[Congressional Record Volume 162, Number 43 (Thursday, March 17, 2016)]
[Senate]
[Pages S1556-S1557]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                    VETERANS' ACCESS TO HEALTH CARE

  Mr. MORAN. Mr. President, I want to take a moment or two to speak 
about our Nation's veterans. The Presiding Officer and I have the honor 
of serving together on the Senate Veterans' Affair Committee. I take 
that responsibility--as does the Presiding Officer--very seriously. 
There is no other group of people that we should hold in higher regard 
than those who served our country. Today I want to talk about some of 
the challenges they are facing as a result of our failure to do that.
  Who would we expect to get the very best health care in our country? 
We want everyone to have good quality, affordable health care. But of 
all the people we would want to make certain received the health care 
services they were promised, clearly, it would be those who served our 
country--the men and women of our military who are now veterans. They 
deserve timely, high-quality health care. That is true whether they 
live in an urban or suburban setting or a rural place like your State 
and mine. There are more than 221,000 veterans who call Kansas home, 
and the vast majority of them live in very rural parts of our State.
  Before being elected to the Senate, before the honor that Kansans 
allowed me to serve them here in the Senate, I served in the U.S. House 
of Representatives. I represented the First District of Kansas, 
generally known in our State as the Big First. That is a congressional 
district larger than the State of Illinois, and there isn't a VA 
hospital in that congressional district. Veterans in this part of 
Kansas drive hours on end to get care, or they simply go without it all 
together.
  Over the past year, Congress has repeatedly passed legislation 
designed to ease the burden for veterans who are struggling to get 
health care from VA facilities in my State and yours and across the 
country. In the wake of the scandal, we learned across the country 
about the false waiting list for veterans. The VA put people on a 
waiting list that didn't really exist. The scandal across our country 
allowed us, as Members of the Congress and the Senate, to come 
together--Republicans and Democrats--and we passed legislation called 
the Choice Act. This legislation allows veterans who can't get timely 
service to access that service with a provider outside of the VA.

  Importantly--and what I want to talk about today--the Choice Act says 
that if you are a veteran who lives more than 40 miles from a VA 
facility, then at your request you can have those services provided by 
a local hometown physician, be admitted to your hometown hospital, see 
your local optometrist, and be treated by your local physical therapist 
or chiropractor. All of those things make a lot of sense for the 
veterans who live in the places where I come from.
  In the process of doing that, part of the goal was to ease the 
burden, in addition to providing quality and timely services, for those 
who live in rural places. Part of the theory--and I think rightly so--
in passage of the Choice Act was to lift a bit of the burden on the VA 
off of the VA. It has been difficult for them to have the necessary 
health care providers to meet the needs of veterans. So we began 
providing services in the community. And we are also speeding up the 
process by which a veteran who still goes to a VA hospital or still 
goes to a VA clinic gets services in a more timely and effective way.
  This past July Congress passed legislation to amend the Choice Act. 
We did so because of the number of problems we were encountering as a 
result of the stories that I heard from my veterans across our State--
and I know it is true of many Senators, if not all--about problems with 
the way the Choice Act was being implemented by the Department of 
Veterans Affairs. We amended that legislation to try to make it work 
better. In my view, that shouldn't have been necessary. The VA could 
have solved this challenge on their own but didn't.
  What it says is that it is not a facility. I have used this example 
on the Senate floor before. My hometown is a town of about 1,900 
people. It is about 23 miles from the community of Hays--about 20,000 
people--where there is an outpatient clinic of the Department of 
Veterans Affairs. The VA was saying that you cannot access the Choice 
Act if you live within 40 miles of a facility, and the problem was that 
they were saying even if that facility doesn't provide the service the 
veteran needs. So by law, we changed the definition of what a VA 
facility is, and it said that it is not a VA facility if it is not open 
full time and doesn't have a full-time physician--a pretty commonsense 
kind of thing that we needed to apparently put in the law to get the 
Department of Veterans Affairs to implement and to interpret the Choice 
Act in a commonsense way that was designed to meet the needs of 
veterans.
  Unfortunately, many of our veterans remain unaware of their options. 
I talk to lots of veterans, some who have given up on Choice, some who 
don't know it is an option, and some who tried and are caught up in a 
bureaucratic system and are trying to get an answer about whether they 
qualify, and even if they do, where they can go and how their bill will 
get paid.
  Examples in my State: One of the Kansas VA community-based outpatient 
clinics--known as a CBOC--is only open 2 days a month, and it shouldn't 
be counted as part of the Choice Act, a facility of the Choice Act. 
There are 9 out of 14 CBOCs in Kansas that do not have a full-time 
medical doctor. Those nine community-based outpatient clinics should 
not be counted under Choice. I want to highlight that for veterans from 
Kansas and across the country who might happen to hear what I have to 
say today so they know there are more options than they may realize.
  Many Kansas veterans choose to live in rural communities. Many of us 
often choose to live in rural communities and raise our families, see 
our grandkids, and more often than not, those communities don't have a 
VA hospital or a clinic to serve those veterans' needs.
  In townhall meeting after townhall meeting and up and down Main 
Streets of communities in my State, the most common conversation I now 
have is with veterans who are expressing how the system is failing 
them, the frustration they are encountering, and that they are not 
seeing the improvements and changes for the betterment of the care they 
are entitled to.
  As I said earlier, many veterans are so frustrated with the back-and-
forth they have with the VA and the redtape, they simply give up and 
either go without health care or end up trying to pay for it out of 
their own pocket. That is exactly what occurred to Mr. Lamoine Guinn, 
who is a rural Kansan. Mr. Guinn shared his story with me not to try to 
get me to solve the problem, but he wanted others to know how this 
program needed to change so that other veterans would benefit. After a 
year of dealing with the VA, he decided to simply give up on Choice. I 
don't want to let that happen. I don't want veterans to give up on 
Choice. I don't want the Department of Veterans Affairs to have the 
excuse to say Choice is not a viable

[[Page S1557]]

program, veterans don't like it, and come back to Congress and tell us 
that it is no longer needed.
  If I were home in Kansas, I would explain it this way: Again, my 
hometown, Plainville--population now 1,900--used to have rail service, 
and over time the rail service diminished and became less effective. 
The rates went up, and fewer people used the rail service, the 
railroad, to haul grain in particular. Then the railroad could go to 
the regulators and say: Nobody is using the railroad; can we just 
abandon it?
  I worry that that kind of attitude and approach could happen with 
this issue if we don't make certain our veterans see the benefit and 
actually receive the benefits that come from the Choice Act. I don't 
want to give anybody--the Department of Veterans Affairs or other 
Members of Congress--the opportunity to say ``The Choice Act doesn't 
matter. People don't like it. It is not popular. Let's do something 
different'' when the reality is that it would be popular if it were 
working effectively and in a timely way and veterans were being cared 
for.
  Mr. Guinn lives in Oberlin, a small town, a county seat town in 
Decatur County, almost in Nebraska. It is one of those typical Kansas 
small farming communities. The closest VA facility to him is actually 
in Grand Island, NE. Although he is a Kansas resident, he is part of 
the Nebraska VA network because of its proximity to Grand Island. He is 
eligible under the Choice Program, and he needed to schedule spinal 
surgery with the community provider. That is what he wanted to do. So 
the VA referred him to HealthNet. HealthNet is the organization that 
manages this program for the Department of Veterans Affairs. HealthNet 
then referred him to TriWest because he is a Kansas resident. TriWest 
covers Kansas while HealthNet covers Nebraska. The health care 
providers were arguing about who is responsible for his care because he 
lives one place and his VA provider is in an adjoining State.
  My complaint is that it shouldn't matter where he lives. He is stuck 
in a bureaucracy. The burden ought not fall to him to solve all of his 
problems. The VA ought to step in and solve the problem for him and 
tell him what it is that ought to be done and get him out of the back-
and-forth between the Nebraska and Kansas networks.
  He has now gone a year without the surgery. He is going to now drive 
to another VA medical center in Omaha--300 miles one way--so he can get 
the surgery he is entitled to have by his hometown provider or a 
regional hospital in his area.
  Many of our veterans--I don't know the age of this particular 
veteran, Mr. Guinn, but many of the veterans who live in those 
communities are World War II veterans and now more likely Vietnam 
veterans. The opportunity for them to have family around them, the 
ability for them to get long distances is a complete challenge. To have 
to go 300 miles, when the law says that he is a veteran and he, who 
served our country, is entitled to services at home, is a terrible 
mistake, and it ought to be something that can be sorted out, but every 
time he has attempted to do that, the burden still rests with him. We 
want the Department of Veterans Affairs to step in and figure this out 
and get it done and get it done quickly.
  Another veteran who reached out to my office for assistance was Mr. 
Francis Wierman, a 92-year-old veteran. He lives in La Crosse. It is a 
county seat town of a couple thousand folks. Because of his age, it is 
difficult for him to travel for his annual physical appointments.
  Mr. President, I ask unanimous consent to speak until I conclude my 
remarks.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. MORAN. I thank the Chair.
  Because of his age--Mr. Wierman needs to travel. It is difficult for 
him to do it. What he needs is an annual physical. So Mr. Wierman has 
attempted to utilize the Choice Program, and he was told there was no 
flexibility to be seen in La Crosse by a hometown doctor or go to a 
hometown hospital due to his proximity, his location next to an 
outpatient clinic.
  Mr. Wierman sacrificed for our country, and he deserves to be able to 
receive his care in his own community given the burden and strain 
traveling imposes upon him, a veteran of 92 years of age. We need to 
make certain he receives the care he is entitled to, and we need to 
make sure the VA is doing what needs to be done to accomplish that.
  My final example today is Mr. Dabney, who suffers from post-traumatic 
stress. He was also told he was eligible for Choice, so he set up an 
appointment with the local care provider. Despite the OK from the VA 
practitioner about getting care outside of the VA, the handoff got lost 
in the shuffle, and somehow the VA determined that it was Mr. Dabney's 
fault that the paperwork didn't follow him, leaving him with the bill 
for the services provided by the outside-the-VA practitioner.
  I shared this case with Secretary McDonald at a hearing the Presiding 
Officer and I attended several months ago. The conclusion months later 
by the VA was that Mr. Dabney simply didn't understand the Choice Act 
and he should have tried harder to get an official authorization before 
setting up the appointment; therefore, the bill still rests with him. 
Thankfully, the provider, the network TriWest, disagreed, and they are 
now elevating his case to try to make certain he doesn't have to pay 
the bill for the services the VA originally authorized him to receive 
outside of the VA.
  The Choice Act was designed specifically to help these veterans. They 
gave of themselves to serve our country and fought on our behalf, and 
they deserve the care and respect they should be receiving today from 
or country and its Department of Veterans Affairs. Our country must 
fulfill its commitments to these individuals and to others who provide 
for those who sacrificed for our Nation, regardless of the community 
they call home.
  Last week I joined my Senate colleagues in sponsoring the Veterans 
Choice Improvement Act of 2016. This legislation is designed to fix 
problems with the original Choice Act that the VA has been unable to 
resolve on their own to make sure these veterans receive what they are 
entitled to. As a member of the Senate Veterans' Affairs Committee, I 
look forward to working with the Presiding Officer and other members 
and with our chairman, Johnny Isakson from Georgia, as well as the 
ranking member, Senator Blumenthal, for purposes of making sure that we 
get this right and that we make certain the VA does its job in caring 
for these men and women who served our country.
  I will continue to make certain that happens, and I continue to 
express my gratitude to those who served our country and renew my 
willingness and my desire to make sure they receive the health care 
they are entitled to.
  Mr. President, I yield the floor.
  The PRESIDING OFFICER. The Senator from Arkansas.
  (The remarks of Mr. Cotton pertaining to the introduction of S. 2708 
are printed in today's Record under ``Statements on Introduced Bills 
and Joint Resolutions.'')
  Mr. COTTON. I yield the floor.
  The PRESIDING OFFICER (Mrs. Fischer). The Senator from Rhode Island.

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