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




           INTRODUCTION OF RURAL VETERANS ACCESS TO CARE ACT

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Nebraska (Mr. Osborne) is recognized for 5 minutes.
  Mr. OSBORNE. Mr. Speaker, I would like to thank the gentleman from 
Texas for his kind words and his support. The gentleman from Texas (Mr. 
Stenholm) and I share very similar Districts, very large districts.
  My district has 68 counties, 160,000 square miles. It is the third or 
fourth largest district in the United States. As a result, veterans who 
need health care must often travel several hours, sometimes hundreds of 
miles, to access VA health care. Sometimes this is as much as a 3-day 
trip, a day down, a day at the facility and a day back, and the problem 
is that usually transportation is very difficult to access. A person 
has to have a son or a daughter or a friend or somebody who can take 
off work for 2 days or 3 days to provide that transportation. So it is 
a tremendous hardship on a number of people.
  Often, all a veteran needs is to adjust medication, have a blood 
pressure test, receive an EKG or take a blood analysis. So these are 
very simple, routine matters that still take tremendous resources to 
have attended to. Routine medical care could be handled at the local 
hospital or clinic where that person resides or near where that 
individual resides, and this would require minimal travel time, minimal 
waiting time for an appointment because sometimes these appointments, 
you have a waiting time of 3, 4, 5, 6 months and also minimal expense.
  So I looked at various options to address this problem and developed 
H.R. 2379, the Rural Veterans Access to Care Act. H.R. 2379 would 
encourage the VA to use its authority to contract for routine medical 
care with local providers for geographically remote veterans who are 
enrolled in the VA. They must be enrolled in the VA previously in order 
to access the provisions of this bill.
  So how will it be funded? The VISN director will use the funding for 
acute or chronic symptom management, non-therapeutic medical services 
and other medical services as determined appropriate by the director of 
the VISN after consultation with the VA physician responsible for 
primary care for the veteran.
  H.R. 2379 sets aside 5 percent of the appropriated VA medical care 
allocation in each VISN to be used for routine medical care for 
geographically remote veterans. We are talking about taking just 5 
percent of the funding and setting it aside for veterans who live at 
some significant distance from a VA facility.
  H.R. 2379 uses 60 minutes travel time or more as an initial 
determinant, but there is also an exception to the legislation if the 
VA finds it is a hardship for a veteran to travel to a VA facility, 
regardless of how long it will take. It is conceivable that somebody 
might live only 30 or 40 minutes away but because of age or severity of 
illness or whatever it may be much more convenient to attend a closer 
facility that would enhance that person's health.
  I want to assure veterans, this legislation is not a voucher program. 
My legislation allows only enrolled veterans who have been approved by 
the VA to seek routine care from a local provider.
  Reducing demands for routine care could also help with appointment 
backlogs in VA facilities, which are significant at this time.
  According to the CARES Commission report, the benefits of contracting 
are, it can add capacity and improve access faster than can be 
accomplished through capital investment. In other words, building new 
facilities is not nearly as efficient as letting them use preexisting 
local clinics or hospitals. It provides flexibility to add and 
discontinue services as needed and allows VA to provide services in 
areas where the small workload may not support a VA infrastructure, 
which is very much the case in my district and in the gentleman from 
Texas' (Mr. Stenholm), and this was for highly rural veterans.
  During the hearings, the CARES Commission received testimony stating 
that contracted care improves access and that there was little 
dissatisfaction with contracted care. Therefore, I urge my colleagues 
to support H.R. 2379 and help our rural veterans as they access VA 
health care.

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