May 11, 1995 CONGRESSIONAL RECORD — Extensions of Remarks E 1015

‘‘benefit’’ from your efforts to bring VA up

to the private, modern standards you admire

are veterans with service-connected injuries

or illnesses rate 10% or 20% disabling who do

not meet an economic-need test that you

failed to disclose and, thus, would lose their

benefits. These veterans could have lost two

fingers or four toes, or they might have persistent, moderate swelling of a foot as a residual of frostbite, or any of a wide range of

other impairments—for which VA pays about

1.2 million veterans monthly compensation

in the amount of $89 (the 10% rate or $170

(the 20% rate). These veterans, the target of

your efforts to provide the ‘‘benefits’’ of

what the private sector provides, will certainly be grateful for your efforts. I am also

certain that they will find dismaying, as will

all disabled veterans and all other Americans with disabilities, your unfounded conclusion that ‘‘[d]isabity is no longer a major

hindrance in finding work.’’

You also urge that disability compensation

payments be limited to those disabled as a

result of ‘‘direct’’ active duty experiences.

This apparently would mean that compensation would no longer be paid for disabilities

incurred during military service unless it

can be shown they were caused by the performance of official duties. However, military personnel are considered to be on duty

24 hours a day and are subject to military

discipline and the military system of criminal justice around the clock every day of the

year. Unlike civilian employees, who can

refuse assignments and leave their jobs, service members cannot refuse orders sending

them to remote or unfamiliar areas in the

United States or overseas. Doing so would

subject them to criminal prosecution, as

would unauthorized absences. In addition,

our people in uniform are often subjected to

unusual physical and psychological stress,

including the special dangers involved in

training for combat and the horrible risks

and unique hardships of armed conflict. In a

very real sense, whatever happens to them

during their period of service is in the line of

duty.

Given these unique circumstances of military service, it is only fair and reasonable

that the package of pay and benefits for our

military personnel includes comprehensive

health care during service and, thereafter, a

system of disability compensation and medical benefits for any disabilities incurred during service. I see these benefits as essential

to the maintenance of our All-Volunteer

Force.

Moreover, I believe it would be a disgrace,

as well as very harmful to recruitment, if

our military were to take a young man who

was left paralyzed from an off-base accident,

for example in Thailand or on an icy road in

New England, and simply send him back to

his parents and tell them that the Government was not going to be responsible for his

medical bills or pay him compensation to

make up for his lost earning power. To me,

that would be a tragic reversal of our current, very sound policies.

MEDICAL CARE

Your assertion that the VA health-care

system provides poor care to American veterans is totally unsubstantiated—except for

a newspaper article by a disgruntled former

VA employee (hardly the type of scholarship

expected of a prestigious policy institute).

Our accreditation scores are consistently

substantially higher than those in the private sector. You say that ‘‘most telling is

that only 9.6 percent of eligible veterans rely

exclusively on the VA system for their

health care.’’ What this tells is not that VA

provides poor service. Rather, it says that

VA does not have the resources to treat

many veterans who are not service-disabled

or poor. Veterans groups tell us that many of

their members who are locked out by current

constraints would prefer to use VA healthcare services.

You cite as evidence of poor medical care

successful malpractice suits against VA of

$254 million during the decade 1983–1992. That

comes to an average of about $25 million per

year. Our data indicate a slightly higher

number, about $30 million annually. However, in the absence of any comparative data

regarding the private sector, these numbers

have no significance. In fact, when you consider that VA runs the largest health care

system in the country and annually provides

care to 2.5 million veterans, including 1 million episodes of inpatient care and 26 million

outpatient visits, that figure does not seem

out of line. Perhaps, your figures show just

the opposite; that VA is providing high quality care.

You advocate a voucher system to provide

health care for veterans. You say that this

would permit veterans to choose their own

insurance plans and that this would help

save $7.9 billion over five years. I would really like to see the economic analysis underlying that ridiculous projection. To whom

would you provide vouchers: The 2.5 million

veterans who receive VA care in any given

year; the 5 million who receive care over a

five-year span; or the approximately 12 million service-disabled and low-income veterans who have entitlement to VA care? How

much would these vouchers be worth? Would

they be sufficient for our veterans with a

history of heart attacks or cancer to purchase comprehensive health care? Would

they enable veterans with chronic mental illness, diabetes, or epilepsy to obtain all the

care they need? Would your vouchers cover

the complete health-care and rehabilitation

needs of veterans with spinal-cord injuries,

missing limbs, and blindness? Would you provide vouchers for World War II veterans

needing long-term care? Or would your

vouchers shift major costs of care to sick

and disabled veterans or simply leave many

of them out in the cold?

Have you examined the several studies suggesting that VA care is less costly than private care? How did you arrive at your apparent conclusion that private care would be

more economical?

I believe you also need to realize that

about 1 million of our patients have Medicare eligibility but have chosen VA as their

health-care provider.

You want VA to close many of its hospitals, and you claim that the majority of

VA buildings are under-used. Our hospitals

run at an occupancy rate of 75 percent, compared to the private sector average of 67 percent. Our nursing homes have an occupancy

rate of over 90 percent; and our domiciliaries, 83 percent. What kind of survey enabled you to reach the preposterous conclusion that most VA facilities are underused?

Again, I would like to see the underlying research and analysis.

You call for a halt to all new VA construction. You obviously haven’t seen the things

that I have—veterans housed in open wards,

communal bathrooms, inadequate facilities

for female patients. These deficiencies need

to be corrected; and we need to meet the

growing need for modern outpatient facilities and fill major gaps in inpatient care in

certain areas. We can’t just terminate our

construction program, unless we wish to

close down the VA system. Unfortunately,

that appears to be your goal.

You also mistakenly took a swipe at VA

construction as ‘‘pork barrel spending.’’

Very little pork creeps into VA construction,

and your unfamiliarity with veterans’ programs is revealed by your silly, mistaken

reference to the appropriation of $5 million

for bedside phones ‘‘in Virginia medical centers.’’

The appropriations conference report item

you referred to used the expression ‘‘VA

medical centers.’’ The money was to assist in

VA’s national effort to provide bedside

phones in all VA hospitals. In the veterans’

area, ‘‘VA’’ usually means the Department of

Veterans Affairs, not Virginia. If you continue to work in this field, this is one of the

many, many things with which you’ll need

to become acquainted. Most are more consequential, such as the extent of the Nation’s

obligation to those who have served and sacrificed so much and the gratitude that the

American people feel for their defenders.

Because of your reputation as a think

tank, your report will receive serious consideration in Congress. It’s a shame that it is as

lacking in concern for our Nation’s veterans

as it is in rigorous analysis and pertinent

data. I wish you had done a better job.

Sincerely,

fJESSE BROWN.

SPEAKING OUT ON MEDICARE/

MEDICAID BUDGET CUTS

HON. LOUIS STOKES OF OHIO

IN THE HOUSE OF REPRESENTATIVES

Thursday, May 11, 1995

Mr. STOKES. Mr. Speaker, I want to thank

my distinguished colleagues, FRANK PALLONE,

KAREN MCCARTHY, and CAL DOOLEY, for sponsoring this special order. I am pleased to join

them for this candid discussion on proposed

budget cuts to the Medicare and Medicaid

Programs.

The Republican plan calls for nearly $200

billion in cuts to Medicaid and other health initiatives. In my congressional district, and in

communities throughout the United States,

millions of Americans are served by the Medicare and Medicaid Programs. In spite of this

critical need, in order to fund a tax cut for the

wealthy, Republicans in Congress have placed

Medicare and Medicaid on the chopping block.

By taking this position, they are continuing to

exhibit a callous disregard for those most vulnerable in our society—those in the dawn of

life, our children; those in the twilight of life,

the elderly; and those who are in the shadow

of life—the sick, the needy and the handicapped.

Medicaid is America’s largest health care

program for the poor, covering about 60 percent of all Americans, This year, Medicaid will

provide basic health care coverage for over 36

million low-income children, mothers, elderly,

and disabled Americans.

Mr. Speaker, approximately 40 million Americans have no health insurance coverage.

Without Medicaid, the number of uninsured

would nearly double. This would result in

needless suffering, and death and disease

would increase. Further, we have not considered the drain this would create on the Nation’s health care delivery system in treating

those who are uninsured.

Between 1988 and 1994, Medicaid was expanded to provide coverage for pregnant

women and children. This was done in an effort to decrease the Nation’s infant mortality

rate, and, at the same time, increase childhood immunizations. The expansion signalled

our commitment to guarantee our children a

healthy start and thus, a brighter future.
E 1016 CONGRESSIONAL RECORD — Extensions of Remarks May 11, 1995

Mr. Speaker, the Republican leadership has

promised to balance the budget by cutting $1

trillion from the budget over 7 years. This

would finance a proposed $350 billion tax

break for America’s wealthiest citizens. In addition to its assault on Medicare and Medicaid,

the Budget plan represents an assault on programs such as housing, summer jobs for our

youth, education, job training, and energy assistance for our elderly.

As Members of Congress, we must take a

strong stance in defense of our Nation’s seniors. It is estimated that the proposed $282 billion in cuts to Medicare would add more than

$3,000 to seniors’ health costs. In fact, if the

cuts to Medicare become law, the average

Medicare beneficiary is expected to pay approximately $3,500 more in health costs over

the same 7-year period.

According to the Urban Institute, the typical

Medicare beneficiaries already dedicate a

staggering 21 percent of their incomes to pay

out-of-pocket health care expenditures. While

our Republican colleagues say that they aren’t

cutting Social Security, under their budget proposal for Medicare, seniors would see 40 to

50 percent of their cost-of-living adjustment

consumed by increases in Medicare cost sharing and premiums.

Mr. Speaker, I am grateful to my colleagues

for allowing this meaningful discussion on a

very important issue. I share their concern that

we must protect Medicare and Medicaid from

the Republican budget ax. We must not allow

the Republican Party to balance the budget on

the backs of those most in need. By the same

token, we will not allow our seniors and the

poor to be used as pawns in a tax give-away

scheme for the rich.

INTRODUCTION OF THE CONSOLIDATED AND REFORMED EDUfCATION, EMPLOYMENT, AND REHABILITATION SYSTEMS ACT,

THE CAREERS ACT

HON. HOWARD P. ‘‘BUCK’’ McKEON OF CALIFORNIA

IN THE HOUSE OF REPRESENTATIVES

Thursday, May 11, 1995

Mr. McKEON. Mr. Speaker, today I am joining the distinguished Chairman of the Committee on Economic and Educational Opportunities, Rep. BILL GOODLING, all Republican Members of our Committee, and Representatives

KASICH, DELAY, BOEHNER, and DAVIS, in introduction of the Consolidated and Reformed

Education, Employment, and Rehabilitation

Systems Act—better known as the Careers

Act of 1995. This legislation transforms this

Nation’s vast array of career-related education, employment, and job training programs

into a true system of workforce preparation

and development.

As was brought to the attention of the Congress by the U.S. General Accounting Office

over the past several years, the United States

currently has as many as 163 different Federal

programs, totaling $20 billion, which offer

some form of job training and/or employment

assistance for youth and adults. In addition to

the excessive number of Federal programs,

the quality of U.S. training programs varies

significantly. As a result, earlier this year we

introduced H.R. 511, the Workforce Preparation and Development Act, which pledged that

the 104th Congress would, thoroughly evaluate our current programs, and subsequently

develop and enact legislation that: First, Eliminates duplication and fragmentation in federal

workforce development programs; Second,

transfers major decision-making to States and

local communities; Third, stresses the vital

role of the private sector, at all levels, in the

design and implementation of the workforce

preparation system; Fourth, is market driven,

accountable, reinforces individual responsibility, and provides customer choice and easy

access to services; and Fifth, establishes a

national labor market information system that

provides employers, job seekers, students,

teachers, training providers, and others with

accurate and timely information on the local

economy, on occupations in demand and the

skill requirements for such occupations, and

information on the performance of service providers in the local community.

Today, after a comprehensive set of hearings on this issue, we are following through on

our promise. We are introducing legislation

that will do what was pledged in H.R. 511.

The Careers Act, does all of the above and

more. The Careers Act would consolidate and

eliminate over 150 existing education, training,

and employment assistance programs into 4

consolidation grants to the States. Such grants

would include: A Youth Workforce Preparation

Grant; and Adult Employment and Training

Grant; a Vocational Rehabilitation Grant; and

an Adult Education and Literacy Grant. And

these 4 programs, working together, will form

each State’s workforce preparation system.

Our bill provides maximum authority to

States and localities in the design and operation of their workforce preparation systems.

We significantly reduce administrative requirements, paperwork, duplicative planning, reporting, and data collection requirements across

the various programs—in general eliminating

vast bureaucracy within the system. However,

our legislation does provide some broad parameters for the design of a workforce development system, that we feel are necessary to

move the system in the right direction, based

on testimony heard in our numerous hearings,

and in talking to people around the country.

Specifically, title I of Careers, is designed to

build an infrastructure in States and local communities for development and implementation

of a comprehensive workforce development

system. At the State level, Governors are

asked to pull together key State agency heads

and leaders from business and education to

develop a single State plan and performance

measurement system for the entire workforce

development system. Governors are also

asked to designate workforce development

areas throughout the State, for the distribution

of funds and service delivery under much of

the system.

To ensure the involvement of employers in

the design and implementation of local systems, Careers requires the establishment of

local, employer-led, workforce development

boards. These boards would provide policy

guidance and oversight over local systems,

and would be responsible for the establishment of local one-stop delivery systems—easily accessible single points of entry into the

local workforce preparation system.

The youth workforce development program

pulls school systems and postsecondary institutions together with local business leaders to

develop a school-to-work system for both inschool, and out-of-school youth in the community. This system is designed to result in challenging academic and occupational competency gains for all youth in the community,

as well as completion of high school, or its

equivalent, and other positive outcomes such

as placement and retention in employment, or

continuation into postsecondary education or

training. States would also be require to show

how special population students meet the performance standards.

Under the adult and the vocational rehabilitation programs, upfront or core services—

such as information on jobs, assessment of

skills, counseling, job search assistance, information on education, training, and vocational

rehabilitation programs in the local community,

assessment of eligibility for such programs—

including eligibility for student financial aid—

and referral to appropriate programs would be

available to all individuals through a net work

of one-stop career centers and affiliated satellite centers throughout each community. For

individuals with severe disabilities and determined to be in need of more intensive services, such services would be available through

vouchers and other means to be used with approved providers of vocational rehabilitation

services. Under the adult training system, for

individuals who are unable to obtain employment through the core services, more intensive service such as specialized assessment

and counseling, and development of employability plans, would be available—also through

the one-stops. For those unable to obtain employment through these services and determined to be in need of education or training,

such services would be provided—through the

use of vouchers or other means that offer

maximum customer choice in the selection of

training providers. States would be required to

establish a certification system for the identification of legitimate providers of education

and training for receipt of vouchers—taking

into account the recommendations of local

workforce boards.

Finally, beyond the specific area of job training, the Careers Act includes privatization proposals for 2 existing government sponsored

enterprises—again focusing on the streamlining of federal programs. Sallie Mae and

Connie Lee were created by the Higher Education Act and are examples of for-profit,

stockholder owned GSEs which have successfully fulfilled their intended purposes. Privatization cuts the ties to the Federal Government

and establishes a willingness on the part of

the Government to take a successful publicprivate partnership and turn it into a completely private venture when government support is no longer necessary. I want to thank

the administration for its thoughtful testimony

at our hearing on the issue of privatization and

for its assistance in identifying and addressing

the important and complex issue involved in

privatization proposals. And also, I would like

to thank the administration for its testimony

and advice on reform of our job training system.

As a Congressman from a district in California that has been hit hard by defense and

aerospace cutbacks—I understand that the

skills of this Nation’s workforce are more important today then ever before to U.S. competitiveness. However, our current patchwork

of Federal programs is not the answer. The

Careers Act addresses our long term

workforce preparation strategy by creating a