Panel Weighs Concerns About Rural Veterans’ Access to Care

Congressional Quarterly

A House panel Thursday began sifting through a variety of bills to improve medical care for veterans, with access to treatment in rural areas among the top concerns addressed by the stack of proposals.

Dominating the hearing by the House Veterans’ Affairs Health Subcommittee were stories of rural veterans spending entire days routinely traveling hundreds of miles to the briefest of appointments, but veterans’ groups voiced ambivalence about how lawmakers would address the problem.

The subcommittee listened to more than half a dozen House members pitch their bills for improving veterans’ care, a number of which call for increased contracting by the Veterans Health Administration at the Department of Veterans Affairs with local providers to treat veterans who live in areas distant from VA facilities.

But some veterans’ lobbyists expressed fear that broader contracting to provide more timely and convenient treatment would undermine the VA’s system for directly providing care itself through its own hospitals and clinics.

Rep. Ginny Brown-Waite, R-Fla., made a pitch for her bill (HR 92) that would set standards for timely access to care. Veterans would have to be able to get appointments for primary care from the VA hospitals or clinics within 30 days. In certain instances, if the VA were unable to live up to that standard, it would have to contract for care with private providers.

Although the VA claims that almost all of its facilities comply with the 30-day standard 90 percent or more of the time, but Brown-Waite said many veterans wait much longer than that. “I guess it’s in dog years that they are counting it, because it’s not human days,” she said.

Rep. Solomon P. Ortiz, D-Texas, said that young veterans in his south Texas district face complex medical needs, yet the closest VA hospital is many hours away. A veteran spends five-and-a-half hours to get to the nearest VA hospital to get a 15-minute checkup and then has to spend another five-and-a-half hours getting back home, he said.

“Now we are beginning to see wounds that we have not seen before,” Ortiz said of the injuries sustained by U.S. solders from explosive devices in Iraq. Yet the federal government continues its longtime resistance to building a VA facility in his district, he said. “Young men went and fought a war thinking we were going to take care of their problems,” he said. The government can find money to fight a war, he said, “but for some reason we can’t find the money to keep the promises that we made” to care for them if they are injured or sick.

Ortiz is urging passage of a bill (HR 538) that would establish an in-patient VA facility in his district to serve the more than 100,000 veterans living there.

Overall, the VA has made much progress in providing more timely care, said Dennis M. Cullinan, legislative director of the Veterans of Foreign Wars. “A few years ago, there were over 300,000 veterans throughout the country who were waiting six months or more for primary health care, but VA has made great strides to reduce this and most initial appointments are being made” within 30 days, he said.

Cullinan said contracting for care in certain geographic where this is not the case raised concerns about what it would cost.“While it would greatly benefit veterans in areas with long waiting times, we must be mindful of it not eating into the health care budget for other locations.”

Adrian Atizado, legislative director of the Disabled American Veterans (DAV), expressed similar concerns about contracting. “The DAV is opposed to any initiative that would turn VA into a primary insurer rather than a provider of health care to veterans,” he said.

Rep. Michael H. Michaud, D-Maine, chairman of the subcommittee, was noncommittal about the bills, saying the hearing was just the first of many his panel would hold to consider legislation.

But Michaud also outlined some of his own thinking on the rural access issue, noting that he has prepared a draft proposal for discussion purposes that would establish mobile clinics to provide care in rural areas, create a special advisory committee on rural veterans to improve access to care and also create “centers of excellence” to carry out research on improving rural access to care.

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