[Congressional Record (Bound Edition), Volume 150 (2004), Part 3]
[House]
[Pages 3885-3886]
[From the U.S. Government Publishing Office, www.gpo.gov]




     IN SUPPORT OF RURAL VETERANS ACCESS TO HEALTH CARE ACT OF 2003

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Hawaii (Mr. Case) is recognized for 5 minutes.
  Mr. CASE. Mr. Speaker, good evening and aloha.
  I am very happy to stand on the floor of the House today and join my 
colleagues the gentleman from Nebraska (Mr. Osborne), the gentleman 
from Texas (Mr. Stenholm) and many others in introducing the Rural 
Veterans Access to Health Care Act of 2003.
  We are all very well aware of the commitment that we have made, at 
least in principle, although the practice has been lacking of recent 
years, but the principle that we will take care of veterans when they 
come home. The truth, however, is that as we try to honor that 
principle and the practice, the equality of access to health care 
throughout our country is inconsistent, and this is most particularly 
true in the rural areas of our country. In these areas, our veterans 
simply do not have the same level of access to the veterans' health 
care as they do in the urban areas.
  This is true in Hawaii's 2nd District, which is a rural area of our 
country, just as others are, but we have a little wrinkle in the 2nd 
Congressional District that creates a unique complication. The wrinkle 
is that my district is

[[Page 3886]]

not contiguous. It is made up of islands. It is not possible for the 
veterans of my district to hop on the nearest road and get to the 
nearest clinic. It is not possible for the most part for my veterans to 
hop on the nearest ferry to get to the nearest clinic. Their access is 
by air.
  There are some VA medical clinics on many of the islands that I 
represent. Of the seven inhabited islands, four have VA clinics; three 
do not. The islands of Molokai, Lanai and Niihau do not, and these are 
the particular problems that this bill seeks to address.
  But it is not limited only to those islands. For the islands that do 
have VA clinics do not have the large specialized hospitals. There is 
only one of them on the island of Oahu. So for six out of the seven 
islands, the veterans that live on those islands have a particular 
difficulty in getting to treatment when they need it, and with airfares 
rising rapidly, with a round trip now well over $200 in some cases, we 
can see that the problem is quite evident.
  Let me give my colleagues just a real life example, one proud veteran 
who I have gotten to know over the last couple of years, a gentleman by 
the name of Patrick Esclito, of the island of Lanai. Pat asked for my 
office's help last year. He had rheumatoid arthritis and had also 
suffered a massive heart attack in 2002. His condition required him to 
drive from Lanai, one of the smallest, most isolated areas, to Oahu 
where he was able to be cared for. Every time he went there he had to 
pay almost $300 in airfare and his wife as well because they did not 
want him to travel alone.
  As my colleagues can understand, he needed assistance in getting the 
basic health care that was promised to him by our country, and we were 
successful, in part, by accommodating the possibility that he would be 
treated instead on the island of Maui, which still requires a boat ride 
at least, not quite as expensive, but he still has to get there, and I 
doubt that Pat's case is unique. It is certainly not unique in the 
remainder of the 2nd District of Hawaii.
  I surveyed all of the veterans in my district currently retaining or 
receiving benefits in the last couple of months and asked them what is 
on your mind the most. Every single one of them said health care, 
access to health care. That is what it is all about, and I am sure that 
this is the case in most of the rural and more isolated areas of our 
country.
  We are going to have a great debate this Congress, as we did last 
Congress, over the overall adequacy of our treatment of our veterans, 
over the overall adequacy, both this year and in the next 5 years at 
least, in terms of the budget, in terms of the projections on many 
aspects of veterans' care, primarily health care.

                              {time}  2015

  And that debate is a debate that we should have. Because, again, it 
is one thing to express a principle and it is another thing to practice 
that principle. But as we go through this debate, I am happy to say 
that on the floor of the House tonight at least we have bipartisan 
agreement that one area that we have to focus on, and that we are 
focusing on in this bill, is our rural veterans, recognizing the unique 
problems that they have in access to basic health care.
  Mr. Speaker, I rise today to join 52 of my colleagues in support of 
this vital bill, a bill that will help keep our Nation's promise to its 
veterans who live in our more isolated, rural areas.
  We are all well aware of the commitment we all, as a great country, 
have made to our veterans. However, the truth is that our ability to 
deliver on this commitment varies throughout the United States. Most 
particularly, in rural areas of the country, our veterans simply do not 
have reasonable access to veterans' clinics.
  The veterans of Hawaii's Second District have this very challenge, 
but with a unique complication. This is because my district is not 
contiguous, but composed of seven inhabited islands in the middle of 
the Pacific Ocean.
  There are VA medical facilities on only four of those islands, and it 
is not possible for those veterans who live on the remaining islands of 
Molokai, Lanai, or Niihau to drive to a clinic. The same is true of 
those living on the remaining islands with clinics; they must travel to 
Honolulu for more advanced treatment.
  Currently, the VA will reimburse all veterans for travel to service-
related injuries, but it will not reimburse travel for those veterans 
with less than 30 percent disability rating for nonservice-related 
injuries. This would be the case, for example, of a veteran who has a 
bad back, a service-related injury, who then has to have dental work.
  Let me give you a real-life example of one proud veteran, Patrick 
Esclito, who lives on the Island of Lanai. Pat requested my help last 
year; he was afflicted with rheumatoid arthritis and had also suffered 
a massive heart attack in 2002. His condition required him to travel to 
the Island of Oahu for treatment at a cost close to $300 per roundtrip. 
His wife traveled with him--another almost $300--because they were both 
concerned with his traveling alone. My office assisted him in receiving 
approval for treatment instead on the Island of Maui. However, he still 
must pay for travel by boat from Lanai to Maui because his ailments are 
not service-related.
  Pat's case is not unique. There are 120,000 veterans living in the 
State of Hawaii, and many live in areas with no easy or even adequate 
access to the VA health clinics to which they are entitled. Throughout 
my Second District, with the cost of air travel skyrocketing, it costs 
$200 or more for a round trip plane ticket between Hawaii's islands.
  This is why, when, last year, I surveyed all veterans in my district 
who are currently receiving VA benefits, and asked them what was and 
was not working, their number one issue by far was access to health 
care. I am sure that this is the case in most rural areas of our 
country.
  This bill will allow all veterans to receive adequate access to 
health care, regardless of where they live in this great country. 
Nonetheless, the President's 2005 Veterans' Affairs budget provides 
$29.8 billion for appropriated veterans programs, $257 million below 
the amount that the Congressional Budget Office estimates is needed to 
maintain purchasing power at the 2004 level. The picture is even worse 
after 2005. Taking into account inflation, but not caseload increases, 
the administration's figures reveal that over the next 5 years, the 
budget for appropriated programs for veterans is $13.5 billion below 
the amount needed to maintain programs and services at the 2004 level. 
Even the Secretary of Veterans' Affairs has admitted that the funding 
levels for 2006 through 2009 in the President's budget may not be 
realistic. I have no doubt that it will be the rural veterans who will 
be affected the most.
  Contrary to what some critics claim, H.R. 2379 will not harm the 
Veterans' Affairs (VA) healthcare system. Instead, this bill will 
enhance access to healthcare for veterans who have earned it, but are 
having to pay to travel to that care. Furthermore, by contracting 
locally for health care for enrolled veterans, the rural communities 
that provide these services will benefit economically. H.R. 2379 is a 
necessary bill to truly fulfill this country's obligation to all 
veterans.
  Mr. Speaker, as the President has repeatedly declared: ``We are 
currently a country at war.'' Hundreds upon thousands of this Nation's 
finest men and women are abroad in support of the Global War on 
Terrorism. Some 4,500 soldiers from the 25th Light Infantry Division 
from Schofield Barracks in Hawaii have deployed to Iraq; another 5,400 
soldiers from the 25th will soon be deployed to Afghanistan. Reservists 
and Guard members from my State, many from my Second District, are also 
serving on Active Duty.
  What kind of message does our country's failure to provide access to 
healthcare for rural veterans send to the thousands of American men and 
women in uniform currently risking their lives overseas? Our veterans 
and our future veterans serving overseas deserve better. If we value 
all our veterans, we need to give them the respect they deserve by 
properly funding full and adequate access to healthcare for each and 
every one.

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