S-5497-119
Read twice and referred to the Committee on Veterans' Affairs.
Sponsored by Angus King (I-ME)
What it does
The bill would require the VA Secretary, at a State home's election, to either reimburse the home for a costly medication or furnish it to the home, in addition to the existing per diem payment for nursing home care. A drug would count as costly if its one-month average wholesale price plus a 3 percent fee exceeds 8.5 percent of the VA payment for that veteran's care that month. It applies only to State homes that provide such a drug under a VA contract or agreement for nursing home care. Other limits apply.
Who benefits
State veterans' homes, which would no longer have to absorb the full cost of very expensive drugs under fixed VA per diem payments. Veterans in those homes who need high-cost medications, who may be less likely to face access limits tied to a home's budget. State governments that fund or subsidize these homes could also see lower costs.
Who is hurt
Federal taxpayers and the VA budget, which would likely bear new drug costs, with the amount depending on how many homes elect and which drugs qualify. VA staff would face added administrative work in reimbursing or supplying drugs. Other VA programs could face competing budget pressure if no new funding is provided. Drug makers are not directly hurt, but the average-wholesale-price formula could affect which drugs qualify.
Supporters argue
Supporters argue that fixed per diem payments do not account for a small number of extremely expensive drugs, which can strain State home budgets and put veterans' access to needed care at risk. They contend that letting each home choose between reimbursement and VA-supplied drugs gives flexibility, and that the VA already has purchasing channels that can lower the price of these medications.
Opponents argue
Opponents argue that the bill would create an open-ended federal obligation, since the cost depends on drug prices and on how many homes elect, and no funding source or cost estimate is included. They contend the average-wholesale-price formula could overstate actual costs, and that State homes already receive per diem payments and state support, so the change shifts costs from states to the federal government.
Constitutional context
The bill rests on Congress's spending power (Art. I, Sec. 8, Cl. 1) and its control of appropriations (Art. I, Sec. 9, Cl. 7); any payments would depend on funds Congress provides. It raises no significant constitutional question, and no landmark case closely governs.
Checks and balances
Congress expands the VA's statutory duty and controls the funding, while the executive branch (the VA Secretary) implements it; Congress's appropriations oversight is the main check.