[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
BEYOND THE CITY LIMITS:
DELIVERING FOR RURAL VETERANS
=======================================================================
HEARING
before the
SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION
of the
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
FRIDAY, JULY 25, 2025
__________
Serial No. 119-33
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILANLE IN TIFF FORMAT
Available via http://govinfo.gov
U.S. GOVERNMENT PUBLISHING OFFICE
61-507 WASHINGTON : 2025
COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION
TOM BARRETT, Michigan, Chairman
NANCY MACE, South Carolina NIKKI BUDZINSKI, Illinois, Ranking
MORGAN LUTTRELL, Texas Member
SHEILA CHERFILUS-MCCORMICK,
Florida
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
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FRIDAY, JULY 25, 2025
Page
OPENING STATEMENTS
The Honorable Tom Barrett, Chairman.............................. 1
The Honorable Nikki Budzinski, Ranking Member.................... 4
WITNESSES
Panel I
Dr. Daniel Zomchek, Ph.D, Director, Veteran Integrated Service
Network 12, Veterans Health Administration, U.S. Department of
Veterans Affairs............................................... 6
Accompanied by:
Dr. Staci Williams, PharmD, RPh, Executive Director, VA
Illiana Healthcare System, Veterans Health
Administration, U.S. Department of Veterans Affairs
Dr. Peter Kaboli, MD, MS, Executive Director, Office of Rural
Health, Veterans Health Administration, U.S. Department
of Veterans Affairs
Mr. John Lawson, Superintendent, Veterans Assistance Commission
of St. Clair County............................................ 7
Ms. Hillary Rains, Community Engagement Manager, Illinois Office
of Broadband, Illinois Department of Commerce and Economic
Opportunity.................................................... 9
Mr. Kim Kirchner, Veteran, United States Air Force, Illinois Air
National Guard................................................. 11
Ms. Christina Schauer, President & Co-Founder, Tri-State Women
Warriors....................................................... 12
APPENDIX
Prepared Statements Of Witnesses
Dr. Daniel Zomchek, Ph.D Prepared Statement...................... 33
Mr. John Lawson Prepared Statement............................... 35
Ms. Hillary Rains Prepared Statement............................. 37
Mr. Kim Kirchner Prepared Statement.............................. 40
Ms. Christina Schauer Prepared Statement......................... 41
BEYOND THE CITY LIMITS:
DELIVERING FOR RURAL VETERANS
----------
FRIDAY, JULY 25, 2025
Subcommittee on Technology Modernization,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:10 a.m., at
Chez Veterans Center, 908 West Nevada Street, Urbana, Illinois,
Hon. Tom Barrett (chairman of the subcommittee) presiding.
Present: Representatives Barrett and Budzinski.
OPENING STATEMENT OF TOM BARRETT, CHAIRMAN
Mr. Barrett. Good morning, everyone. How are you?
Thank you so much and thank you for the opportunity to join
you today.
The Subcommittee on Technology Modernization will come to
order. I want to start by thanking our ranking member and the
host today in your district, Ranking Member Budzinski, for
welcoming us to Illinois' 13th District. I appreciate the
hospitality and the welcome, and everyone, and really just the
warmth that I can feel for how you care for veterans and how
you have welcomed us on the committee here today, and I really
deeply appreciate all of that.
I would also like to thank the University of Illinois and
the Chez Veterans Center for hosting us, and for all of the
staff at the university that helped make this hearing possible.
I know many of you went out of your way to put this together.
Colonel, I appreciate your willingness to help pull this
together and everything that you did. Even though you were
voluntold, I appreciate your willingness to step up and do
that.
I appreciate our conversation earlier, really about that
transition from military back into civilian life, and the
challenges that some of our veterans face, whether they are on
campus or not, and how we can do a better job of really making
that transition easier for our veterans.
I also want to thank Garrett Anderson who is here. Where is
Garrett? Very good. Garrett, thank you so much for taking me on
the tour this morning. Really appreciate all of your very, very
clear commitment to veterans and making sure that they are
welcomed home and treated with the dignity that they need and
really transition as effectively as possible. I can tell that
you take a great deal of pride in that, and we appreciate your
work in that regard, so thank you.
The mission of the Technology Modernization Subcommittee is
to make sure that U.S. Department of Veterans Affairs (VA) is
buying, using, and developing the right information technology
(IT) in order to deliver the best care and services for our
veterans. That is the task that we have on this subcommittee
and plays into why we are here today.
Technology plays a huge role in delivering VA care to rural
veterans because VA simply cannot give all the care and
services they need at traditional brick and mortar facilities
that are often too far for veterans to reach or might not be as
convenient to them because of their limitations for travel.
This topic is also personal to me. I served 22 years in the
United States Army, and I am now building a family in a rural
part of Michigan myself. I also represent Michigan State
University in my district, so I do have to say a ``Go Green''
while I am here.
I know firsthand the frustration that veterans feel when
the care they have earned is out of reach simply because of
where they live. I actually do not have a VA hospital facility
in the district that I represent. The 800,000 or so residents
of my district and the veterans there have to travel outside of
my congressional district if they go to a VA hospital.
That is what today is about, making sure rural veterans are
not left behind. The reality is veterans in rural communities
face serious barriers to accessing VA care. Nearly one third of
VA-enrolled veterans live in rural communities. They drive
longer distances. They wait longer for appointments, have fewer
providers to choose from, and deal with limited broadband and
transportation options. However each community is different,
and rural veterans do not all have the same experience with the
VA. I am glad the ranking member and I were able to take our
subcommittee on the road and talk to you all where you live and
learn about the specific challenges that you face.
In Washington, we hear a lot of experiences from people. I
think we all benefit from going directly to the source for
where things are happening. That is a good reason why we are
here today.
One of the most important tools that exists for rural
veterans is the Community Care Program. Community care allows
veterans, especially those in rural and underserved areas to
see outside providers when brick and mortar VA facilities
cannot meet their needs. Community care is VA care, and
millions of veterans rely on it every single year.
Having used community care personally, I know there is room
for improvement. I want to ensure every veteran watching this
hearing knows they only need to meet one of the several
criteria to qualify for community care. One is if the VA does
not offer the service that is needed. Another is if the VA
facility is not in the area in which they are located. If the
VA cannot schedule an appointment quickly enough or close
enough to them. Or if community care is in the veteran's best
medical interest.
Under the leadership of Chairman Mike Bost, chairman of
this committee, whose district is not too far south of here,
this committee is working hard to ensure that rural veterans
are able to make their own choice on whether community care is
the right option for them, if they are eligible.
In addition to community care, VA has many other resources
that are important for rural veterans, including telehealth,
mobile medical units, and much more that we will hear about
today. Technology has a big role to play here, and that is
where this subcommittee comes in.
There are a lot of exciting opportunities for technology to
drive better VA care and services in rural communities. A great
example is the External Provider Scheduling (EPS) System, which
allows VA staff to see realtime appointment availability and
book directly with community providers or within the VA system,
depending on which is available first and closer to home. While
it is only active at around 50 VA medical centers currently, it
has empowered staff to schedule up to four times more
appointments per day by eliminating delays, confusion, and
honestly a game of telephone that goes back and forth.
Another great example is telemedicine. When it comes to
mental health, where isolation is a real risk, tools like tele-
mental health and remote monitoring are essential lifelines for
veterans who otherwise might fall through the cracks. I want to
say I am very impressed by the services that you have here that
allow veterans to access those services around other veterans
who may have had a shared experience to them. I think that is
another important community aspect of this.
Even with these tools, there is room for improvement.
Reports from Government Accountability Office (GAO) and the VA
Inspector General have shown that rural health programs lack
clear performance goals, outreach strategies that are
inconsistent at the Veterans Integrated Service Network (VISN)
level, and community care referrals still take too long,
especially in high-need areas like mental health and women's
care that we are still trying to make strides in.
Provider participation in VA's cellular networks is also
lagging, with some rural providers walking away due to red
tape, poor communication, or late payments. We cannot let
bureaucracy or outdated processes get in the way of quality and
timely health care.
This subcommittee is committed to ensuring that VA's rural
health programs are well managed, accountable, and truly
reaching the veterans they are meant to serve. That means
cutting the red tape, improving access to care, ensuring every
veteran understands their options for quality care, and that we
leave no veteran behind to figure this out for themselves. It
also means ensuring the resources are there to sustain proven
services and tools, like the external provider scheduling
system, telehealth, transportation services, and others.
My goal is to ensure every program is driven by measurable
outcomes that validate better health outcomes, not just good
intentions. In fact, we talked about that today earlier. There
are so many veteran organizations out there, each with good
intentions, sometimes duplicating services, sometimes
duplicating intentions. Having a real drive to find out where
we can get that done in the best way is really important.
The bottom line is this-Geography should never be a barrier
to care. If a veteran qualifies for VA health care, it is our
job to make sure they can get it without delays, without
confusion, without frustration, and without giving up. We hear
too many stories about veterans who have simply abandoned the
benefits that they have earned because they cannot untangle the
confusion.
I look forward to hearing from you all about how we can
accomplish this today.
Before I turn it over to the ranking member, I just want to
remind everyone here that this is not an open forum but is a
oversight hearing for Members of Congress and the witnesses
that are before us today. They will be testifying under oath.
This is not a forum for individuals to participate. I know,
seeing as how we are in the ranking member's district, if you
do have questions of your own, I am sure she is available to
work with you on those.
With that, I will yield to the ranking member for her
opening statement. Thank you again for having us.
OPENING STATEMENT OF NIKKI BUDZINSKI, RANKING MEMBER
Ms. Budzinski. Thank you very much, Chairman Barrett, for
coming to the 13th District. Welcome to Urbana. It is really
great to have you here. I appreciate you making that trip.
I also want to just echo a sincere thank you to the Chez
Veterans Center and the leadership. I have had the privilege of
visiting the center and I know the important work that you are
doing for veterans, student veterans on campus, and just want
to say it is so special to be here, having you host us for this
field hearing. I want to say a sincere thank you. Thank you to
the University of Illinois.
You know, Chairman Barrett's district and mine are probably
very similar. He mentioned Michigan State, so I have to say,
``Go Illini.''
Very similar in a lot of different ways. I think that this
forum, this panel is going to be, I think, really important to
both of us and we will take all of this information back with
us to Washington. I look forward to a robust conversation about
the experiences specifically for our rural veterans, gaps in
access to care and benefits, and resources that are available
to bridge them.
I want to also welcome our diverse panel of witnesses
representing VA leadership, veterans service organizations,
county and State programs, and most importantly veterans. I am
grateful to all of you for being here, and I know that many of
you traveled long distances to participate. Please know that I
appreciate those efforts, and this conversation would not be as
productive without you. Thank you.
For the rural veterans in the room, this type of travel is
nothing new. Whether it is driving hours to the closest VA
medical center, or even farther for a compensation and pension
exam, rural veterans are unfortunately used to traveling to
access the care and benefits they have earned through their
service to our Nation. I think something the chairman mentioned
I share in common, Danville, Illinois is actually outside of my
district, about 45 minutes from here, but is the closest VA
hospital. The 13th District is serviced by VA hospitals, but
just outside of it.
This is the biggest reason that I believe that community
care, though, has to remain available to rural veterans.
Unfortunately, community care access in rural America is not
guaranteed. Due to financial issues and national provider and
nursing shortages, rural health care is dying. Changes to
Medicaid will only make it worse.
According to the Center for Health Care Quality and Payment
Reform, 700 rural hospitals, a third of all rural hospitals in
the country, are at risk of closing in the near future. Almost
half of those are deemed at immediate risk of closing. In fact,
Illinois has already lost three community hospitals in recent
years, and nine more have been deemed at immediate risk. We
cannot have a conversation about community care without
addressing the fact that it may not be there to take care of
our veterans.
I hope to hear from VA regarding its plans to ensure that
veterans continue to have access to care. The work that
Chairman Barrett and I do on the Technology Modernization
Subcommittee seeks to help VA bridge some of these gaps through
the use of technology. VA has long been a pioneer of
telehealth, and during the COVID-19 pandemic, the Department
quickly pivoted to expand telehealth, which allowed many
veterans to continue to receive much of their care.
Unfortunately, telehealth is only a solution for veterans who
have access to sufficient internet and the technical knowledge
to use it.
It is sad that in 2025, there are still parts of Illinois
and the country that do not have access to broadband internet.
Sadly, it is not just a rural America issue, either. Even in
places where broadband internet is available, it can be
prohibitively expensive, especially for veterans living on a
fixed income.
I am looking forward to hearing about our efforts to
address the access and cost to make internet available to
veterans so that they can access their care and benefits.
I hope that we can have a fruitful conversation about these
issues and possible solutions.
Thank you again, Mr. Chairman, for being here, and I will
yield back.
Mr. Barrett. Thank you, Ranking Member Budzinski. I will
now introduce our witnesses.
From the Department of Veterans Affairs, we have Mr. Daniel
Zomchek, the Executive Director of VISN 12 for this region.
Thank you for being here.
Accompanying Mr. Zomchek is Dr. Staci Williams, the
Executive Director of the Illiana Healthcare System--did I say
that right? Illiana, sorry. My apologies. They even spelled it
phonetically for me. Yes. I am an Army grunt, so--I was in the
artillery. We just got to get close.
[Laughter.]
Mr. Barrett. Dr. Peter Kaboli, Executive Director of the
Office of Rural Health. Thank you.
We also have Mr. John Lawson, Army veteran and
Superintendent of the St. Clair County Veterans Assistance
Commission. Thank you.
Ms. Hillary Rains from the Illinois Department of Commerce
and Economic Opportunity. We met back in the coffee room
earlier. Thank you. I think you told me you traveled a bit of a
distance to get here today, so appreciate it. Thank you for
being here.
Finally, we have Mr. Kim Kirchner, an Air Force veteran
from Girard, Illinois, and Ms. Christina Schauer, an Army
veteran and co-founder of Tri-State Women Warriors. Thank you
both for being here as well.
At this time, we will ask the witnesses to please stand and
raise your right hand.
[Witnesses sworn.]
Mr. Barrett. Very good, thank you. Let the record reflect
that all witnesses have answered in the affirmative.
Mr. Zomchek, you are now recognized for 5 minutes to
deliver your opening statement on behalf of VA.
STATEMENT OF DANIEL ZOMCHEK
Dr. Zomchek. Well, thank you very much. Good morning,
Chairman Barrett, Ranking Member Budzinski, and our
distinguished guests. Thank you for this opportunity to discuss
VA's efforts to enhance the well-being of our rural veterans,
especially within the VA Illiana Healthcare System.
As you announced, my name is Dan Zomchek. I am the network
director of VISN 12. Joining me today are Dr. Staci Williams,
from the VA Illiana Healthcare System, and Dr. Peter Kaboli
from the Office of Rural Health in Veterans Health
Administration (VHA).
I would like to take some time to share some highlights
about the work that we are doing within VA, VISN 12, and
specifically the VA Illiana Healthcare System in providing
essential care to our rural veterans. Having been with the VA
for over 20 years and serving as the network director of VISN
12 for almost 3 years, I am deeply committed to our veterans
and to our mission. We strive to ensure that veterans, no
matter where they live, receive the top notch care that they
have earned and deserve.
I will start with the health care services provided by the
VA Illiana Healthcare System. This system has been a
cornerstone within the Danville community for over 125 years,
with a dedicated team of over 1,500 health care professionals
taking care of about 30,000 veterans in the community. Covering
34 counties in east-central Illinois and west-central Indiana,
we reach vets in both urban and rural areas.
Over two dozen of our sites across VISN 12 serve a
population where more than half of those veterans are enrolled
from rural areas. Given that 4.2 million of the 16.5 million
U.S. veterans live in rural areas, our services play a crucial
role in ensuring these veterans have access to the health care
that they have earned and deserve.
It is also important to note that veterans in rural areas
enroll in VHA care at higher rates, that is 65 percent,
compared to 47 percent for their urban counterparts.
I would like to touch on a few key initiatives that support
rural veterans, starting with community care as you mentioned.
Through the Veterans Community Care Program, we ensure timely
care closer to home via a network of over 1.4 million non-VA
providers. The network here is vital for delivering hospital
care, medical services, and specialty care, especially for
those vets that need to travel long distances. We have
streamlined referrals and improved care coordination to ensure
quality and continuity.
Next, telehealth, which was also mentioned earlier, and
virtual mental health services have truly been a game changer
for our veterans in rural and remote areas. VA has invested in
telehealth infrastructure, enabling veterans to connect with
primary care providers and specialists through platforms like
VA Video Connect, that we call VVC, reducing travel and
improving health outcomes. We have also ramped up on virtual
mental health services, including therapy, medication
management, and crisis intervention, all critical for
addressing mental health needs of our veterans. As a former VA
psychologist and intern, this is a particular area that is of
importance to me, is mental health.
Last, on beneficiary travel, we recognize that getting to
appointments can be challenging for our veterans in rural
areas. VA's Veterans Transportation Service, or VTS, provides
door-to-door rides for eligible veterans. Our Highly Rural
Transportation Grants Program helps vets to travel to VA
medical centers. The Volunteer Transportation Network, backed
primarily by the Disabled American Veterans Organization, which
is a fantastic partner for us and our veterans, offers free
rides through volunteers.
That is it, Chairman Barrett and Ranking Member Budzinski.
I want to thank you for allowing me and us to share our efforts
in assisting our rural veterans. With your backing, VA
continues to expand its reach, ensuring more veterans receive
the care that they have earned and deserve. We appreciate your
commitment, and we look forward to discussing these points
further during today's field hearing.
[The Prepared Statement Of Daniel Zomchek Appears In The
Appendix]
Mr. Barrett. Thank you. The written statement of Mr.
Zomchek will be entered into the hearing record, and appreciate
your testimony.
Mr. Lawson, you are now recognized for 5 minutes to deliver
your opening statement.
STATEMENT OF JOHN LAWSON
Mr. Lawson. Chairman Barrett, Ranking Member Budzinski and
the members of the subcommittee, on behalf of the Veterans of
St. Clair County, thank you for the opportunity to provide
remarks on challenges faced by veterans residing in rural
America and, in our opinion, the best State for veterans, the
Land of Lincoln, the great State of Illinois.
My name is John Lawson. I am the superintendent of the
Veterans Assistance Commission of St. Clair County, Illinois. I
am a VA-accredited government veterans service officer (VSO)
through the National Association of County Veterans Service
Officers (NACVSO). I am also a life member of the Veterans of
Foreign Wars of the United States (VFW) Post 1739 in
Belleville, Illinois, and currently serving as the VFW State of
Illinois legislative co-chairman, and a life member of the
Disabled American Veterans Chapter 24 in Freeburg, Illinois.
I lead a small team of five other full-time veterans
service officers who are fully invested in ensuring our
veterans receive the benefits that they have earned, and
safeguarding them from predatory, unaccredited claims
consultants.
St. Clair County is unique in that, while we do have a
suburban feel and a significant active military presence at
Scott Air Force Base, much of our veteran population exists in
the small towns that dot rural Illinois. We consider ourselves
very fortunate to have our VA community-based outpatient
clinic, the CBOC, in Shiloh, Illinois, and one more forecasted
to open on Scott Air Force Base.
Even with these two facilities, our population of veterans
from St. Clair County and surrounding counties have eclipsed
the safe patient load of our great care providers at the CBOC.
Many veterans cannot use this facility due to these patient
load caps. Coupling this limiting factor is the limited scope
of care available at the CBOC that nearly always leads to a
veteran being referred to a VA medical center for specialty or
advanced care needs. Our veterans are served by the St. Louis
Veterans Administration Medical Center (VAMC) that also serves
over 110,000 eligible veterans on the Missouri side of the
river.
Although we understand that full-service VAMC on the
Illinois side of the St. Louis metro may not necessarily be in
the cards for the nearly 104,000 eligible veterans of the
Illinois 12th and 13th congressional Districts, we do need a
much larger footprint and improved service capacity for our
veterans by way of a higher level of care facility that is able
to accommodate our needs beyond routine physicals and blood
draws.
At my last count, we had five patient-aligned care teams
(PACT) at the St. Clair County CBOC with a max patient load of
6,000 veterans, with two additional patient-aligned care teams
forecasted for the future Scott Air Force Base CBOC. This
combined maximum patient load of 8,400 only represents about 33
percent of the eligible veteran population of St. Clair County,
according to the 2023 VA Georgraphic Distribution of VA
Expenditures (GDX) and roughly 8 percent of the eligible
veterans of the 12th and 13th congressional Districts.
The non-forecasted number is even more disappointing at
approximately 24 percent for St. Clair County and 5 percent for
the combined congressional districts without inclusion of the
forecasted Scott Air Force Base CBOC.
We do believe that H.R. 740, the Veterans' Assuring
Critical Care Expansions to Support Servicemembers (ACCESS) Act
of 2025 will be a good start for St. Clair County veterans,
especially as our CBOC in Shiloh sits directly between two
full-service hospitals less than two miles to the east or west,
much closer than the nearest VAMC in St. Louis, Missouri, at 45
minutes to an hour away.
We look forward to the subcommittee's help to help our
veterans by working with the VA to direct the development of
automated approvals of community care applications to reduce
the time to approval, reduce travel, reduce the delays in
receiving care, and also supporting the local community by
veterans utilizing their earned VA compensation where it was
intended, in that veteran's local community, not in another
State.
Additionally, we would like to ensure that the veterans do
not receive bills for this care when applicable. Negotiated
reimbursements and payment submission portals for providers
should be developed to ensure clarity of responsibility of
payment for the provider and patient.
Last, ensuring our VA electronic health records (EHR) are
two way accessible to the VA primary care providers and the
community care providers is essential in ensuring the best
possible outcomes for our veteran patients. In situations
involving advanced or specialty care, miscommunication between
providers can cause irreparable harm to the veteran.
I wish to emphasize that our support for the Veterans'
ACCESS Act of 2025 is not to be an indication that we support
substitution or privatization for direct VA care for our
veterans. To be straightforward, we do not. Our support of this
proposal is as a supplemental partnership with the community
medical providers to ensure timely access to care and the best
possible health outcomes for our veterans.
It is important to remember that providing resources for
care only in the community and not also for VA direct care can
lead to a less capable VA, which is a detriment to our veteran
care. In military terms, community care is a force multiplier
when leveraged correctly, not a substitution.
Chairman Barrett, Ranking Member Budzinski, this concludes
my testimony. I have also submitted written testimony on other
pending legislation matters for your review.
I welcome any questions from you or members of the
subcommittee.
[The Prepared Statement Of John Lawson Appears In The
Appendix]
Mr. Barrett. With 2 seconds to spare, we appreciate your
testimony today. Did you time that out?
Mr. Lawson. Yes, sir, I did. I am a slow talker from the
Ozarks; I am surprised I got it out that fast.
Mr. Barrett. Thank you for your testimony. Thank you for
being here. The written statement of Mr. Lawson will be entered
into the hearing record. Thank you.
Ms. Rains, you are now recognized for 5 minutes to deliver
your opening statement.
STATEMENT OF HILLARY RAINS
Ms. Rains. Thank you so much, Mr. Chairman. Chairman
Barrett, Ranking Member Budzinski, and distinguished guests,
thank you for the opportunity to testify today on behalf of the
Illinois Department of Commerce and Economic Opportunity, and
the Illinois Office of Broadband. I am here to talk about the
critical intersection of telehealth access for rural veterans
and the impact of the digital divide on their health and well-
being.
When we talk about the digital divide in 2025, we are
talking about a disparity in access to fast, affordable, and
robust internet, as well as to the devices, tools, and skills
that allow people to connect to critical supports throughout
their lives. Vulnerable populations often find themselves on
the wrong side of this divide, and veterans, of course, are one
of them, with only about 67 percent of Illinois veterans having
and using broadband access.
Veterans are often also part of more than one vulnerable
population, as 56 percent are over the age of 60 and 26 percent
nationwide, over 4 million people, live in rural areas. Rural
residents have their own challenges where internet connectivity
is concerned. The Federal Communications Commission (FCC)
estimates that 28 percent, almost a third, of rural residents
lack broadband access.
Fifty-seven percent of rural locations in Illinois alone
are entirely unserved or underserved, receiving internet speeds
below the FCC's minimum recommendation of 100 by 20 megabits
per second. This recommendation is indeed the bare minimum, as
it is only often adequate for one user at a time to do everyday
tasks like videoconferencing, streaming, and emailing. The
inability to complete these tasks from home disadvantages rural
veterans, especially when trying to access telemedicine
resources.
The VA obviously provides vital care centers and hospitals
across the country. When we look at veterans who live in rural
areas, they live an average of 45 miles--and that is an
average--to be seen in person at a VA center. As veterans are
twice as likely as nonveterans to suffer from two or more
chronic health conditions, frequent checkups and appointments
are especially important.
Telehealth resources began to be promoted heavily just
before the pandemic to alleviate those challenges with
transportation and provider availability. Adoption rates in
rural areas suffered because of the lack of broadband access.
When considering additional complications such as subscription
affordability, device ownership, and varying degrees of digital
literacy and skill, especially in the more than half of
veterans over 60, the problem is laid out in stark relief.
Illinois has already worked diligently to increase
broadband access for rural residents through the Connect
Illinois broadband infrastructure grant. Connect Illinois
allows internet service providers to build high-speed fiber
infrastructure in rural areas that often have low population or
subscriber density and are isolated from middle mile
infrastructure.
As of today, three State and federally funded rounds of
this program have connected approximately 7,500 households,
with 46,000 total more to be connected over the next 3 years.
The fourth round is currently being funded by the Federal
Broadband Access Equity and Deployment Act, you might have
heard BAED, Program, and stands to connect over 165,000
Illinois residents and almost 5 million other households across
the country without adequate connectivity.
While the BAED program is in progress, there is another
program that can fund veteran-serving organizations on the
ground and helped to provide rural residents with device
access, digital skill building, one-on-one troubleshooting
support, and more. That program is the Digital Equity Act. This
program was poised to provide $2.75 billion to states to
support programming and sub-grants to direct service
organizations with veterans being targeted as one of the
vulnerable populations most affected by the digital divide.
Illinois was to receive more than $23 million to equip
households and residents with the skills, resources, and tools
needed to use the high-speed internet.
Illinois received over 260 sub-grant applications
throughout the State, with the full ask over $100 million, far
outstripping the available funds, showing the need. Some of the
programs proposed were to support telehealth and resource
access for recently separated women veterans in the rural
southwest central region, veteran-focused digital literacy
classes, mobile skill-building hubs, and secure community
telehealth rooms. Unfortunately, the Digital Equity Act and its
$2.75 billion of appropriated funding were terminated by
executive order, leaving these programs unfunded.
Expanding access is the key to health and well-being of
rural veterans. Thank you so much and thank you for having us
today.
[The Prepared Statement Of Hillary Rains Appears In The
Appendix]
Mr. Barrett. Thank you for your testimony. Thank you for
being here.
The written statement of Ms. Rains will be entered into the
hearing record.
Mr. Kirchner, you are now recognized for 5 minutes to
deliver your opening statement.
STATEMENT OF KIM KIRCHNER
Mr. Kirchner. Good morning. Thank you everyone for taking
the time out of your day to listen to my testimony. My name is
Kim Kirchner, and I am a proud veteran who served in the United
States Air Force, Illinois Air National Guard, and served in
Operation Iraqi Freedom and Operation Enduring Freedom (OIF/
OEF). I am currently a sergeant with the Macoupin County
Sheriff's Department.
I am writing the testimony in regard to the care that I
have received at a compensation and pension exam. I drove over
30 minutes to an exam that the VA scheduled for me with a
contract provider. When I arrived, the medical provider
informed me that I was not on her schedule and that she could
not find my medical records. I told her that the VA had called
me and asked me to come in at an earlier date due to an
opening. She finally found my records, but had an attitude
through the entire exam, which lasted a total of 3 minutes. At
no time did she conduct a medical exam on me. She only reviewed
my medical record. Based on that exam, VA denied my claim. In
order to finally get my claim awarded, I had to do a whole
other medical exam. This was a massive waste of my time and
taxpayers' money.
I firmly believe that I am not the only veteran this has
happened to, and the outsourcing of these exams definitely
needs to be looked into. When a veteran goes for an exam, they
should be treated with the utmost respect they deserved,
especially for putting their lives on the line for our country.
When I walked out of that exam that did not last approximately
3 minutes, I have never felt so disrespected in my life. It was
very frustrating to get treated this way, especially having to
drive 30 minutes to the exam due to living in a small town and
nowhere close to a VA clinic.
I firmly believe that the VA need to pay more attention to
the care we are receiving from them outsourcing their
compensation and pension exams.
Thank you everyone, and I am happy to answer any questions
that you may have.
[The Prepared Statement Of Kim Kirchner Appears In The
Appendix]
Mr. Barrett. Thank you, Mr. Kirchner, and thank you for
your service then and your service now. I have heard from other
veterans with similar experiences to yours with that
compensation and pension, so I want to make sure that we
correct that. I hope your experience since then has been far
better and far more respectful. If not, I know the ranking
member and I would be very interested in ensuring that that
happens for you going forward.
Your written statement will be entered into the hearing
record, and again I appreciate your willingness to come and
testify today.
Ms. Schauer, you are now recognized for 5 minutes to
deliver your opening statement.
STATEMENT OF CHRISTINA SCHAUER
Ms. Schauer. Chairman Barrett, Ranking Member Budzinski,
and members of the subcommittee, thank you for the opportunity
to speak today. My name is Christina Schauer. I am a U.S. Army
Iraq War veteran and president of the Tri-State Women Warriors,
a nonprofit with a mission to provide connection and advocacy
for the unique needs of women veterans and service members.
Today, I will focus on three key areas of impact for rural
veterans: Enhanced community outreach, coordinated and
purposeful community care utilization, and a strong rural VA
presence.
Community outreach is vital to ensure veterans understand
their benefits, how to access them, and why they matter,
especially in isolated rural areas. The VA's community
engagement and partnerships for suicide prevention program has
been essential in supporting local coalitions like ours working
to prevent veteran suicide.
Our local engagement coordinator has been a behind-the-
scenes champion of the Tri-State Women Warriors, which has now
served over 100 local women through live events and helped many
access VA care for the first time. Some, for trauma experienced
decades ago. These outreach programs serve a vital role in
ensuring rural communities stay informed and engaged with the
VA.
While many of our members prefer VA care, almost all of us
have relied on VA community care at some point, due to
specialty care needs, wait times, or distance. Despite its
necessity, community care is not optimized. Research shows that
community care clinicians often report learning about policy
and workflow changes only through error notifications and
request denials, which is consistent with reports we hear from
veterans in our community.
Any policy change that impacts community care partners,
such as the Veterans Comprehensive Prevention, Access to Care,
and Treatment (COMPACT) Act, should follow an effective
standardized communication process that includes clinical
services as well as billing departments to safeguard veteran
care and prevent them from receiving medical bills in error.
Care continuity is also an ongoing issue. Successful
implementation of a comprehensive EHR is paramount to ensure
the seamless flow of communication across care teams.
Lack of cultural competency has also been a pain point for
community care. Unfortunately initiatives to improve this are
resource intensive. With 48 percent of rural hospitals
operating at a financial loss in 2023, and the recent passing
of H.R. 1, most rural hospitals are strategizing ways to ensure
their doors stay open and would struggle to absorb any
additional financial strain.
With health care viability in mind, it is also important to
acknowledge that 92 rural hospitals have closed or have been
unable to continue providing inpatient services in the last
decade. A recent study showed that even in major cities,
average wait times across specialties are increasing, and
nearly 62 percent of mental health provider shortage areas in
the United States are rural. Expanding community care without
addressing provider shortages could exacerbate current access
issues if VA resources are lost within these communities.
Our local CBOC is a trusted anchor, and this committee's
greatest focus should be ensuring rural veterans have access to
VHA's veteran-centered patient care. Research shows rural
veterans report higher satisfaction with VA care than community
care, and that VA facilities often outperform or match non-VA
providers in quality and safety.
When a permanent, physical VA presence is not possible,
strategic telehealth can extend resources and build
connections. Evaluating when face-to-face interactions are most
critical to building trust, and supplementing with telehealth
can broaden the meaningful--sorry.
Evaluating when face-to-face interactions are most critical
to building trust, and supplementing with telehealth, can
broaden the meaningful reach of these CBOCs.
Finally, we must protect the psychological safety of the VA
workforce, many of whom are veterans themselves. Successful
deployment of a modernized EHR will rely heavily on a strong,
confident workforce, which is only possible when employees feel
valued and supported.
This subcommittee is uniquely positioned to lead in
expanding VA access to rural veterans through technology.
Community care is vital, but history shows that even well-
intended privatization can lead to inequitable services for
rural communities, as resources naturally shift to more
profitable urban areas. As we see this disparity in the broader
health care system today, the VA remains a vital equalizer. A
balanced, bipartisan approach can strengthen both VA and
community care to ensure our most vulnerable veterans are not
forgotten.
The VA I returned to in 2004 after my deployment to Iraq as
a student on this campus, where I was told by the VA in
Danville that my new breathing issues were likely from anxiety,
is not the VA we have today. The progress we have made has been
intentional and remarkable. Let us continue investing in this
transformation and use modern tools to bring care and benefits
closer to rural veterans who have earned them. Thank you.
[The Prepared Statement Of Christina Schauer Appears In The
Appendix]
Mr. Barrett. Thank you, Ms. Schauer. I appreciate your
testimony, and your written statement will be also entered into
the hearing record.
We will now proceed to questioning, and I will recognize
myself for 5 minutes. I forgot to advise you ahead of time, but
we have a light system here in front of you, green, yellow, and
red. Pretty self-explanatory. Yellow is you are getting close
and red is you are out of time. We will begin questioning.
We genuinely appreciate each of you that are here today and
the testimony that you offered today.
Ms. Schauer, you say you were deployed in Iraq, 2003, 2004
sometime? Where were you operating out of there?
Ms. Schauer. Baghdad International Airport.
Mr. Barrett. Okay, and what was your job?
Ms. Schauer. I was a combat medic.
Mr. Barrett. Oh, very good. Well, thank you. I was there a
few years after you and certainly appreciate your service
there. Thank you.
Ms. Schauer. Thank you.
Mr. Barrett. Mr. Kirchner, you say you were Army as well?
Mr. Kirchner. No, sir. Air Force.
Mr. Barrett. Air Force, okay. Where were you deployed when
you were in service?
Mr. Kirchner. Incirlik, Turkey.
Mr. Barrett. Okay. I did kind of a layover there one time.
I was in Guantanamo Bay, on my way to Afghanistan. It was
great, because they had a Taco Bell there, so it was good for
morale.
Ms. Rains, I wanted to ask you, I know you mentioned a lot
of the access to telemedicine and some of the extension of
broadband. You mentioned access to fiber for rural residents. I
live in a pretty rural part of Michigan. In fact, I am not
joking, my neighbors across the street from me are Amish. They
are not so into the broadband. Nonetheless, in the community
that I live in, we have folks like me that need access to
internet and broadband.
Do you know, you said you had connected about 7,500 homes
that way. Do you know what the cost for that 7,500 homes was?
Ms. Rains. That 7,500 with the 46,000 altogether will be
about $350 million, and most of that is--I believe all of that
has been fiber, yes. We were with the United States Department
of Agriculture (USDA) Rural Development Opportunity Fund, which
is in Illinois mostly wireless.
Mr. Barrett. How many millions again?
Ms. Rains. Three hundred and fifty million dollars, about,
for those were State and Federal funds in the first three
rounds of the Connect Illinois program.
Mr. Barrett. $350 million for how many homes are going to
be connected for that?
Ms. Rains. It is just over 50,000.
Mr. Barrett. Okay. That would be a substantial cost per
home with fiber.
Ms. Rains. Yes.
Mr. Barrett. I guess Dr. Kaboli, maybe you could help me
answer this. Is there any opportunity, perhaps, or we could
just outfit veterans who are accessing telehealth with a fixed
wireless connection? I have one of those in my home. It works
pretty well, actually. It allows me to use, you know, if I were
using telehealth, I can use Zoom. My wife works from home and
is able to do her work that way.
I feel like for $350 million, we could buy a lot of people
a home internet, you know, fixed wireless provider type of
thing and pay $50 a month for them and not hit $350 million for
a great long time.
Either one of you.
Ms. Rains. Wireless internet is an excellent stopgap, yes.
In areas in Illinois, especially where I am from down in
Crawford County, Robbins, Illinois, there is no cell signal in
a lot of the county. Even if you had a hotspot, you are not
able to access it. Wireless internet is coming but wireless is
slower speeds, it is interrupted by any kind of weather,
rainstorm or thunderstorms, which are very common on the
prairie, as you know.
It is an opportunity to get people connected faster.
Mr. Barrett. I actually found--I mean, I had cable, copper,
it was not fiber, but it was like a lower speed, but it was
into the home through the phone line--I do not know. I have
actually had more reliable service through the Verizon--not
just a little hockey puck hot spot that you would take while
you are traveling, but like the fixed, plug-into-the-wall kind
of service that comes over the air. I feel like delivering to
those folks you talk about that are the most stranded, I mean,
it is going to be a huge expense to run fiber to them, and I
almost wonder if we would be better served putting more of that
into some of the more accessible already options available.
Ms. Rains. Yes. The wireless tower that provides the
Verizon service is served by fiber middle mile infrastructure.
Middle mile infrastructure still needs to go out to provide
that wireless service. Fiberoptic, of course, is more expensive
at the installation. It is also what we call kind of future
proof. It is 50 years is its serviceable life in the ground,
and it is still being tested, so it could be even longer than
that.
As speeds increase over time and technology improvement,
the cable does not need to be upgraded, just the data centers
on either side, because it carries information at the speed of
light.
Mr. Barrett. Sure. Not to cut you off, I just wanted to get
Dr. Kaboli's thoughts really quick----
Ms. Rains. Oh, of course.
Mr. Barrett.--before I yield to the ranking member. Then we
can come back after that. Go ahead.
Dr. Kaboli. Yes, real quickly, I think the other thing to
think about is low Earth orbit satellite internet. We looked
into this the last couple years to see if we could, the Office
of Rural Health, could provide that service for veterans.
Unfortunately, there is no legislative mandate to allow us, or
authority to allow us to actually pay for it. You are right,
the cost per month would be much less if we could just
subsidize it, but we cannot.
Mr. Barrett. Okay.
Dr. Kaboli. We do have a pilot with a company to sort of
identify sort of what the challenges are. One of the challenges
in rural areas is actually the installation. You know, you have
to get somebody to come in, drive in, set up the satellite and
all that kind of thing. I will stop there, but I think there is
a lot of other options out there.
Mr. Barrett. Thank you. Thank you.
Ms. Rains. Just to finish, in Illinois and across the
country, we are using a mix of technologies. Of course, we are
looking toward the future. That is why we prioritize fiber, but
it is definitely going to be a mix of all these things, as well
as low Earth orbit, to deliver service.
Mr. Barrett. Sure, thank you.
I am going to yield to the ranking member for 5 minutes for
her questions.
Ms. Budzinski. Thank you, Mr. Chairman.
My first kind of set of questions is really just to the
panelists from the VA directly. I would love to hear from each
of your perspectives just a general question about gaps in
care, access to care, that you see within the VA and what those
barriers are that exist in filling those gaps, especially in
our rural communities, obviously, with the topic today. Then
just to ask you in addition what kind of feedback you get from
veterans as it relates to these gaps and filling them.
Dr. Zomchek. Well, thank you, Congresswoman. I would say
there are certainly less opportunities for rural veterans,
especially the more specialized the services that they are.
Throughout VISN 12, we have a fair amount of rural areas, not
only in VA Illiana but in Iron Mountain, particularly, where it
is literally a four and a half hour drive from Sault Ste.
Marie, the CBOC, to the main campus.
I think--I think when it comes to primary care and mental
health treatment, both virtual and face to face is where we
have really been able to close the gap more so. We are
continuing to expand our CBOCs, not only growing them and doing
construction, but also trying to create new specialty services
there.
Certainly across the board, that is why I think community
care, as was stated, is so critical. We can do a lot in the VA.
We have a lot of opportunities that we can offer for our vets.
There are some things that we cannot. Having that partnership
of community care can really help us.
There is a lot of mobile opportunities that we do, too. I
think maybe Dr. Kaboli could talk a bit more about that.
Dr. Williams. Here at VA Illiana, and I actually have spent
over 30 years in health care specifically relating to providing
services to individuals in rural areas, so rural health care is
a passion for me. At VA Illiana, we have actually implemented a
screening program titled ACORN, which stands for Assessing
Circumstances and Offering Resources for Needs.
To speak to some of the testimony that we have already
heard, when we have done this screening through our social work
team, it really addresses some of the social determinants of
health like food, housing, utilities, transportation,
education, employment, digital needs and the like. We have
actually found that 19 percent of our veterans are positive for
digital needs, and another 65 percent positive for social
isolation and loneliness.
Since we are a rural Department of Veterans Affairs
hospital, we do have CBOCs spread throughout this area. We
certainly recognize the needs of our veterans to try to remain
connected with not only health care but with one another.
Dr. Kaboli. I just want to say to start out, though, I am
actually from Iowa City, Iowa. I grew up across the river from
Illinois in southeast Iowa, so ``Go Hawks.'' We have the Big 10
covered here. I did wear my Illini colors today because I knew
where I was.
No, I think to answer your question about access and gaps,
I think it comes down to sort of, kind of like Ms. Rains said,
about you just--you use every possible thing you have. You
know, what do we have that we can get veterans access to care?
It is face-to-face care with us, face-to-face care in the
community, telemedicine, instant messaging, you know, we have
all these things offered out there. The thing is not every
veteran wants telemedicine. Of veterans that have used
telemedicine, 80 percent say, yes, I want this. Twenty percent
say, you know, I tried it, it is not for me. Pretty much all of
us had some form of telemedicine during the pandemic, so we
have had experiences with it. Really, veterans want more
telemedicine.
Again, what do they want? Let us either bring them to care
or bring the care to them.
Ms. Budzinski. Could I ask just one follow-up question? One
thing I have noticed within the district just within health
care in general, just even beyond providing care to veterans,
is we lack the ability to attract specialty care, health care
professionals, doctors, nurses. We have a shortage of health
care professionals just within our hospital systems.
Is that reflected as well at the VA in Danville that you
have those shortages or a hard time kind of attracting those
professionals?
Dr. Williams. We have very similar challenges to what are
experienced in the private sector in the community care
network, yes.
Dr. Kaboli. If I can add to that, we think one of the
things that we do have is because we are a national network of
providers, we actually do not have a shortage, say, of primary
care providers. Even though there are shortages everywhere. We
just do not have them all in the right places at the right
time.
Like you were talking about PACT teams and how many
providers they have. You know, we can supplement that through
the clinical resource hub program, so we can supplement primary
care, mental health, specialty care. A nephrologist in Boston
who has extra effort to give can provide care in rural
Illinois, and that is----
Ms. Budzinski. By telehealth.
Dr. Kaboli. By telehealth, yes.
Ms. Budzinski. Telehealth is key to that, yes. Okay.
I will go ahead and yield back.
Mr. Barrett. Sure, thank you.
I will now recognize myself for 5 minutes.
I know a couple of you, I think Mr. Lawson and Ms. Schauer,
you mentioned the electronic health record upgrades that are
necessary to kind of integrate that community care and VA care
together, because oftentimes veterans will, even if they are
using community care, will also have a segment of their health
care through VA. That has been a major subject of consideration
by our subcommittee. I feel like it has taken up 80 percent of
my life these days.
If you can give us any of your perspective as to your
expectations for that? I know Cerner has now been acquired by
Oracle. The VISN that I live in specifically in Michigan is the
next region to receive this update and, you know, it has
frankly not gone well in the places it has been rolled out in
the past, minus the exception here in Illinois. I am curious if
you have any thoughts on how that will take place and what
would be things we ought to look for on this committee to make
sure that it is done appropriately?
Mr. Lawson. Yes. When we think about, you know, those
electronic health records, even speaking from the private
sector experience in my previous life before the
superintendency here, the systems do not talk with one another.
You might have one health care facility using--I do not want to
endorse any places here--but Epic and then one may be on
Cerner. Those two hospitals might even be owned by the same
ownership group but do not communicate with one another with
those records because they do not intermix.
I think what we would be looking here is, you know, we look
to like software as service type of mechanisms, to where maybe
providers might be provided login access, something along those
lines, to direct access those records from the VA.
On that software rollout from Oracle and Cerner, we did get
an update about that last week at the NACVSO annual conference.
When we think about those records coming in from the active
duty component of the U.S. Armed Forces, it is happening. It
seems or appears or we have been told that those bugs have been
worked out. Time will tell. However, we are looking at 18
months to 24 months of full rollout, you know. Illinois is not
among the next states, by the way. We would like to see that
happen.
That really kind of covers that active duty component. I
think what we really need to really focus on is how do we make
access for those community care providers, either through a
software service platform or some other type of agreement with
those providers.
Mr. Barrett. You are saying instead of like sending the
file back and forth, having an access portal for the community
care providers to access your VA record?
Mr. Lawson. Yes.
Mr. Barrett. Make maybe even some edit privileges to that
for the community care work that is being done?
Mr. Lawson. Correct. Very similar to how a VSO has Veterans
Benefits Management System (VBMS) access. I can get in there
and I can kind of see what is going on with a case file. I
think something very similar to that but with a bit more
privilege, you know, from a provider end, to add to and edit.
Mr. Barrett. Sure. Very good.
Ms. Schauer, I do not know if you have any thoughts on that
yourself?
Ms. Schauer. My background is nursing and not IT, so I want
to give that caveat. As a clinician, just being able to access
the records you need when you need them is especially helpful.
It goes two ways. It is the VA EHR, but then also figuring out
with the community care, as you mentioned. Everybody is working
on different systems. Making sure it works with a variety of
systems.
Another additional thing just to point out, I know up until
recently, we did have an EHR change in my organization. When
that interoperability is not there, sometimes it does rely on
actually making a phone call to the CBOC or to the primary care
team, which that relies on that CBOC being open. Weekends,
holidays, nights, you do not always have that ability to access
those records.
If this was ever a possibility, I would love to see a
future where not only do we ensure that any veteran that is
eligible for community care receives the information about what
they are eligible for and where they can go, but alternatively
we have a lot of veterans that are not using their VA care;
they are using the community on their private insurance. They
may not have any awareness. I would love to see some way for
some sort of integration that would allow community providers
to easily screen and then refer to VA when somebody meets those
criteria.
Mr. Barrett. Yes, I do not disagree with you. One of the
bills that I introduced was the Veterans Community Care
Scheduling Improvement Act to allow for that integration with
community care providers within the VA, so they could see that
matrix of what is available. One of the revisions we made to
that bill was a requirement that if a veteran called for a
scheduled appointment, they would be advised of both options
available to them, so that they would know what is available,
so that they would then be able to choose between I am willing
to travel a little bit further to get an appointment maybe
sooner, or I am going to stay closer for an appointment a
little bit later. Or just that entire decision matrix that they
may have. Or maybe they are like a lot of folks in my district
who travel to Florida in the wintertime, and they spend part of
their time there, part of their time in Michigan, and having,
you know, other options available to them is really something
that is important. We are working through a lot of this
electronic health record, you know, tangled issue right now.
I know, Mr. Lawson, you pointed out in your testimony just
that certainty that if you have, for example, a referral for a
critical need, that it is not getting lost in that gap,
perhaps, before this is fully integrated. That we know if you
send a referral for a test or a service, it is going to be
received on the other end and actioned appropriately in a
timely way to make sure that it is not falling through the
cracks. I appreciate that.
I want to yield to the ranking member for 5 minutes.
Ms. Budzinski. Great, thank you. Thank you again.
My next question, Mr. Lawson, actually, we could spend
probably this entire hearing talking about health care. I do
want to talk about access to benefits. I just was curious if
you could speak a little bit to that, and what you are hearing
from your fellow service members just about access to benefits,
barriers to that, challenges with it in our more rural
communities, obviously.
Mr. Lawson. Sure. I think the first priority is ensuring
that we have got access to accredited veterans service officers
for these veterans in rural areas. In my office, we are going
through quite a bit of a transformation to make ourselves
available to veterans wherever they may be. We even service
veterans outside of our county. We have got clients as far away
as Ireland that we are able to do remotely, work through the
claims process with them.
Part of what we do, you know, is educating veterans on
that. They have to be into the system first. If you have not
entered the VA system, meaning that you have not applied for a
VA home loan, if you have not entered VA care, if you have not
used education benefits, you are not counted and you are not in
the system.
We need to make sure that you are enrolled and counted in
the system. One, it gives our VA administrative staff and
planning staff some better head count of numbers so we know
where to center our care and where to look to build facilities
or expand out options. You know, but for us, the challenge is,
especially as we stand up here in Illinois are veterans
assistance commissions, making sure that we have got an
accredited veterans service officer in every county. These
veterans service offices are free for the veteran to use. They
should use free veterans services officers at all times and
never pay for the service. That is a benefit that they have
earned, and they should not be charged to access it. That is
that.
Ms. Budzinski. Thank you. Yes, one of the things we have
tried to do in my office is host resource center, you know,
resource fairs, connecting veterans to the VA, to services. It
is challenging. It is challenging. We did it at one of our
community colleges not far from here. We had light attendance.
Any observations or kind of suggestions you might have on how
we can better connect?
Mr. Lawson. Yes, that is one thing we have been wrestling
with. We attended one of your resource fairs as well at the
Legion in Edwardsville. We have noticed that as well, that the
resource fairs--the face of the veteran is changing. We have to
look at the demographics of these veterans, how they access
care, how they consume information.
Resource fairs used to work back when the internet did not
exist. Now that veteran has more access to information through
their handheld computer on their phone than they ever will at a
resource fair.
There is so much, as Congressman Barrett mentioned, so many
groups out there that are trying to do good things. It is just
not a very coordinated effort in my opinion. That we need to,
you know, figure out what that next generation of outreach is.
Is it through social media? Is it through other platforms? It
is just it takes money, quite honestly, to commit to those
types of things.
We are looking and exploring how do we offer these things
or these services or education opportunities in a more modern
setting to appeal to the OIF/OEF generation, which is ours, and
currently in the most need for care at this point.
Ms. Budzinski. I would love to keep working with you,
working with you on that to figure that out, for sure.
Mr. Lawson. I would be happy to.
Ms. Budzinski. Thank you.
Dr. Williams, I wanted to ask, I know you are currently the
medical center director up in Chicago at the Jesse Brown VAMC.
I was just wondering if you could maybe, since we are talking
about rural health care, obviously Chicago not being rural, if
you could kind of just talk to us a little bit about, you know,
as you are practicing working up north, kind of the comparison
between resources, any things you see different between what
can be offered in a community that is more rural, the
challenges or the lesser of the resources that might be down
here, or maybe we have adequate, you know, same amount of
resources than Chicago. I was just curious if you could reflect
on that?
Dr. Williams. Actually, what is very interesting about my
time at Chicago is that the Jesse Brown VA actually hosts the
clinical resource hub for VISN 12. Some of the rural health
care that Dr. Kaboli was mentioning being provided through the
clinical resource hub, I see the opposite end of that care. I
see those providers and those specialists in my role as the
medical center director at Jesse Brown. Then I see my home
site, VA Illiana, as a consumer of those services. That
partnership with the clinical resource hub is critical.
There are some, you know, obviously, differences between
urban and rural health care. One other noticeable difference is
the relationship or affiliations with the educational
institutions in the different communities. Because a larger VA
medical center obviously has typically a broader range of
services, including specialties, there is a much tighter
relationship with their academic affiliate.
We do have a great partnership down here at VA Illiana with
the University of Illinois Urbana-Champaign, so we are very
fortunate to that. It is a different relationship than what I
see in Chicago.
Ms. Budzinski. Okay, thank you. I will yield back.
Mr. Barrett. Sure, thank you. I wanted to follow up a
little bit more, Dr. Zomchek, about the EPS scheduling and how
that has been integrated. I know it is not fully at every
facility yet. I am curious in your VISN where it is being used
and how it is being utilized, and if you have any feedback for
us as to how that is going in its real application sense now.
Dr. Zomchek. Yes, thanks for that question. EPS, I am well
aware of it. Part of being the governance board that has been
discussed for a number of months now, and so I have been
involved in those discussions and in the rollout, kind of input
about the planning. At this point, we do not have any of our
eight facilities in VISN 12 that are in the pilot, as you had
mentioned. However, I think it is a great thing. I think it is
a wonderful opportunity to provide more resources and access
for our vets, and timeliness. I mean, literally it is moving
appointment scheduling from days or weeks in some cases to the
period of minutes.
I am encouraged about it. I do think it is a--it is a
double-side-coin idea in terms of implementation, right? You
really need the local medical center to be engaged in opening
up those clinic slots. You also need the community partner, and
a connection like Chief Executive Officer (CEO) to CEO, to open
up those grids and then kind of get proof of concept so that it
can be expanded.
Mr. Barrett. Sure. For those that may be here today
unfamiliar, basically when you call to schedule an appointment,
often in community care, I had this example happen to me. I was
at an audiology appointment, and they had to first call me and
get my availability, then call these other providers that were
available, then call me back. They scheduled it at a time I
told them I was not available. Then they told me, well, when
that happens, we just schedule you for the next appointment if
we cannot meet your timeline that you are available.
I am like, I am literally going to be out of the State. You
know, I am going to be in Washington, DC, and you scheduled me
an appointment in Michigan at the same time. It was a very
significant hassle. I think having that realtime awareness so
you are not going through that game of telephone is really
critically important.
I think you are right, though. You need both the VA
scheduler as well as the community care provider to opt into
that, that meshing of information, so that that scheduling is
going to be available for people and they can know what is
close to home, what is available, and what am I willing to
travel farther for or what is nearby and timely and everything
else. Think that is, you know, an important thing that we have
got to kind of pull together, basically.
Dr. Kaboli, on that piece of it, and maybe I am not sure if
you have awareness of this, do you feel like there is that
awareness and buy-in by potential community care partners when
we offer this to them that they have this willingness to
participate?
Dr. Kaboli. Absolutely. Our office has kind of followed the
external scheduling program for the last 3 years. You know, we
have worked, for example, with the Nebraska Rural Health
Association, because they are really tied into the rural
communities and saying, we will partner with you to make sure
that they are on the grids.
Like you said, if the scheduler has access to both grids at
that exact moment in time when they are on the phone with the
veteran, they can say, we can get you into the VA in 32 days or
we can get you into this other clinic in 47 days. Which would
you rather have?
I think if it works half as well as we hope it does, it
will still be good. You know, I think they are up to, what,
there were 4,000 appointments made last month in June. It is
ramping up quickly. I think it will prove to be mutually
beneficial, and that is where it will work.
Mr. Barrett. Yes. I am not sure if this is the best
question for you or not. The community care partners, do you
feel that they feel like they are getting a--everybody always
wants a greater reimbursement. Do you feel it at least is a
market reimbursement rate that is something that will draw in
community care partnerships?
Dr. Kaboli. Yes, so we have gone around and met with
community partners. I still practice in Iowa, and I talk to
these other providers all the time. They are happy with the
rates that we provide. It is just you have to make it easy.
Mr. Barrett. Right.
Dr. Kaboli. The harder you make it, especially, you know,
with record exchange, the harder we make it, it just becomes a
hassle. I think they are really committed to the veterans in
their community, and I have never heard anybody in the
community ever say, you know what? Taking care of veterans is
not a priority for us. They always want to care for veterans.
Mr. Barrett. We want to draw in the best that we can by
having a reimbursement rate that is reflective of the service
that is provided, that does that to really strengthen those
particularly rural community partners that we have. Thank you.
I can yield to the ranking member. Do you have other
questions? Go ahead.
Ms. Budzinski. I was just going to follow up on telehealth,
actually, and maybe ask Dr. Zomchek, when you are talking about
telehealth and using it specifically for mental health
challenges, do you find that there are still a lot of barriers
around stigma related to seeking this care? Barriers to, you
know, a veteran coming in in person or utilizing telehealth? Is
telehealth making it more easily accessible for a veteran that
might be trying to get over a stigma about seeking that care?
Dr. Zomchek. Well, I think, first of all, VA care and
mental health is second to none. I think the plethora of
services that we offer and modalities that we offer mitigates
stigma that historically was there.
I think it is still there, certainly. I think candidly, I
think it is part of the disease process to some extent for
people to be reluctant to seek care when they really need it. I
think we will never stop in terms of that outreach and finding
connectivity for our vets, whether it is through VVC or coming
to a local CBOC and using telehealth.
One of the programs that we have related to this broadband
discussion we have been having is what we call the digital
divide program. That is where we have literally issued VA-
loaned iPads, tablets that have internet connectivity for
veterans that are in rural areas who cannot afford it. Then
that gives them the ability to connect with their clinician at
their kitchen table.
Ms. Budzinski. Right.
Dr. Zomchek. We have distributed thousands of those across
the network.
Ms. Budzinski. That is great. Yes, that is great.
Can I open the question up to--I know we have a number of
veterans, obviously, on the panel--specifically around
barriers. Anything you could speak to as far as barriers that
we could help overcome in helping connect veterans to
telehealth services, mental health services?
Mr. Lawson. I think, when we think about the telehealth
services, I used telehealth, telehealth mental health, even. I
am not ashamed to admit it. It was wonderful. It worked. I am
at work. I am a working adult. I am still in the workforce. I
think sometimes there is this misconception that, you know, oh,
you can just take off work to go to an appointment.
Here in Illinois, we have got legislation pushing forward
to kind of help those veterans take some extra time off,
compensated, to go to these appointments for service-related
conditions. A lot of this is going to come on educating,
especially for some of our older veterans who are just not
quite at the technology level maybe some of us are.
You know, we are still seeing Vietnam-era veterans that are
now coming in for the first time for Post-Traumatic Stress
Disorder (PTSD). You know, it breaks your heart to see them
dealing with that for so long. We have got to figure out ways
to also, as we issue out those iPads and pieces of technology,
how do we educate them to use it?
You know, one of the things we do in our office is, you
know, when they come to see us for claims, do you have VA.gov
app on your phone? Most veterans do have phones at this point,
even the older ones. How do we educate them to use that VA app?
They can communicate with their primary care provider on there.
They can retrieve records, letters, medical records, decision
notices. They get notices for appointments coming up on their
app. It is really a great tool, and we really do love that app.
It is just, again, how do we educate those veterans on using
it?
Making sure that we have got access, critical. Also
education on how to use the tool.
Ms. Budzinski. Any others? Yes.
Ms. Schauer. One of the biggest barriers I see is just a
lack of awareness of eligibility. I think that the veterans
that are within the VA somehow or have ever been connected with
VA will get some information. You can access so much
information on the internet. It is almost too much, it is hard
to digest, you do not know what is worth going after. Not
everybody even realizes that it is something that they should
pursue.
I think again that outreach is so important. Going to where
the veterans are. We find a lot of luck meeting women veterans
in places like the farmers market. You know, like places just
that veterans are, versus having a fair where they come to you.
If I do not believe--we have a lot of veterans that do not even
understand that they are a veteran, they do not identify as a
veteran. That resource fair for them is not for them.
Finding ways to meet the veterans where they are and make
sure that you have those conversations about what you are
eligible for. Most of our women, that is why they have now
gotten VA care is because they learned that they could. They
did not even know that it was a possibility before.
Ms. Budzinski. Okay, thank you. I will go ahead and yield
back.
Mr. Barrett. Sure, thank you. Thank you for that. I think
you are right. I think it speaks to a thing--when I, prior to
coming to Congress, I was in the State legislature in Michigan.
We would always model our outreach and instead of asking, are
you a veteran, because you are right, because people will self-
select out of that definition, you ask, did you ever serve in
the military, and then you can kind of explore that from there.
It is hard to hold a resource fair and advertise it as a
did-you-ever-serve-in-the-military fair. It is a little bit
harder to package. I think it is part of that, going where
people are instead of expecting them to come to us. I think
there is a lot of--part of this is an inertia thing. You begin
unpacking this and then you work through the process and maybe
obtain the benefits that you have kind of had on the back
burner. Life comes at you, you are transitioning to civilian
life. Things are difficult. It is like being in a batting cage
and you are figuring out how to get stood up again. Then you
think you will worry about it later. Then life comes in and you
have a lot of other priorities.
Even for our Vietnam generation coming home, they were
treated so poorly when they came back that many of them just
kind of packed it away and then life took over. Then they moved
to a different phase of life and those things they had tried to
pack away come to kind of percolate back out.
I really hope, and I think we are making the strident
effort of making up the lost ground that we had with that
generation. They truly did suffer unnecessarily.
I will say, I am grateful that that generation made sure
that our generation was welcomed back respectfully and with the
dignity that all veterans deserve. I think that each of our
Vietnam veterans are owed a great deal of appreciation for
that.
Mr. Kirchner, I wanted to ask you a question. Since your
really tragic experience with that provider, have you found or
have you gone back into any community care services? What have
your experiences been like more recently, and can you give us
any insight into how that may or may not have improved, and
where you think those improvements ought to go?
Mr. Kirchner. Sure. First of all, community care,
excellent. Excellent. Every time they call about the
appointment, like you said, we will get back with you, 24 or 48
hours. It is within 10 minutes they are calling. You know, they
are bringing their A game.
Where I see that could be a benefit for the veterans and
the VA is if I am going to an audiology appointment, I want my
records to be reviewed by an audiologist, not a heart doctor or
a person that is had the training. I do not believe the people
that are doing these exams are the right people doing the
exams. I think that is where the----
Mr. Barrett. You are talking for the compensation, pension?
Mr. Kirchner. Correct.
Mr. Barrett. Okay. Not the community care ongoing medical--
--
Mr. Kirchner. No, the community care, they are doing
everything to get you there.
Mr. Barrett. Sure. Sure.
Mr. Kirchner. You know, that is where community care is on
top of their game. I think that is where it is falling apart,
is whenever community care is done, that is where it is falling
off the board.
Mr. Barrett. We will take that back, because I am not sure,
sitting here, what the qualifications for those delegated
outsourced, you know, compensation and benefit exams, what a
requirement is for that person to be. I am sure they have to be
a medical doctor, but I am not sure in which specialty or what
that would involve. We will take that back for consideration,
for some questions to VA about that. I appreciate your insight
there.
Dr. Zomchek, one thing, I know you have talked about
outreach with mental health and that being important, and I
think that is a continuing effort we have to keep working
toward. One population that we found some success in Michigan
was actually reaching out to spouses of veterans as well,
because oftentimes they are observing the behavioral challenges
that veterans may have in a more, you know, intimate setting
back home that they are not displaying out in public at their
job, or they are, you know, taking that hardship back home with
them. I think that that outreach to the spouses of saying, hey,
here are some benefits that may be available to your loved one,
may be that soft encouragement that they need to, you know,
make the decision to come in to receive the help that they
should have and that certainly have earned. I do not know if
that is anything you have explored at all or if it is worthy of
your consideration or not.
Dr. Zomchek. Yes, that is a great point. We know the
connectivity with our veterans is often with family members,
often children. Could be a neighbor. I think, as I hear this
discussion about outreach and connectivity with our veterans,
of course we have telehealth coordinators, we have people to
talk and to train and to teach our veterans and family members.
I really think that a multifaceted approach is what is needed.
There can be some of these standardized approaches that we
are doing. What I have seen in my network is I have very rural
and very urban centers, and even some of the hospitals that are
very urban have very rural CBOCs. Having a group--each of the
facilities does, I think, a great job of even with town hall
meetings in reaching out and opening up our connections.
Sometimes it is in person, sometimes it is with Facebook.
Whenever possible, we certainly invite spouses and family
members to be involved in the care, so long as it is, you know,
it is okay from a health information standpoint.
Mr. Barrett. Do you know of any way that we kind of tried
to do the direct outreach to the spouses or near close family
members of veterans, you know, with resources from the VA, to
encourage them to try and encourage their veteran loved one to
explore their benefits?
Dr. Zomchek. I would have to take that back.
Mr. Barrett. Okay.
Dr. Zomchek. I would be happy to follow up with you about
any specific program or initiative about that.
Mr. Barrett. Sure.
Dr. Zomchek. I think mostly what we do, it is all
encompassing, so all of the outreach that we do, we do not turn
down if someone is asking about their father or mother or a
sibling.
Mr. Barrett. I just think it might be a useful inroad with
veterans. As it turns out, I have a wife, and she thinks I am
rather stubborn. Maybe I am the only one, I do not know. Thank
you. Appreciate it.
Dr. Zomchek. Thank you.
Mr. Barrett. Ranking Member Budzinski, go ahead.
Ms. Budzinski. Sure, I just had a final question for Ms.
Schauer. I was wondering if you could speak about specifically
women veterans? We have had a lot of conversation, obviously,
focused on rural health care. I think that those challenges to
access for women is probably greater. I was wondering if you
could speak a little bit to that experience?
Ms. Schauer. Yes, our women veteran population, of course,
we have a lot of unique needs. Military sexual trauma is
probably one of the most prominent, though not isolated to
women veterans, a higher percentage of women veterans. What I
find in our community is hesitance toward using the VA because
of experiences they had 10, 20 years ago, you know, when you
dig into it. Just trying to encourage them that today's VA is
different and you are in a place where you will be welcomed.
Once they try it again, they see and they believe, and they
socialize it with each other. I think it is getting them in
that door.
I think the social isolation that you are talking about, I
love--I want to learn more about that program, because that is
really why our community was created, and hearing about the
high suicide rates for women veterans which, as a nurse, having
been a nurse for 15 years at that point, I was completely
unaware of.
When we started our group, we had immediate energy behind
it. It just keeps growing and it just shows that need for
people. Often, it does take asking them two, three, four times
to come. Once they come, they are like so excited for the next
meetup.
I do think women have unique needs that have gone a little
bit unnoticed and unrecognized for a while. I am really happy
that today's VA is seeing that and addressing that.
Ms. Budzinski. Thank you very much. I will yield back, Mr.
Chairman.
Mr. Barrett. Sure, thank you. I appreciate that insight as
well. I think maybe doing some public service outreach to women
to really--like having firsthand testimonials of women who have
come back and now received care at the VA to advocate for other
women to, hey, this is not--number one, this is not the
military. Whatever trauma you may have experienced there is
not--I get that this is still the U.S. Government and there is
a hill we have to climb to reestablish trust in many ways. This
is not the same VA that may have been unprepared during those
early days of the War on Terror and the war in Iraq and coming
back home, and a lack of capacity and understanding and, you
know, kind of a little bit of a legacy VA that has since
transformed, and through a lot of work that was done and paths
that were forged by women like yourself and other veterans
coming back home, and advocates like many of you here and folks
that work within the VA. We appreciate your work doing that.
I now want to yield to the ranking member for your closing
statement.
Ms. Budzinski. Yes, thank you, Mr. Chairman. I just want to
say again, thank you for coming to the 13th District. I really
appreciate that.
Thank you to all the panelists. This was very informative
on the work that we have ahead of us back in Washington. I
really appreciate all of your time in making the trip here.
As the ranking member on the subcommittee with Chairman
Barrett on Tech and Modernization, it was great to hear some of
that conversation and how that is integrated into the rural
experience for our veterans. I think we both know we have a
long way to go, and we are a partner in that work because it is
just so critical, whether it is scheduling or the electronic
health records system, getting that fully operational within
the VA is something that is critically important and will be to
the benefit of the services that the veterans so well deserve.
Thank you again for being here. To the veterans, thank you
for your service. I will yield back to the chairman.
Mr. Barrett. Thank you. Thank you, Ranking Member
Budzinski, for hosting us today and for allowing me to see a
little bit of a glimpse of your district, and appreciate both
similarities and some of the differences between communities
that we represent and how things are done. I really cannot say
enough about how impressed I am by this facility, the outreach
that is done, and the success stories that you have all had and
the work that is ongoing that you are doing.
Kind of like we talked about earlier, Colonel, allowing
veterans to find that next sense of real purpose, and I
appreciate the work that you are doing here to make that
happen.
One thing that I think can give us some really focused
motivation for this is there are statistics around this. Of
course, during that 20-year-long span of the War on Terror, we
had just over 7,000 troops die on the battlefield. Every single
one of them is an absolute tragedy. I have friends, and many of
us who served have friends that were lost in that effort. We
lost 35,000 more to suicide during the same period of time.
That really to me speaks about that total--the real total
human cost of war that we have yet to fully appreciate. We have
a lot further to go in that and how we can prevent those, each
of which are preventable with the right intervention and the
right outreach and the right care and treatment. That is a real
mission of what we on this committee are focused on. A piece of
that is this technology aspect of how we deliver benefits to
veterans and how we really do a better job of making sure that
they have the adequate access that they have all earned, to
really head off at the pass the next veteran who may be going
down that path.
Then also looking at veterans who are not contemplating
suicide, but still need help for, you know, the back injury
they sustained or the other service-connected conditions they
may be facing or dealing with. What education benefits do they
have that are available to them? What compensation and benefits
are available for that continuation? All of the other services
that VA provides that are really truly important and fall under
this rather broad umbrella of the subcommittee and the work
that we do.
I cannot tell you how much we appreciate each of you being,
you know, really on-the-ground advocates, and with the
firsthand knowledge and experience that you have of how we go
about that.
You know, Washington, DC, is an 11-hour drive from here. We
almost had to drive because of the weather with the flights
yesterday. It is a long ways away from here, and it is a long
ways away from everyday America. These are the communities that
we represent.
I say this in my own district. It is my job to be my
district's representative in Washington, DC, not Washington's
representative back home in my district. That should really be
a one-way street where we take our voices of our constituents
and the folks that we represent and go advocate for them in our
Nation's capital, and not come back here and tell you, well,
you know, this is how it really works, and you have just got to
get on board with it. That is not the role of Congress and that
is never going to be what we do on this subcommittee.
This field hearing today really allows us to gather that
insight from all of you here and take this with us back to our
Nation's capital to really do our best and strive to make the
best public policy that we can on behalf of our veterans and on
behalf of the communities that we represent.
I thank you again for hosting us today, and we look forward
to welcoming you to Michigan in the future to do another
hearing in my district. Certainly for those of you that have
further insight or thoughts for us, we welcome your insight. If
you make it to Washington, we would love to have you in our
hearing there as well.
Thank you again to everyone. Thank you to the staff, both
committee staff on both sides, as well as the staff for
arranging all of this, for those that were here providing other
services, for hosting us today. I really do appreciate each and
every one of you.
With that, I will ask unanimous consent that all members
have five legislative days to revise and extend the remarks and
include extraneous material. Without objection, it is so
ordered.
And this hearing is adjourned.
[Whereupon, at 11:37 a.m., the subcommittee was adjourned.]
?
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A P P E N D I X
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Prepared Statements of Witnesses
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Prepared Statement of Daniel Zomchek
Good morning, Chairman Barrett, Ranking Member Budzinski, and
distinguished guests, thank you for the opportunity to discuss the
Department of Veterans Affairs' (VA) extensive efforts to enhance the
well-being of Veterans living in rural areas broadly as well as in the
VA Illiana Healthcare System service area. My name is Daniel Zomchek,
and I am the Network Director of Veterans Integrated Service Network
(VISN) 12. I am accompanied today by Dr. Staci Williams, Executive
Director of VA Illiana Healthcare System, and Dr. Peter Kaboli,
Executive Director, Office of Rural Health (ORH), VHA.
Today, I will discuss key initiatives within the VA Illiana
Healthcare System, VISN 12, and VA that exemplify our commitment to
Veterans living in rural areas. From implementing advanced telehealth
services to expanding our reach through community collaborations, VA,
VISN 12, and the VA Illiana Healthcare System continually strive to
bridge the gap in health care access faced by Veterans living in rural
areas.
Our goal across VA, and certainly here in VISN 12, is to ensure
that Veterans residing in rural areas have the same access to high-
quality care as those in urban centers. ORH is instrumental in
addressing the challenges faced by Veterans living in rural areas. VA
is dedicated to putting Veterans first, prioritizing their needs, and
continually improving access to care - especially for Veterans in rural
areas. ORH supports 34 innovative enterprise-wide initiatives (EWI),
which are field-based solutions that have been tested in multiple
locations - including here in VISN 12 - and shown to be effective and
efficient methods for standardized care delivery.
We understand the unique circumstances and needs of Veterans living
in rural areas and are dedicated to developing sustainable and
impactful solutions to meet those needs. By sharing our experiences and
strategies, we hope to provide a clearer understanding of both the
challenges faced and the progress made in delivering high-quality
health care to Veterans living in rural areas.
Status of Rural Health in the VA Illiana Healthcare System
We are proud of the comprehensive range of health care services we
provide to Veterans through the VA Illiana Healthcare System. VA
Illiana Healthcare System has been serving the Danville community for
over 125 years. We employ over 1,500 health care professionals across
our service area and deliver care to 30,000 Veterans annually. We are
committed to expanding rural health access across our 34-county service
area, reaching Veterans in both urban and rural areas in east-central
Illinois and west-central Indiana.
Of the estimated 18 million Veterans living in the United States
and its territories, approximately 4.7 million Veterans reside in rural
areas. We also know that Veterans in rural areas enroll in VHA health
care at a higher rate (65 percent) than their urban counterparts (47
percent). Out of the 62 VHA facilities in VISN 12, 43.5 percent (27
facilities) serve a population where 50 percent or more of enrolled
Veterans are from rural areas. We understand the unique challenges they
face, including difficulties accessing VA care due to geographical
isolation.
I would like to highlight several areas of particular importance to
us as we continue to put Veterans first and to enhance our outreach and
capacity to reach Veterans living in rural areas: community care,
telehealth to include virtual mental health care, and beneficiary
travel.
Community Care
VA continues to enhance the Veterans Community Care Program (VCCP)
to ensure Veterans - especially those in rural or underserved areas--
receive timely, high-quality care closer to home. Through VCCP, VA uses
a network of more than 1.4 million non-VA providers to deliver
essential hospital care and medical services (including mental health
and specialty care), as well as extended care services, to eligible
Veterans when they elect to receive care from such providers. This
network is particularly vital for Veterans living in rural areas, who
often face geographic and transportation barriers to care. VA has taken
steps to streamline referrals, improve care coordination, and enhance
oversight of community providers to ensure continuity and quality of
care. The integration of community care with VA care reflects VA's
commitment to meeting Veterans where they are and offering them more
options while upholding the same high standards of Veteran-centered
care.
Telehealth and Virtual Mental Health Services
Telehealth has become a lifeline for Veterans living in rural and
remote areas, where distance and limited local health care options can
make it difficult to access timely care. VA has invested significantly
in the telehealth infrastructure, enabling Veterans and other
beneficiaries in rural areas to connect with primary care providers,
specialists, and care teams through platforms like VA Video Connect.
This technology eliminates the need for long travel times, supports
continuity of care, and improves the management of chronic conditions.
By leveraging telehealth, VA is not only expanding access but also
improving health outcomes for Veterans in rural areas, ensuring they
receive high-quality care regardless of where they live.
An essential aspect of telehealth and virtual health services is
its pivotal role in addressing the mental health needs of Veterans.
Access to mental health care remains a critical need for Veterans
living in rural areas, where provider shortages and geographic
isolation can create significant barriers to timely treatment.
Recognizing this, VA has significantly expanded its virtual mental
health services, ensuring that such Veterans can connect with
psychologists, psychiatrists, and counselors from the privacy and
convenience of their homes. Through VA Video Connect, Veterans receive
care ranging from therapy and medication management to crisis
intervention, all while avoiding long travel times. This digital
infrastructure is helping to close care gaps, reduce stigma, and
provide continuous support for Veterans who might otherwise go without
essential mental health services.
To further meet Veterans' needs, VA has launched several telehealth
initiatives including the VA Clinical Resource Hub program; Accessing
Telehealth through Local Area Stations, Digital Divide Consult, Mobile
Connectivity Program, clinic-to-clinic telehealth links, and the My VA
Images app. These initiatives help increase clinical capacity and
enhance health care delivery in rural areas.
Beneficiary Travel
Veterans in rural areas can face significant barriers in accessing
health care services due to longer travel distances. Recognizing these
challenges, VA has developed a range of robust programs to facilitate
transportation for Veterans designed to meet the diverse needs of
Veterans and ensure that no Veteran - especially those living in rural
areas - is left without options. VA operates several programs designed
to meet the transportation needs of Veterans, including:
Veterans Transportation Service (VTS): Through VTS, VA
transports eligible persons to or from a VA or VA-authorized facility
or other place for the purpose of examination, treatment, or care. VTS
offers safe, reliable door-to-door transportation for Veterans,
particularly those with disabilities, through a fleet of vehicles at
many VA medical centers.
Highly Rural Transportation Grants (HRTG): VA's HRTG
program provides grants to eligible entities to assist Veterans in
highly rural areas through innovative transportation services to travel
to VA medical centers and to otherwise assist in providing
transportation services in connection with the provision of VA medical
care to these Veterans.
Volunteer Transportation Network (VTN): VTN, principally
supported by the Veterans Service Organization, Disabled American
Veterans, provides free transportation for Veterans through volunteers
using personal or VA vehicles to ensure access to appointments.
VA's beneficiary travel program offers payments or allowances for
eligible individuals. This includes both mileage reimbursement and
special mode transportation, and beneficiaries can receive assistance
when traveling for various examinations and care. This program helps
reduce travel expenses, especially for those living in rural or remote
areas.
Conclusion
Chairman Barrett and Ranking Member Budzinski, thank you for the
opportunity to discuss VA's efforts to serve Veterans in rural areas
and to highlight the work of VA broadly and here in the Urbana,
Illinois area. Thanks to Congress' support, VA has expanded its reach,
delivering more care to a greater number of Veterans than ever before.
We value your ongoing efforts as we strive to better serve those who
have served.
Prepared Statement of John Lawson
H.R. 3132, CHOICE for Veterans Act of 2025
We adamantly oppose H.R. 3132, CHOICE for Veterans Act of 2025 as
written. We do not view this proposal as a compromise contrary to some
commentary being published and will continue to oppose any legislation
that charges veterans for initial claims assistance based on their
future benefits. This proposal has the likely outcome of putting
veterans into debt before even receiving a single penny in their earned
benefit. The companies engaging in this currently illegal activity
should be punished, not rewarded with a disabled veterans compensation
benefit. Congress' inaction on this matter has forced veterans to seek
remedy at the statehouse, namely here in Illinois with the passage of
SB3479 codified in Public Act 103-0783 under the Consumer Fraud and
Deceptive Business Practices Act. Free VA accredited veterans service
officers all over the country are ready to assist our fellow veterans
without taking any part of their earned disability benefit. We expect
our elected representatives to work with us to help serve the veterans
in their districts and not to line pockets of claim sharks with money
the taxpayers set aside to provide for the disabled veterans of the
United States Armed Forces. We are extremely disappointed we must
continue to have dialog on this topic, year after year after year. This
legislation is also strongly opposed by the Veterans of Foreign Wars
and Disabled American Veterans.
Veterans Benefits Improvement Act: Enhancing Communication
With regard to the implementation of the Veterans Benefits
Improvement Act: Enhancing Communication, Veterans Service Officers are
still not experiencing the mandated communication in Section 3 between
Claims and Pension (C&P) Examiners and veteran's representatives. It is
essential to the timely adjudication of a veteran's claim that when
issues arise or clarity is needed, an examiner attempts to resolve the
issue directly with the veteran's representative, not by sending more
letters or kicking the can to another work queue. Additionally, Section
4 of the same Act mandates that the VA provides regular reports on how
it can improve communication with veterans' representatives. This
includes assigning veteran liaisons to local facilities and enhancing
access to VA systems, all aimed at fostering better coordination and
ensuring veterans have the support they deserve throughout their
benefits process. To date, this has not occurred in any meaningful way
with our accrediting body, the National Association of County Veterans
Service Officers (NACVSO).
H.R. 3951, Rural Veterans' Improved Access to Benefits Act of 2025
We encourage support of this legislation to extend the license
portability for contracted health care professionals to perform VA
disability examinations to January 2031. The disability examination
system has evolved and expanded over many years. In 1996, as part of a
pilot program, VA granted temporary license portability to allow
contracted physicians to assist with disability examinations. Since the
fall of 2016, VA has transitioned from VA-conducted examinations in VA
settings to contracted examinations in non-VA settings for nearly all
disability examinations. Exceptions are examinations that VA personnel
must specifically perform by law. By increasing the number of eligible
providers, this legislation would accelerate the initial stage of the
disability claims process, particularly for rural and tribal veterans
who often have few examination options near their homes.
S. 784, Rural Veterans Transportation to Care Act
We encourage support of this legislation that would expand
eligibility for the Highly Rural Transportation Grant (HRTG) program.
It would also grant as much as $80,000 to State and county veterans
service agencies, such as the Veterans Assistance Commission of St.
Clair County and its Veterans Service Organization members to purchase
vehicles, including those compliant with the Americans with
Disabilities Act of 1990 (Public Law 101-336) to provide innovative
transportation options for veterans in rural or highly rural areas
traveling to and from medical treatment.
Unique to the HRTG program is the definition of ``highly rural'' as
a location that contains no more than seven persons per square mile,
which is a highly restrictive criterion. Other VA rural programs use
the Rural-Urban Commuting Areas (RUCA) coding system to assess
rurality. This bill would expand eligibility by including veterans who
reside in either rural as defined by RUCA, or highly rural areas as
defined by HRTG. This uniformity in standard will simplify processes
and be more a more realistic approach to solving transportation issues
in rural communities such as St. Clair County.
Our Public transportation options, taxis, and ridesharing companies
that urban dwellers take for granted are virtually non-existent in
rural St. Clair County, severely disadvantaging ill or injured veterans
or those who do not drive or own a vehicle. This expanded program would
satisfy a pressing need and ensure veterans could use their earned
benefits regardless of where they live.
Prepared Statement of Hillary Rains
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Prepared Statement of Kim Kirchner
Good morning and thank you everyone for taking the time out of your
day to listen to my testimony. My name is Kim Kirchner and I am a proud
veteran who served in the United States Air Force/Illinois Air National
Guard and served in Operation Iraqi Freedom and Operation Enduring
Freedom. I'm currently a Sergeant with the Macoupin County Sheriff's
Department.
I am writing the testimony in regard to the care that I have
received at a compensation and pension exam. I drove over thirty
minutes to an exam that VA scheduled for me with a contract provider.
When I arrived, the medical provider informed me that I was not on her
schedule and that she couldn't find my medical records. I told her that
VA called me and asked me to come at an earlier date due to an opening.
She finally found my records but had an attitude through the entire
exam, which lasted a total of 3 minutes.At no time did she conduct a
medical exam on me, she only reviewed my medical record. Based on that
exam VA denied my claim. In order to finally get my claim awarded, I
had to do a whole other medical exam. This was a massive waste of my
time and taxpayer money.
I firmly believe that I am not the only veteran this has happened
to and the outsourcing of these exams definitely needs to be looked
into. When a veteran goes for an exam they should be treated with the
upmost respect they deserve especially for putting their lives on the
line for our country. When I walked out of the exam that didn't last
approximately 3 minutes I have never felt so disrespected in my life.
It is very frustrating to get treated this way especially having to
drive 30 minutes to the exam due to living in a small town and nowhere
close to a VA Clinic. I firmly believe that the VA needs to pay more
attention to the care we are receiving from them outsourcing their
compensation and pension exams.
Thank you and I am happy to answer any questions you may have.
Prepared Statement of Christina Schauer
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