[Congressional Record Volume 160, Number 89 (Tuesday, June 10, 2014)]
[Senate]
[Pages S3525-S3526]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          VETERANS HEALTH CARE

  Mr. HOEVEN. Mr. President, I rise to speak today on behalf of our 
veterans. I am here to speak about both challenge and opportunity. The 
challenge is the problems we face with our Veterans' Administration, 
which is that we are not getting the care for our veterans that they 
need and that we all want them to have and that they so very much 
deserve.
  We also have a real opportunity because we have been working on 
legislation. We have legislation on the Republican side in the Senate 
and on the Democratic side, and now we are working to bring those two 
pieces of legislation together. So I think this creates a real 
opportunity, and it is a vitally important opportunity--one that we 
grab and that we address on behalf of our veterans. We need to make 
sure we come together on bipartisan legislation that fixes the 
Veterans' Administration health care system, and it takes care of our 
veterans.
  I believe the solution, the real key to solving the problem, is 
choice--or another way to put it might be access to health care. I 
think that not only solves the problems we have seen with the wait 
lists but also the problem of distance, which is also an issue, and it 
is a challenge we see in States such as my own. For example, in our 
State the issue truly is distance. In other places it is access to 
health care. We know, for example, in places such as Phoenix, veterans 
were put on wait lists and in that way denied access to care. That is 
absolutely unacceptable--absolutely unacceptable.
  I think the Veterans Choice Act, which I am pleased to cosponsor with 
a number of my fellow colleagues, solves that problem, and it solves 
not only the access and the wait list problem but also, as I have said, 
the distance problem essentially by providing choice, meaning that if a 
vet can't get access to a veterans health care facility, then the 
veteran can go to another health care provider. I believe that works 
for the vet and it works for the health care provider. The veteran can 
go to a hospital or a clinic that has the service he or she needs if he 
can't get into the VA facility in a timely way, and then that hospital 
or clinic is reimbursed just as if it were for a Medicare patient. 
Clearly, our health care system has the facilities in place, the 
resources to handle that type of reimbursement just as they do for 
Medicare patients.
  Now I wish to speak about the distance issue for just a minute 
because in North Dakota the distance issue is the one we face. For 
example, in North Dakota it is about 800 miles round trip from 
Williston to the VA health care system in Fargo. Some services, as we 
all know, are provided by CBOCs--community-based operating clinics--and 
we have those around the State. But where we don't have CBOCs or where 
they are not able to get the service they need from that CBOC or walk-
in clinic, then it can be an 800-mile trip to get services.
  Not too long ago I held an open forum in Williston, ND, which, as 
many people know, is the site of an incredible energy boon, the 
Williston Basin. Now in North Dakota we produce about 1 million barrels 
of oil a day--second only to the State of Texas. So we have a 
tremendous number of people moving into this region. We are the fastest 
growing State in the Nation. We have veterans there who are driving 
long distances to get medical services. So this is a different 
challenge than we faced in some of the centers such as Phoenix where 
they were waiting to get patient care. In our case they are having to 
drive long distances--as I said, 800 miles round trip to Williston; 400 
miles to Fargo and then 400 miles back.
  I recently held a forum up in Williston to discuss this issue and 
look for solutions on behalf of our veterans. I met with our veterans, 
I met with veterans service officers, as well as health care providers 
from the region. I talked to two vets who told me their story about 
trying to get health care. We have a walk-in clinic, a CBOC--community-
based operating clinic--in Williston. There were two cases where 
veterans needed some health care services. In one case, because they 
couldn't--the first veteran couldn't get it at the local CBOC, that 
individual took a day to drive to Fargo, which is 400 miles, stayed in 
a hotel, the next day went in and got those services, stayed in a hotel 
that night, and then drove back the third day. So he had to take 3 days 
off of work to get services. He had to drive 800 miles round trip. He 
had to be put up in a hotel for 2 nights. Now, all of that is 
reimbursed, as far as the travel in the State, by the VA. So for a 
relatively straightforward procedure, the VA paid a lot more and 
inconvenienced that veteran terribly and cost him money because that 
individual had to take 3 days off from work. That doesn't make any 
sense.
  In the second case, a veteran in a similar situation wanted to get 
the service at the local CBOC, wasn't able to do that, but instead of 
driving all the way to Fargo and doing what the first veteran did, the 
second individual just went into the local clinic or hospital in 
Williston and got the service that afternoon. Unfortunately, the second 
veteran is still trying to get reimbursement out of the VA for that 
procedure.
  The individual in the second case did not have to take 3 days off 
from work, which is smart and, frankly, saved the VA a lot of money 
because it was not a case where you had to drive down, get reimbursed 
for that stay with over two

[[Page S3526]]

nights in a hotel, and then drive back. So it actually saved the VA 
money. But still they have not gotten a reimbursement for the cost of 
that medical treatment because the VA does provide that service in 
Fargo. But again, in that situation, unless that veteran is reimbursed, 
you are not truly serving the veteran and, frankly, not doing the 
sensible thing to save the taxpayer money.
  That is why the Veterans Choice Act that I am cosponsoring with 
others, again, is the solution because we provide choice, we provide 
access. If the veteran cannot get that service in a timely way in the 
local community, then the veteran can access another health care 
facility. That is why the legislation works.
  So what I have offered--and, of course, now we are working on 
bringing two bills together: the Veterans Choice Act, but then also 
legislation offered by Senator Bernie Sanders; and that legislation is 
the Ensuring Veterans Access to Care Act.
  I think we can bring them together, and I think we can get a good 
solution that serves everybody, most importantly that serves our 
veterans. But we need to serve all of our veterans--all of our 
veterans--regardless of where they live. That is why I have offered 
simple, clarifying language--this is a technical fix--that would 
clarify and ensure that if a veteran cannot get service in a CBOC, then 
that veteran can go to a local health care provider on the same basis 
as an individual who lives more than 40 miles away from the walk-in 
clinic.
  This legislation, this clarification is important to ensure that a 
veteran is not in any way actually disadvantaged by having a walk-in 
clinic in the local community, and that all vets can access services on 
the same basis. Again, it is because of the way this legislation is 
coming together that requires that if you are within 40 miles of a 
walk-in clinic or you have to wait more than 14 days, then you can go 
to another health care provider. But if either one of those criteria 
apply--you are within the 40-mile radius and you can get an appointment 
within 14 days to see a doctor--then you have to go to the VA. That 
works, and that is consistent only if you applied both criteria to the 
same clinic, to the same health care center.
  What I mean is this. Remember the example I gave just a minute ago: 
Williston, ND, and Fargo, ND. In Williston you have a walk-in clinic. 
In Fargo you have a full hospital--a full VA medical center. Take the 
test we are applying in this legislation: If you are within 40 miles, 
you have to go to the VA facility, as long as you can get in within 14 
days. But that 14 days has to also apply to the facility that is within 
that 40-mile radius; otherwise, you get an inconsistent, unfair result 
and actually disadvantage somebody who is within 40 miles of a walk-in 
clinic versus somebody who is outside that radius.
  Let me give two examples to illuminate what I am saying.
  You have a vet. He lives in Williston, ND. He is within 40 miles of 
that facility. He goes in, and he gets his shots or whatever it is in 
that facility--no problem. But what happens if he cannot, if that walk-
in clinic does not supply the service? What does he do? Well, if the 
14-day rule applies to the Fargo VA hospital, even though he is within 
40 miles of the CBOC, if the CBOC--the walk-in clinic--does not provide 
that service, he still has to drive 800 miles roundtrip for that shot I 
just talked about a minute ago or that service--the two veterans I 
described a minute ago. So he still has to travel 800 miles to get 
service.
  Take another individual. He lives 41 miles from that walk-in clinic. 
Even if the Fargo VA can take him within 14 days, he can still go get 
local service in Williston, can't he? Why? Because he is 41 miles away. 
So ask yourself, the veteran who lives within 39 miles of that walk-in 
clinic, he might have to drive 800 miles roundtrip to get a service 
that the individual who is 41 miles from that facility can go get in 
the local community.
  Does that make sense? That is the kind of thing we have to make sure 
we get right so that all veterans, regardless of where they live, get 
the same fair and consistent treatment. That is why I am saying, as we 
put this legislation together, we have to be careful to make sure we 
get that kind of fair and consistent result so this legislation serves 
all of our veterans and takes care of all of our veterans, and they 
truly all have that access. Whether the problem is a wait list or long 
distances, let's make sure this works for all of them.
  Believe me, they are out there. Every one of them has put their life 
on the line and stepped up. All of them have done that for us. Let's 
make sure, as we work through and file this legislation--something I 
know we can do; on a bipartisan basis we can get this done--let's make 
sure it works for all of our veterans and it works well and it works 
consistently and it truly solves the problem; that is, we make sure 
they get the health care they deserve.
  I thank the Presiding Officer.
  With that, I yield the floor.
  The PRESIDING OFFICER (Ms. Warren). The Senator from Georgia.

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