[Congressional Record (Bound Edition), Volume 152 (2006), Part 8]
[Extensions of Remarks]
[Pages 10184-10186]
[From the U.S. Government Publishing Office, www.gpo.gov]




     INTRODUCING H.R. 5524, RURAL VETERANS HEALTH CARE ACT OF 2006

                                 ______
                                 

                        HON. MICHAEL H. MICHAUD

                                of maine

                    in the house of representatives

                         Tuesday, June 6, 2006

  Mr. MICHAUD. Mr. Speaker, today I am introducing H.R. 5524, the Rural 
Veterans Health Care Act of 2006, to strengthen and improve access to 
health care for rural veterans.
  The Memorial Day weekend has recently passed us by. The holiday 
reminded us all of

[[Page 10185]]

the great sacrifices made by our Nation's veterans and their families. 
It is important that we honor our veterans with action and not just 
words. We must not forget that we have soldiers in harm's way in Iraq 
and Afghanistan, and they too have earned the support of a grateful 
nation, just as generations before them.
  Meeting the needs of our veterans and their families should be a top 
priority. While the Department of Veterans Affairs (VA) does a good job 
in delivering quality medical care, treatment is sometimes harder to 
access for veterans in rural areas.
  Rural communities have always answered their Nation's call to 
service. Nationwide, more than 44 percent of recent U.S. military 
recruits come from rural areas. This tradition of service is true in my 
home State of Maine where approximately one in six residents is a 
veteran--one of the highest proportions in the country. Across the 
country, one in five veterans who is enrolled to receive VA health care 
lives in a rural area.
  Veterans who live in rural settings are often older and have more 
physical and mental health diseases as compared to veterans who live in 
suburban or urban settings. According to the 2005 Institute of Medicine 
report, The Future of Rural Health, ``the smaller, poorer, and more 
isolated a rural community is, the more difficult it is to ensure the 
availability of high-quality health services.''
  It is important that we address the unique challenges that rural 
veterans face in accessing health care. At my request last summer, the 
House Veterans' Affairs Subcommittee on Health held a hearing at 
Eastern Maine Community College in Bangor to raise awareness of this 
issue and to search for solutions. The field hearing focused on rural 
veterans' access to primary care and gave the Chairman and me the 
opportunity to hear directly from veterans and health care providers in 
Maine.
  It was clear to the Chairman and me that if our rural veterans are 
going to get the care they deserve, the VA needs to have a focused 
effort to increase access to quality health care for those living in 
non-urban areas of our country.
  My legislation is a result of the findings from the Maine field 
hearing, an ongoing dialogue between my office and Maine veterans and 
health care providers, and reports published by the Institute of 
Medicine that focused on improving health care in rural areas.
  Specifically, my bill would help rural communities address the needs 
of returning veterans who are serving in Iraq and Afghanistan by 
requiring the VA to conduct an extensive outreach program to these 
veterans who reside in rural communities. The VA would be required to 
collaborate with employers, state agencies, community health centers, 
rural health clinics and the National Guard to conduct this extensive 
outreach program to ensure that returning troops have access to the 
benefits they have earned.
  The legislation would also build on the strength of the Vet Centers 
program. Vet Centers are located in the community outside of the larger 
VA medical facilities, in easily accessible, consumer-oriented 
facilities. They are highly responsive to the needs of local veterans. 
In 2005, the 206 Vet Centers saw over 132,853 veterans. For nearly one 
out of four veterans seen at Vet Centers, these centers are their 
access to VA programs and benefits. This core group of veteran users 
primarily received counseling for military-related trauma. My bill 
would require the VA to expand its presence in rural areas and to 
establish a pilot program to have mobile Vet Centers that could help 
reach veterans in the most rural and remote areas.
  Consistent with the promise made to veterans in the CARES process, my 
legislation would hold the VA accountable for improving access for 
rural veterans through Community Based Outpatient Clinics (CBOCs) and 
other access points by requiring the VA to develop and implement a plan 
for improving veterans' access to quality care in rural areas. The May 
2004 Secretary's CARES decision identified 156 priority CBOCs and new 
sites of care nationwide. The VA Secretary would also be required to 
develop a plan for meeting the long-term care needs of rural veterans, 
expanding adult day-care and respite care programs for rural veterans, 
expanding the use of telemedicine to enhance the care of rural 
veterans, and expand access to mental health care for rural veterans.
  The 2005 groundbreaking Institute of Medicine report on The Future of 
Rural Health recommended that the federal government incorporate a 
rural focus in planning and developing a national health information 
infrastructure. The VA has been a leader in developing an electronic 
medical record system to enhance patient safety and improve quality of 
care. This legislation recognizes that VA has a leading role and 
responsibility to help rural veterans and their providers. The bill 
would establish a health information technology pilot to ensure a 
continuum of quality of care for veterans that rely on VA provided 
care, VA fee-basis care and contracted care. The pilot would have the 
VA partner with a range of providers including community health 
centers, rural health clinics and critical access hospitals, where 
appropriate.
  Rural veterans, veteran service organizations and other experts need 
a seat at the table to help the VA consider important program and 
policy decisions that affect rural veterans. The legislation would 
establish a Rural Veterans Advisory Committee to harness the knowledge 
and expertise of representatives from other federal agencies, academic 
affiliates, veterans and other experts to recommend opportunities to 
meet the challenges of veterans' rural health care.
  This legislation would also put VA in the forefront of researching, 
developing and evaluating innovative approaches in the delivery of 
rural health care by establishing four Rural Health Research, 
Education, and Clinical Care Centers. These centers of rural health 
care excellence will conduct research on rural health services, allow 
the VA to pioneer models for furnishing services to treat rural 
veterans, provide education and training for health care professionals, 
and develop and implement innovative clinical activities and systems of 
care. These centers would maximize the investment of federal tax 
dollars by collaborating with Department of Health and Human Services 
Rural Research Centers.
  Health workforce shortages and recruitment and retention of the 
health care workers are key challenges to rural veterans' access to 
care and quality of care. Rural Americans face a unique combination of 
factors that create disparities in health care not found in urban 
areas. Only 10 percent of physicians practice in rural areas despite 
the fact that one-fourth of the U.S. population lives in these areas. 
State offices of rural health identify access to mental health care and 
concerns for suicide, stress, depression, and anxiety disorders as 
major rural health concerns. The 2005 IOM report recommended that the 
federal government initiate a renewed, vigorous and comprehensive 
effort to enhance the supply of health professionals working in rural 
areas.
  The VA's involvement in medical and nursing education of future rural 
providers is essential. Almost 28,000 medical residents and 16,000 
medical students receive some of their training in the VA every year. 
In addition, over 32,000 associated health students, including future 
nurses, pharmacists, dentists, audiologists, social workers, 
psychologists, physical therapists, optometrists, respiratory 
therapists, physician assistants and nurse practitioners, receive 
training through the VA.
  This legislation would place VA at the forefront of enhancing the 
rural education and training of health professionals. The legislation 
requires the VA Secretary to institute additional rotations for medical 
residents in rural areas; establish programs to enhance the education, 
training, recruitment and retention of nurses in rural areas; and 
create programs to enhance the education, training, recruitment and 
retention of allied health professionals in rural areas.
  Helping homeless veterans in rural and remote locations recover, 
rehabilitate and reintegrate into society is complex and challenging. 
The VA has no specific programs to help community providers who focus 
on homeless veterans in rural and remote locations. This legislation 
would authorize special grants to community providers to meet the needs 
of homeless rural veterans.
  Native American, Native Hawaiian and Native Alaskan veterans have 
unique needs. This legislation would expand VA's health care presence 
in these rural and remote communities.
  Rural America has always answered the call to service. We should do 
everything we can to ensure that rural veterans have the same 
reasonable access to the high quality care available through the VA as 
veterans in suburban and urban areas. I urge my colleagues to support 
the Rural Veterans Health' Care Act of 2006.


                                          The American Legion,

                                     Washington, DC, June 5, 2006.
     Hon. Michael Michaud,
     House of Representatives,
     Washington, DC.
       Dear Representative Michaud: On behalf of the 2.7 million 
     members of The American Legion, I would like to express our 
     support for your legislation addressing rural veterans health 
     care.
       The American Legion understands the dire straits that many 
     veterans who reside in rural and highly rural areas find 
     themselves. As the Global War on Terror and the ongoing 
     conflicts in Afghanistan and Iraq continue to escalate, the 
     need for the nation's Active Duty, National Guard and Reserve 
     service members to deploy not once, twice, but three

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     times is becoming the rule and not the exception. The need 
     for the Department of Veterans Affairs (VA) to reach out to 
     these veterans, many of them in rural communities, has 
     reached an unprecedented scale. The time is now for VA to 
     take responsibility to bring those veterans in and provide 
     them the services they not only need, but also earned.
       Adequate and directed outreach, rural mental health 
     services, trained medical staff, rural health research and 
     homeless rural veterans are all key components of your 
     legislation that address the growing dilemma that is access 
     to rural health care.
       The American Legion believes this legislation will go a 
     long way in addressing this crucial issue and we thank you 
     for your continued leadership and support of America's 
     veterans and their families.
           Sincerely,

                                              Steve Robertson,

                                                         Director,
     National Legislative Commission.
                                  ____



                                  Vietnam Veterans of America,

                                  Silver Spring, MD, June 2, 2006.
     Hon. Mike Michaud,
     House of Representatives,
     Washington, DC.
       Dear Congressman Michaud: Vietnam Veterans of America 
     applauds your initiative in introducing a bill--a bill that 
     is sensible, necessary, and long overdue--that promises to 
     significantly improve health care delivery to veterans living 
     in rural areas. These veterans have been underserved for far 
     too many years; your bill, when passed, can correct this 
     oversight.
       We are particularly pleased that your bill calls for an 
     expansion of the very effective Vet Center program into rural 
     areas; the establishment of a Rural Veterans Advisory 
     Committee; additional rotations of medical residents to rural 
     areas; and programs to enhance the education, training, 
     recruitment, and retention of health care professionals in 
     rural America.
       With more than four in ten enlistees coming from rural 
     areas, passage of your legislation will serve to send a clear 
     message: that their needs, when they become veterans, will 
     not be overlooked.
       On behalf of VVA members and their families, I thank you 
     for your concern about rural veterans and your desire to 
     ensure that they get better access to the quality health care 
     they have earned by virtue of their military service.
           Sincerely,
                                                       John Rowan,
     National President.
                                  ____



                           Military Order of the Purple Heart,

                                    Springfield, VA, June 5, 2006.
     Hon. Mike Michaud,
     Washington, DC.
       Dear Mr. Michaud: The Military Order of the Purple Heart 
     (MOPH), whose membership is comprised entirely of combat-
     wounded personnel, is pleased with your efforts to improve 
     health care for veterans in rural areas. Health care provided 
     by the Department of Veterans Affairs should be available to 
     all those enrolled in the system without regard to the area 
     in which they live. For too long those veterans living in 
     rural areas have been neglected.
       MOPH thanks you for this effort and will assist you in any 
     way possible to help enact this legislation.
           Respectfully,
                                                 James D. Randles,
     National Commander.

                          ____________________