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Public Statements

Hearing of the Senate Veterans Affairs Committee - Rural Veterans Need Better Access to Health Care Services

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Today, U.S. Sen. Al Franken (D-Minn.) told members of the Senate Veterans Affairs Committee that rural veterans in Minnesota and across the country often find that badly-needed health care services are unavailable in their communities and he urged them to act quickly on his Rural Veterans Health Care Improvement Act.

Sen. Franken introduced the measure with Sen. John Boozman (R-Ark.) last November after hearing about the struggles veterans living in Minnesota's rural communities were facing to get the care they need.

"The purpose of our legislation is very straightforward and very important: to improve access to quality health care for our nation's veterans living in rural areas," Sen. Franken told the committee. "Like many, my state of Minnesota has a lot of veterans who live in rural areas. Nationwide, over 40 percent of all veterans enrolled in the VA system live in rural areas. That presents a challenge to accessing to quality health care through VA...Our legislation will ensure that VA improves access to care for rural veterans, so that they can get the excellent health care they deserve. We owe them nothing less."

Sen. Franken's Rural Veterans Health Care Improvement Act will help the VA better manage resources and ensure that the Office of Rural Health achieves its important mission. The bill requires the VA to develop a five-year strategic plan for the Office of Rural Health within six months of enactment. The plan must include goals and objectives for:

Recruiting and retaining Veterans Health Administration (VHA) healthcare personnel in rural areas.
Ensuring timeliness and quality of care by VHA in rural areas through contract and fee-basis providers.
The implementation, expansion, and enhanced use of telemedicine in rural areas.
The full and effective use of VA's mobile outpatient clinics.
The modification of ORH funding allocation mechanisms so that the funds actually go to initiatives and projects that improve access to and quality of care for rural veterans.
In addition, the strategic plan must include procedures for soliciting from VA rural providers a statement of their clinical capacity, how they handle emergencies that exceed that capacity, including mental health emergencies, and how they provide and coordinate health care for women veterans.

You can watch Sen. Franken deliver his testimony before the committee here or read Sen. Franken's full testimony below:

As Prepared for Delivery
TESTIMONY BEFORE THE SENATE VETERANS AFFAIRS COMMITTEE ON RURAL VETERANS HEALTHCARE IMPROVEMENT ACT

Chairman Murray and Ranking Member Burr, members of the Committee - thank you for the opportunity to testify on behalf of the Rural Veterans Health Care Improvement Act. I'm very pleased to be working together with Senator Boozman on this legislation. His commitment to our nation's veterans, like his unflappable disposition, is well-known and undisputed. I'm honored that he is the lead cosponsor of this legislation, which was considerably improved through his work on it.

The purpose of our legislation is very straightforward and very important: to improve access to quality health care for our nation's veterans living in rural areas. Like many, my state of Minnesota has a lot of veterans who live in rural areas. Nationwide, over 40 percent of all veterans enrolled in the VA system live in rural areas. That presents a challenge to accessing to quality health care through VA.
To address this challenge, VA stood up the Office of Rural Health - or ORH - in 2007. Congress has provided over $1 billion in support of ORH through Fiscal Year 2012 - a significant investment.

But the reality and the results are not yet where they need to be. The funds that Congress has provided have enabled the Office of Rural Health to undertake hundreds of initiatives throughout the country. Unfortunately, there has been no coherent strategic plan for those hundreds of initiatives, and as a result, improvements in veterans' access to health care in rural areas have been piecemeal and uneven. Last year, a VA Inspector General found that ORH lacked reasonable assurance that a majority of its funds - amounting to $273 million - in fiscal years 2009 and 2010 actually improved access to and quality of care for rural veterans. That's a failure: it fails our veterans and it fails the public that funds VA's programs.

When we're talking about that much money, and such an important mission, we're not going to let VA muddle through. We're going to demand that they get it right and get it right now.

The ORH has an essential goal: to bring quality health care to veterans in rural areas. To achieve that, the VA needs to undertake careful strategic planning, including the careful stewardship of taxpayer resources. That is the purpose of our legislation, which requires VA to produce a strong and comprehensive strategic plan for ORH. 
I appreciate that VA has taken some steps to address the problems identified by the Inspector General's report. But these steps are simply not enough. First, the strategic plan that VA put out - which was already out when the IG made its findings - does not move beyond the piecemeal approach ORH had been taking and doesn't develop a comprehensive strategy. The "refresh" of the ORH plan that VA issued late last year was an improvement over the initial plan, but not yet enough of an improvement.

Second, while some of the features required by our legislation are included in the plan that VA put out, others are not. If ORH is to be successful, it needs to address all the important goals and objectives we've identified in the legislation. The Disabled American Veterans in their testimony note a couple of these areas - the full and effective use of mobile outpatient clinics, and the provision of and coordination of care for women veterans in rural areas. 

I will add another, just by way of example. I believe you will not find the word "emergency" or "emergencies" in the VA's current plan. Yet the VA Inspector General has again and again reported on the difficulties that many veterans in rural areas face trying to get care in an emergency. Understandably, many rural clinics are not equipped to handle many types of emergencies, including heart attacks, strokes, and mental health emergencies; they simply go beyond the capacity of these relatively small clinics. But we know that emergencies will happen, and we need to be prepared.  

To address this, our legislation will require VA to ensure that all VA rural health care providers are actually identifying their clinical capacity and have a contingency plan for how they handle emergencies that exceed that capacity. That way, if a veteran shows up with a mental health emergency, for example, he or she will really get the best care possible in addressing that emergency. We can't have veterans committing suicide or suffering intense psychological anguish because they couldn't get care. I've also heard from Minnesota County Veteran Service Officers about veterans who get taken to the hospital for a heart attack and have real trouble getting it covered. The coordination of care that my bill promotes will also make that situation less likely.

Finally, our bill brings much-needed accountability to the VA's Office of Rural Health. I appreciate that VA wants ORH to achieve its mission. This legislation will help make that happen, and happen faster.

I would also note that the Appropriations Committee, in its report accompanying the Military Construction/VA appropriations bill reported unanimously, expressed its belief - quote - "that the VA must do more to plan for and provide quality healthcare to veterans living in rural and highly rural areas."

ORH is dedicated to the provision of health care to rural veterans, and Congress has provided substantial funds for that very important purpose. But thus far, the results have not been good enough. Our legislation will ensure that VA improves access to care for rural veterans, so that they can get the excellent health care they deserve. We owe them nothing less. Thank you.


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