 level.

These reductions come at a time when VA is facing serious problems with the physical plant at many of its facilities. More than one-half of VA facilities are over 30 years old and an increasing number of facilities still in use have exceeded projected useful plant life. The VA's own Capital Facilities Study rated the physical condition of 69 of 132 VA medical facilities built before 1970 as fair, poor or failing-indicating that major construction will be required in the next few years. Without such improvements, the VA will be faced with serious problems in the delivery of high-quality patient care.

The Committee's recommendations last year to restore $140 million to fund five high priority, yet unfunded, projects ultimately won support (and funding) in only one instance. While the major

construction needs at its older facilities become more acute, VA also must address the need for costly new construction it has identified in areas where population migration has strained the capacity of existing facilities, notably in the Sunbelt. Major projects for these locations, such as East Central FL and Phoenix, AZ will require significant amounts of funding. However, with continued reductions in the major construction account, such new projects face an uncertain future.

It is difficult to reconcile the fiscal needs for major construction with this budget, other than to conclude that VA is effectively funding its current medical care requirements at the expense of its future. Such a policy necessarily results in deferring needed construction, and ultimately imperilling the Department's ability to meet the demands of an aging veteran population in the years ahead. One need only examine the closing of the Martinez, CA VAMC in 1991 to learn the consequences of repeatedly deferring major construction projects.

In the area of minor construction, the budget proposes $220 million, an increase of some $29 million. While encouraging, the increase clearly does not offset the trend in the major construction account. It represents a management philosophy which assumes that necessary major projects cannot be undertaken in the time frame dictated by the Capital Facilities Study. Accordingly, VA is proceeding instead in a piece-meal fashion through compromise "solutions."

The Committee, therefore, recommends an additional $198 million for major construction. This amount would fund five high priority major construction projects which did not receive funding in fiscal year 1993. Four of these projects: Tampa, FL; Gainesville, FL; Temple, TX; and Philadelphia, PA have been authorized by this Committee in prior years. Design money for the Gainesville project was appropriated in fiscal year 1990, but has not yet been expended. It is the Committee's desire that appropriations for this project be made available and that the Department move forward with this project as expeditiously as possible. Also included is design funding for a 120-bed nursing home care unit at the Fayetteville, NC VA medical center. Given the growing demand for long-term care, the Committee recommends the addition of this project. It is the Committee's intention to authorize these projects (reauthorization in several instances) in its fiscal year 1993 Construction Resolution. Listed below are the Committee's recommended projects:

This appropriation funds the central management of the VA health care system. Congress in 1992 made additional funding available to this and the medical care account to expand VA's quality assurance programs. $3 million was transferred to the MAMOE appropriation. The proposed Fiscal Year 1993 MAMOE budget would increase to $48 million. After adjusting for pay raises, inflation, and unavoidable one-time costs, this budget remains essentially flat. While this account recently received new positions associated with quality assurance activities, it has lost staffing in other areas. In fact, this budget would provide still fewer staff to carry out MAMOE functions than it had as recently as last year. In contrast to the 531 positions which this budget supports, the account supported 875 positions in 1984. Over the years, both appropriators and OMB cutbacks to MAMOE have resulted in the current substantially reduced staffing level. These cuts have had a demonstrably adverse effect on program management and oversight.

In essence, this budget would devote only 3/10th of one percent of proposed medical spending to the central management, administration, and policy formulation of the VA health care system.

DEPARTMENT OF LABOR

OFFICE OF VETERANS EMPLOYMENT AND TRAINING

Congress has determined that we have a national responsibility to meet the employment and training needs of veterans. In order to meet those needs, the Secretary of Labor is required to effectively and vigorously implement policies and programs which increase opportunities for veterans to obtain employment, job training, counseling, and job placement services. Such implementation is accomplished through the Assistant Secretary of Labor for Veterans Employment and Training (ASVET). The ASVET supervises counseling, training, and placement policies for veterans through the public employment service and other employment and training programs.

Disabled Veterans' Outreach Program.-The Disabled Veterans' Outreach Program (DVOP) was established by Congress to provide intensive employment and training services to service-connected disabled veterans and other veterans in need of job search and placement assistance. DVOPs also serve as workshop facilitators. for the Transition Assistance Program (TAP) described below, develop job and job-training opportunities for veterans through contacts with employers, and provide assistance to community-based