Privatized medicine, by law, may replace Department of Veterans Affairs care only if the VA is not physically available for former service members who live in rural areas.
But if veterans are waiting in line for months for initial exams, are the VA facilities “physically available”?
“I think we’ve established that there is a hardship already,” Andy Behrman, chairman of the Rural Health Policy Board of the National Rural Health Association, told the House Veterans’ Affairs health subcommittee at a hearing Wednesday. “That’s why we’re here.”
With 44 percent of service members today coming from rural towns, the committee hoped to come up with some solutions for the thousands of veterans not getting the care they need. Many veterans struggle because there are no VA facilities in their areas, because they can’t afford the travel expenses to VA facilities, because there is a national crisis in getting mental and specialized health care professionals to work in rural areas, and because the VA system is so backed up that veterans can’t get the care they need when they need it.
“I’m worried that protecting the system isn’t protecting the vets,” said Rep. Vic Snyder, D-Ark.
Representatives of veterans’ groups at the hearing said more funding must go to VA facilities to keep standards of care, as well as expertise in veterans’ issues such as post-traumatic stress disorder and traumatic brain injuries, at the maximum level.
“It’s very important to make sure the quality of care as well as the continuum of care Veterans’ Affairs is known for remain intact,” said Adrian Atizado, assistant national legislative director for Disabled American Veterans.
Atizado also said initial contracts with private companies always look good, but when it’s time to renew those contracts three years later, the costs can go up substantially. The quick fix of privatized care can’t fix the system in the long run and will cost more, he said.
He recommended better funding for the VA, as well as mobile health care clinics to travel to veterans. He also recommended stronger connections with medical schools, and providing veterans with sufficient reimbursement when they do travel long distances for care.
In addition to Atizado’s input, Behrman recommended more contracts with Federally Qualified Community Health Centers in rural areas, more case managers for traumatic brain injuries, and targeted care for minority and female veterans.
Gerald Cross, acting principal deputy undersecretary for health in the Veterans Health Administration, said the VA is holding its own, and noted that 98.5 percent of veterans live within 90 minutes of a VA facility.
“VA’s comprehensive approach for providing care to veterans residing in rural areas has proven successful,” he said. “New technologies and better planning are allowing us to provide quality care in any location.”
He said tele-health allows patients to receive care by phone, and home-based health care have helped people who can’t travel. VA also has increased the number of community-based outpatient clinics by 717 since 1995, and 45 percent of them are in rural areas.
But Shannon Middleton, deputy director for health for the American Legion, said many of the CBOCs “are at or near capacity,” she said, “and many still do not provide adequate mental health services to veterans in need.”
Cross said the VA planned to add 2,000 veterans with PTSD to the telemedicine program by 2008. At that rate, it would take 30 years to reach all of the veterans returning with PTSD, said Rep. Michael Michaud, D-Maine.
“There are 218,000 vets in southern Nevada who have no health care facilities,” said Rep. Shelley Berkley, D-Nev. “We will be taking care of their health care and mental health care needs for many years to come, and we can’t handle what we’ve got.”
Before the subcommittee had a chance to question Cross further about how the VA is addressing the problems, lawmakers had to adjourn the hearing to vote on other matters.
“We have to do better,” Michaud said as the hearing broke up. “I know VA is intending to do better.”