H. Rept. 115-1033 - TO AMEND TITLE 38, UNITED STATES CODE, TO PROHIBIT SMOKING IN ANY FACILITY OF THE VETERANS HEALTH ADMINISTRATION, AND FOR OTHER PURPOSES115th Congress (2017-2018)
Committee Report
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115th Congress } { REPORT
HOUSE OF REPRESENTATIVES
2d Session } { 115-1033
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TO AMEND TITLE 38, UNITED STATES CODE, TO PROHIBIT SMOKING IN ANY
FACILITY OF THE VETERANS HEALTH ADMINISTRATION, AND FOR OTHER PURPOSES
_______
November 16, 2018.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
_______
Mr. Roe of Tennessee, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1662]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred
the bill (H.R. 1662) to amend title 38, United States Code, to
prohibit smoking in any facility of the Veterans Health
Administration, and for other purposes, having considered the
same, report favorably thereon without amendment and recommend
that the bill do pass.
CONTENTS
Page
Purpose and Summary.............................................. 2
Background and Need for Legislation.............................. 2
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............................. 4
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..................... 6
Disclosure of Directed Rulemaking................................ 6
Section-by-Section Analysis of the Legislation................... 7
Changes in Existing Law Made by the Bill as Reported............. 7
Purpose and Summary
H.R. 1662 was introduced by Representative Brad Wenstrup of
Ohio, the Chairman of the Committee on Veterans' Affairs
Subcommittee on Health on March 21, 2017.
H.R. 1662 would prohibit smoking inside any Veterans Health
Administration (VHA) facility. It would also prohibit smoking
outside any VHA facility beginning October 1, 2022.
Background and Need for Legislation
Section 1. Prohibition of smoking in facilities of the Veterans Health
Administration
The negative health effects of both smoking and second-hand
smoke exposure are well documented. According to the American
Cancer Society, illnesses related to tobacco use are
responsible for 1 out of every 5 deaths in the United States
while secondhand smoke is known to cause lung cancer even in
those who have never smoked and may be linked to larynx,
pharynx, nasal sinus, brain, bladder, rectum, stomach and
breast cancer.\1\\2\
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\1\American Cancer Society. Health Risks of Smoking Tobacco.
https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/health-
risks-of-smoking-tobacco.html. Accessed May 15, 2017.
\2\American Cancer Society. Health Risks of Secondhand Smoke.
https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/
secondhand-smoke.html. Accessed May 15, 2017.
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However, the Veterans Health Care Act of 1992 (Public Law
102-585; 106 STAT. 4943) requires each VA medical facility to
establish and maintain suitable designated smoking areas.
Accordingly, VA medical centers across the country provide 971
outdoor smoking areas and 18 indoor smoking areas for veteran
patients and VA employees. According to information VA provided
to the Committee, VA estimates that the total cost to maintain
all outdoor smoking areas at VA medical centers is
approximately $1.2 million per year and that the total cost to
maintain all indoor smoking areas at VA medical centers is
approximately $35,469 per year. Of note, these estimated costs
do not include costs associated with maintaining smoking areas
at other VHA facilities.
Since FY 2013, VA's annual budget submission has included a
legislative proposal to prohibit smoking in VHA facilities, in
line with industry standards and best practices. In support of
this proposal, the Department of Veterans Affairs (VA) cites
100 percent smoke-free policies that have been adopted on the
facilities, grounds, and office buildings of many Department of
Defense medical treatment facilities, four large national
healthcare systems (Kaiser Permanente, Mayo Clinic, SSM Health
Care, and CIGNA Corporation), and more than 4,000 local and/or
state/territory/commonwealth hospitals, health care systems and
clinics.\3\ Yet, ``VHA health care providers and visitors do
not have the same level of protection from the hazardous
effects of second-hand smoke exposure as do patients and
employees in these other systems.''\4\ This is particularly
concerning given that, while only about 20 percent of veteran
enrollees smoke, VA's non-smoking veteran enrollee population
includes veterans who may be particularly vulnerable to
cardiovascular events associated with secondhand smoke
exposure.\5\ For those veteran enrollees who are smokers, 7 out
of 10 want to quit.\6\ VA provides a number of smoking
cessation resources for those veterans. Those resources include
nicotine replacement therapies, medication, counseling, a
smoking ``quitline,'' and text messaging support.\7\
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\3\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing. March 29, 2017. 115th
Cong. 1st sess. Washington: GPO, 2017 (statement from Jennifer S. Lee,
Deputy Under Secretary for Health for Policy and Services, Veterans
Health Administration, U.S. Department of Veterans Affairs)
\4\Ibid.
\5\Ibid.
\6\U.S. Department of Veterans Affairs. Tobacco and Health. https:/
/www.publichealth.va.gov/smoking/index.asp Accessed May 15, 2017.
\7\Ibid.
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There is evidence to suggest that quitting smoking can be
particularly beneficial for veteran patients. VA has found
that--while many veterans, particularly those with mental
health conditions, smoke--smokers are more likely than non-
smokers to have experienced anxiety, panic, stress, depression,
and suicidal thoughts and tobacco smoke can make some
medications--particularly those used for depression, anxiety,
and psychotic disorders--less effective.\8\ On the other hand,
one year after quitting, former smokers reporting feeling
happier and better able to concentrate.\9\
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\8\Ibid.
\9\Ibid.
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Section 1 of the bill would prohibit smoking inside any VHA
facility within 90 days and outside any VHA facility on or
after October 1, 2022. ``Smoke'' would be defined to include
cigarettes, electronic cigarettes (e-cigarettes), cigars,
pipes, and any other combustion of tobacco and ``facility of
VHA'' would be defined as any land or building (to include any
medical center, nursing home, domiciliary facility, outpatient
clinic, or readjustment counseling center) that is under VA's
jurisdiction, under VHA's control, and not under the control of
the General Services Administration. During a legislative
hearing on March 29, 2017, VA estimated that enactment of H.R.
1662 would result in approximately $8.3 million in savings in
fiscal year 2023.\10\
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\10\United States Cong. House Committee on Veterans' Affairs
Subcommittee on Health. Legislative Hearing.
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Hearings
There were no full Committee hearings held on H.R. 1662.
On March 29, 2017, the Subcommittee on Health conducted a
legislative hearing on a number of bills including H.R. 1662.
The following witnesses testified:
The Honorable David. P. Roe M.D. of Tennessee; The
Honorable Jackie Walorski of Indiana; The Honorable
Doug Collins of Georgia; The Honorable Mike Coffman of
Colorado; The Honorable Stephen Knight of California;
The Honorable Ann M. Kuster of New Hampshire; Jennifer
S. Lee, M.D., the Deputy Under Secretary for Health for
Policy and Services for the Veterans Health
Administration of the U.S. Department of Veterans
Affairs who was accompanied by Susan Blauert, the Chief
Counsel for the Health Care Law Group of the Office of
the General Counsel for the U.S. Department of Veterans
Affairs; Kayda Keleher, Legislative Associate for the
National Legislative Service of the Veterans of Foreign
Wars of the United States; Shurhonda Y. Love, the
Assistant National Legislative Director for the
Disabled American Veterans; and, Sarah S. Dean, the
Associate Legislative Director for the Paralyzed
Veterans of America.
Statements for the record were submitted by:
The Honorable Lee Zeldin of New York; The American
Legion; the National Association of State Veteran
Homes; Swords to Plowshares; and, the Wounded Warrior
Project.
Subcommittee Consideration
On April 6, 2017, the Subcommittee on Health met in an open
markup session, a quorum being present, and ordered H.R. 1662
to be reported favorably to the full Committee by voice vote.
Committee Consideration
On May 17, 2017, the full Committee met in open markup
session, a quorum being present, and ordered H.R. 1662 to be
reported favorably to the House of Representatives by voice
vote. A motion by Representative Tim Walz of Minnesota, Ranking
Member of the Committee on Veterans' Affairs, to report H.R.
1662 favorably to the House of Representatives was agreed to by
voice vote.
Committee Votes
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, there were no recorded votes
taken on amendments or in connection with ordering H.R. 1662
reported 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 prohibit smoking inside or outside
VA medical facilities.
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. 1662 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.
1662 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. 1662 provided by the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 24, 2017.
Hon. Phil Roe, M.D.
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. 1662, a bill to
amend title 38, United States Code, to prohibit smoking in any
facility of the Veterans Health Administration, and for other
purposes.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Ann E.
Futrell.
Sincerely,
Keith Hall,
Director.
Enclosure.
H.R. 1662--A bill to amend title 38, United States Code, to prohibit
smoking in any facility of the Veterans Health Administration,
and for other purposes
H.R. 1662 would prohibit smoking indoors at medical
facilities of the Department of Veterans Affairs (VA) and
eliminate the current requirement that VA provide smoking areas
for staff and patients at its major medical facilities. Those
provisions would be effective within 90 days of the bill's
enactment. (The department already prohibits indoor smoking at
its medical facilities.) Beginning in 2023, the bill also would
prohibit individuals from smoking outdoors at VA medical
facilities. Based on information from VA, we expect that the
department would continue to provide outdoor smoking areas
through 2022. While the bill would eventually reduce costs for
maintaining those smoking areas, CBO expects that those
effects, which would probably be small, would occur after 2022.
Thus, CBO estimates that implementing the bill would have no
significant budgetary effects over the 2018-2022 period.
Enacting H.R. 1662 would not affect direct spending or
revenues; therefore, pay-as-you-go procedures do not apply. CBO
estimates that enacting H.R. 1662 would not increase net direct
spending or on-budget deficits in any of the four consecutive
10-year periods beginning in 2028.
H.R. 1662 contains no intergovernmental mandates as defined
in the Unfunded Mandates Reform Act (UMRA) and would not affect
the budgets of state, local, or tribal governments.
The bill would impose new private-sector mandates, as
defined in UMRA, on individuals by prohibiting smoking indoors
in any Veterans Health Administration (VHA) facility upon
enactment and by prohibiting smoking outside of a VHA facility
on or after October I, 2022. CBO estimates that the cost of the
mandates, if any, would fall well below the annual threshold
established in UMRA for private-sector mandates ($156 million
in 2017, adjusted annually for inflation).
The CBO staff contact for this estimate is Ann E. Futrell.
The estimate was approved by H. Samuel Papenfuss, Deputy
Assistant Director for Budget Analysis.
Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates regarding H.R. 1662 prepared by 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.
1662.
Statement of Constitutional Authority
Pursuant to Article I, section 8 of the United States
Constitution, H.R. 1662 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. 1662 does not relate to the
terms and conditions of employment or access to public services
or accommodations within the meaning of section 102(b)(3) of
the Congressional Accountability Act of 1995.
Statement on Duplication of Federal Programs
Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015),
the Committee finds that no provision of H.R. 1662 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 section 3(i) of H. Res. 5, 114th Cong. (2015),
the Committee estimates that H.R. 1662 contains no directed
rulemaking that would require the Secretary to prescribe
regulations.
Section-by-Section Analysis of the Legislation
Section 1. Prohibition on smoking in facilities of the Veterans Health
Administration
Section 1(a) of the bill would amend section 1715 of title
38 U.S.C. to prohibit smoking indoors in any VHA facility upon
enactment and prohibit smoking outside of a VHA facility on or
after October 1, 2022. Section 1(a) of the bill would also
define ``smoke'' to include the smoking of cigarettes
(including e-cigarettes or electronic cigarettes), cigars,
pipes, and any other combustion of tobacco and define
``facility of the Veterans Health Administration'' to mean any
land or building that is under the jurisdiction of VA, under
the control of VHA, and not under the control of the General
Services Administration.
Section 1(b) of the bill would amend the table of sections
at the beginning of chapter 17 of title 38 U.S.C. by striking
the item relating to section 1715 and inserting, ``1715.
Prohibition on smoking in facilities of the Veterans Health
Administration.''. Section 1(b) of the bill would also repeal
section 526 of the Veterans Health Care Act of 1992 (Public Law
102--585; 106 STAT. 4943).
Section 1(c) of the bill would establish an effective date
of 90 days after enactment.
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 italic, existing law in which no change is
proposed is shown in roman):
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 italic, and existing law in which no
change is proposed is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
SUBCHAPTER I--GENERAL
Sec.
1701. Definitions.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
[1715. Tobacco for hospitalized veterans.]
1715. Prohibition on smoking in facilities of the Veterans Health
Administration.
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME, OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
[Sec. 1715. Tobacco for hospitalized veterans
[The Secretary may furnish tobacco to veterans receiving
hospital or domiciliary care.]
Sec. 1715. Prohibition on smoking in facilities of the Veterans Health
Administration
(a) Prohibition.--(1) No person may smoke indoors in any
facility of the Veterans Health Administration.
(2) No person may smoke outdoors in any facility of the
Veterans Health Administration on or after October 1, 2022.
(b) Definitions.--In this section:
(1) The term ``smoke'' includes the smoking of
cigarettes (including e-cigarettes or electronic
cigarettes), cigars, pipes, and any other combustion of
tobacco.
(2) The term ``facility of the Veterans Health
Administration'' means any land or building (including
any medical center, nursing home, domiciliary facility,
outpatient clinic, or center that provides readjustment
counseling) that is--
(A) under the jurisdiction of the Department
of Veterans Affairs;
(B) under the control of the Veterans Health
Administration; and
(C) not under the control of the General
Services Administration.
* * * * * * *
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SECTION 526 OF THE VETERANS HEALTH CARE ACT OF 1992
[SEC. 526. USE OF TOBACCO PRODUCTS IN DEPARTMENT FACILITIES.
[(a) In General.--The Secretary of Veterans Affairs shall
take appropriate actions to ensure that, consistent with
medical requirements and limitations, each facility of the
Department described in subsection (b)--
[(1) establishes and maintains--
[(A) a suitable indoor area in which patients
or residents may smoke and which is ventilated
in a manner that, to the maximum extent
feasible, prevents smoke from entering other
areas of the facility; or
[(B) an area in a building that--
[(i) is detached from the facility;
[(ii) is accessible to patients or
residents of the facility; and
[(iii) has appropriate heating and
air conditioning; and
[(2) provides access to an area established and
maintained under paragraph (1), consistent with medical
requirements and limitations, for patients or residents
of the facility who are receiving care or services and
who desire to smoke tobacco products.
[(b) Covered Facilities.--A Department facility referred to
in subsection (a) is any Department of Veterans Affairs medical
center, nursing home, or domiciliary care facility.
[(c) Reports.--(1) Not later than 180 days after the date of
the enactment of this Act, the Comptroller General shall submit
to the Committees on Veterans' Affairs of the Senate and House
of Representatives a report on the feasibility of the
establishment and maintenance of areas for smoking in
Department facilities under this section. The report shall
include information on--
[(A) the cost of, and a proposed schedule for, the
establishment of such an area at each Department
facility covered by this section;
[(B) the extent to which the ventilating system of
each facility is adequate to ensure that use of the
area for smoking does not result in health problems for
other patients or residents of the facility; and
[(C) the effect of the establishment and maintenance
of an area for smoking in each facility on the
accreditation score issued for the facility by the
Joint Commission on the Accreditation of Health
Organizations.
[(2) Not later than 120 days after the effective date of this
section, the Secretary shall submit to the committees referred
to in paragraph (1) a report on the implementation of this
section. The report shall include a description of the actions
taken at each covered facility to ensure compliance with this
section.
[(d) Effective Date.--The requirement to establish and
maintain areas for smoking under subsection (a) shall take
effect 60 days after the date on which the Comptroller General
submits to the committees referred to in subsection (c)(1) that
report required under that subsection.]
[all]