This is in response to the request by the Senate Committee on Veterans Affairs for the position of The American Legion on the Administration's proposal to extend the contract authority for the provision of medical care to veterans residing in Puerto Rico and the Virgin Islands until September 30, 1988. The American Legion has recognized, identified, and attempted to deal with the problems that exist in the provision of health care in Puerto Rico for over twenty years. At least six official visits by American Legion representatives have been conducted for the purpose of assessing the inherent problems of health care delivery to veterans, and reiterating the urgency of this situation to the Veterans Administration and the Congress. Within recent years, at the request of Congress, the Veterans Administration conducted a study of these health care delivery problems and prepared a report entitled "A Plan for the Delivery of Health Care to Veterans in Puerto Rico and the Virgin Islands." Without going into great detail at this time, it should be pointed out that the VA study describes the foregoing problems, and contains recommendations that, if initiated, would alleviate many of the difficulties, and go far in accomplishing a comprehensive plan for providing appropriate and cost-effective health care to the veterans in Puerto Rico and the Virgin Islands. The American Legion supports the extension of the VA's authority to provide contract care and fee-basis medical services. However, we would urge that the Congress and the Veterans Administration consider the situation that continues to exist, as well as the data amd recommendations contained in the VA study. The problems that exist in Puerto Rico are real, and they need to be addressed. JOHN F. SOMMER, JR. Deputy Director National Veterans Affairs and The purpose of this correspondence is to convey the views of the Disabled American Veterans pertaining to a legislative proposal that, if enacted, would permit the Veterans Administration to collect the cost of hospital, nursing home or outpatient medical care furnished by that agency to veterans who have private health insurance. As you will recall, from our May 7, 1985, written testimony concerning the Committee's legislative hearing on certain issues pertaining to veterans' health care, including third party reimbursement, we expressed our disappointment that we had not been furnished a copy of the proposed legislation for review. Additionally, we requested the opportunity to express our position at a subsequent hearing or in written form following our detailed review and analysis of the proposal. We have now had a chance to review the Administration's proposal and would like to submit our comments for the record. Mr. Chairman, the DAV remains totally and adamantly opposed to any proposal that would give the VA the right to recover the cost of medical care furnished by the VA to veterans with no service-connected disabilities to the extent that they have private health insurance or similar medical coverage. Medical care provided to this nation's veterans by the Veterans Administration has been a time-honored and readily bestowed benefit provided by Congress via the wishes and intentions of a grateful American public. Making the provision of VA health care a "cost-sharing venture" would go against the grain and intent of the program and, in our opinion, the desires of a grateful nation. We feel that should this proposal be enacted into law, it would surely act as the precursor to a merging of the VA health care system into a national health care program whereby disabled veterans would be required to pay for their needed medical care. Also, a degree of discrimination may very well exist wherein the admittance to a VA facility of a nonservice-connected veteran with health insurance may take precedence over the admittance of an as needy or more needy veteran without such similar coverage. The proposal to enact third party reimbursement immediately brings to mind many serious questions, such as: * would the overall cost of national health care increase without improvement in the quality of care furnished? * would a significant, adverse change in the character and mission of the VA health care system be forthcoming? * would the much needed and desired health care cost containment efforts on a national level be diminished? * would the administrative burden imposed on the VA to effectuate billing procedures acceptable to the insurance industry be overwhelming? * would resources designated for health care purposes be shifted to accommodate billing procedures and administrative tasks? * would costly and time consuming litigation occur which * is the assumption regarding the extent of insurance coverage of veterans receiving VA care and the potential recovery accurate or, as we believe, highly speculative and inaccurate? Considering the indigent nature of most VA inpatients, in conjunction with a "means test" that may be administratively or statutorily imposed, it is our view that the majority of veterans treated in VA medical facilities test from whom third party reimbursement could be collected would, at best, be negligible. Therefore, potential cost recoveries under this proposal would seem to be virtually negated. Mr. Chairman, we certainly appreciate your consideration of our comments regarding this issue and again request that this correspondence be made a part of the official June 20, 1985, hearing record of the Committee. PVA PARALYZED VETERANS Chartered by the Congress PREPARED STATEMENT OF BOB MORAN, ASSOCIATE LEGISLATIVE DIRECTOR SUBMITTED FOR THE RECORD TO THE SENATE COMMITTEE ON VETERANS' AFFAIRS CONCERNING HEALTH CARE IN PUERTO RICO JUNE 20, 1985 Mr. Chairman and Members of the Committee, Paralyzed Veterans of America is Our concern is to secure for those veterans living in Puerto Rico, the same quality of health care that veterans living on the mainland receive. PVA has an active Chapter in Puerto Rico, whose members have all experienced spinal cord injury or dysfunction. The "Veterans Administration Health Care Programs Extension Act of 1985" would extend for an additional three years, through September 30, 1988, the VA's authority to provide contract hospital care, and outpatient care that will obviate the need for hospital admission, to certain veterans in Puerto Rico. The VA has submitted reports to Congress regarding the planning for meeting the health care needs of these veterans. We envision the process of 801 Eighteenth Street, N.W., Washington, D.C. 20006 (202) USA-1300 establishing an equitable mechanism for responding to the needs of veterans in Puerto Rico to be a lengthy one. Therefore, we believe this three-year extension is needed to prevent any unnecessary hardship on veterans in Puerto Rico and to give the VA and the Congress an adequate opportunity to achieve the mutual goals with respect to these veterans. This proposal would also extend for three years, to September 30, 1988, the VA's pilot program to contract for care, treatment, and rehabilitative services in halfway houses, therapeutic communities, psychiatric residential treatment centers, and other community-based treatment facilities for eligible veterans suffering from alcohol or drug dependence or abuse disabilities. A study of the pilot program indicated that the contract authority has been and would continue to be a valuable, cost-effective modality to supplement VA treatment and rehabilitation of certain veterans. This concludes PVA's statement and again we appreciate the opportunity to submit our views. |