[Congressional Record (Bound Edition), Volume 154 (2008), Part 13]
[House]
[Pages 18205-18209]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   RURAL VETERANS ACCESS TO CARE ACT

  Mr. FILNER. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1527) to amend title 38, United States Code, to allow highly 
rural veterans enrolled in the health system of the Department of 
Veterans Affairs to receive covered health services through providers 
other than those of the Department, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 1527

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Rural Veterans Access to 
     Care Act''.

     SEC. 2. PILOT PROGRAM OF ENHANCED CONTRACT CARE AUTHORITY FOR 
                   HEALTH CARE NEEDS OF VETERANS IN HIGHLY RURAL 
                   AREAS.

       (a) In General.--Section 1703 of title 38, United States 
     Code, is amended by adding at the end the following new 
     subsection:
       ``(e)(1) The Secretary shall conduct a pilot program which 
     permits highly rural veterans--
       ``(A) who are enrolled in the system of patient enrollment 
     established under section 1705(a) of this title, and
       ``(B) who reside within Veterans Integrated Service Network 
     1, 15, 18, and 19,
     to elect to receive covered health services for which such 
     veterans are eligible through a non-Department health-care 
     provider.
       ``(2) The election under paragraph (1) shall be made by 
     submitting an application to the Secretary in accordance with 
     such regulations as the Secretary prescribes. The Secretary 
     shall authorize such services to be furnished to the veteran 
     pursuant to contracting with such a provider to furnish such 
     services to such veteran.
       ``(3) For purposes of this subsection, a highly rural 
     veteran is one who--
       ``(A) resides in a location that is--
       ``(i) more than 60 miles driving distance from the nearest 
     Department health-care facility providing primary care 
     services, if the veteran is seeking such services;
       ``(ii) more than 120 miles driving distance from the 
     nearest Department health-care facility providing acute 
     hospital care, if the veteran is seeking such care; or
       ``(iii) more than 240 miles driving distance from the 
     nearest Department health-care facility providing tertiary 
     care, if the veteran is seeking such care; or
       ``(B) in the case of a veteran who resides in a location 
     less than the distance indicated in clause (i), (ii), or 
     (iii) of subparagraph (A), as applicable, experiences such 
     hardship or other difficulties in travel to the nearest 
     appropriate Department health-care facility that such travel 
     is not in the best interest of the veteran, as determined by 
     the Secretary pursuant to regulations prescribed for purposes 
     of this subsection.
       ``(4) For purposes of this subsection, a covered health 
     service is any hospital care, medical service, rehabilitative 
     service, or preventative health service authorized to be 
     provided by the Secretary under this chapter or any other 
     provision of law.
       ``(5) For purposes of this subsection, a health-care 
     provider is any qualified entity or individual furnishing a 
     covered health service.
       ``(6) In meeting the requirements of this subsection, the 
     Secretary shall develop the functional capability to provide 
     for the exchange of medical information between the 
     Department and non-Department health-care providers.
       ``(7) This subsection shall apply to covered health 
     services provided during the 3-year period beginning on the 
     120th day after the date of the enactment of this subsection.
       ``(8) Not later than the 30th day after the close of each 
     year of the period described in paragraph (7), the Secretary 
     shall submit a report to the Committees of Veterans' Affairs 
     of the House of Representatives and the Senate a report which 
     includes--
       ``(A) the Secretary's assessment of the program under this 
     subsection, including its cost, volume, quality, patient 
     satisfaction, benefit to veterans, and any other findings and 
     conclusions of the Secretary with respect to such program, 
     and
       ``(B) any recommendations that the Secretary may have for--
       ``(i) continuing the program,
       ``(ii) extending the program to other or all service 
     regions of the Department, and
       ``(iii) making the program permanent.''.
       (b) Effective Date.--The Secretary of Veterans Affairs 
     shall implement the amendment made by subsection (a) not 
     later than the 120th day after the date of the enactment of 
     this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Filner) and the gentleman from Kansas (Mr. Moran) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California.
  Mr. FILNER. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am glad my colleagues and I were able to work together 
to craft this important piece of legislation regarding our rural 
veterans. I want to thank the Subcommittee on Health chairman, Mr. 
Michaud of Maine, and Ranking Member Mr. Miller of Florida for the 
bipartisan leadership they demonstrated in working on this important 
bill. And, of course, the leadership on this bill has been for many 
years Mr. Moran of Kansas.
  As we all know, many rural veterans face significant challenges 
accessing veterans' health care services due to their geographical 
distance from VA facilities and limited transportation services. Some 
of these veterans must face commutes of several hours just to utilize 
some simple health care services.
  The Department of Veterans Affairs has acted to better provide health 
care service to rural veterans, and I appreciate the action they have 
taken in the past. However, more can and should be done to ensure that 
our rural veterans have adequate access to care for the services to 
which they are entitled.
  This bill, H.R. 1527, would supplement existing VA efforts by 
requiring the VA to conduct a 3-year demonstration project to allow 
rural veterans in four Veterans Integrated Service Networks to elect to 
receive covered services through non-VA providers. It would allow some 
rural veterans to receive health care locally, eliminating the 
frustration and hassle of a lengthy commute to the nearest VA medical 
center.
  So I urge my colleagues to support H.R. 1527.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MORAN of Kansas. Mr. Speaker, I rise in obvious support of H.R. 
1527, as amended, the Rural Veterans Access to Care Act. This is a 
piece of legislation that I have worked on for a number of years, and I 
am pleased that under the leadership of Mr. Filner and Mr. Buyer this 
bill is now on the House floor, and I am excited about the 
opportunities that it presents to better care for veterans who live in 
rural America.
  About 39 percent of our veterans enrolled in VA health care live in 
those rural areas. Many face challenges of accessing VA care because of 
the distances between where they live and where the facilities are 
located.
  We are making some progress in regard to rural veterans. In the last 
several years, we have approved an amendment that I have offered for a 
number of years increasing the veterans' mileage reimbursement rate 
from 11 cents per mile to 28.5 cents per mile. The fiscal year 2009 
Military Construction and

[[Page 18206]]

Veterans Affairs Appropriations bill that we passed earlier this year, 
back in July, would increase that from 28.5 cents to 40 cents per mile. 
So that's one step we have taken to help our rural veterans better 
access health care.
  Recently the VA established an Office of Rural Health and a Rural 
Health Advisory Committee to develop solutions to the challenges of 
providing health care to veterans living in rural America, and the VA 
continues to expand community-based outpatient clinics and will 
activate an additional 44 new clinics in the next 15 months, bringing 
the number of those clinics to more than 1,000. The VA has also 
increased the number of readjustment counseling service centers, the 
Vet Centers, nationwide with plans to open an additional 39 Vet Centers 
by the fall of 2009. In my home State of Kansas, we have opened an 
outpatient clinic this year in Hutchinson and opened a Vet Center in 
Manhattan, Kansas; so progress is being made.
  However, despite all those efforts, the reality is that many veterans 
live in remote areas of the country beyond the VA's ability to 
construct medical facilities to care for them. The congressional 
district that I represent in Kansas is an example of an instance where 
veterans experience great difficulty in traveling to VA facilities. My 
congressional district is more than the size of the State of Illinois. 
It has more hospitals than any other congressional district in the 
country but not one VA hospital. Some Kansas veterans are forced to 
travel up to 5 hours to a VA hospital for the care they need; and, 
unfortunately, more often than it should be, they simply forego that 
care altogether.
  H.R. 1527, as amended, would require the VA to conduct a 3-year 
demonstration project to allow highly rural veterans living in four 
VISNs, Veterans Integrated Service Networks, to receive the covered 
services through non-VA providers.
  This pilot will ask the VA to explore in several regions a practical 
approach when the VA care is not otherwise available close by. It would 
give those who live the farthest from VA facilities the choice to 
receive their care closer to home at the local hospital or the local 
physician's office.
  There are criteria by which a veteran must qualify to receive this 
kind of assistance. A veteran must live at least 60 miles from a VA 
clinic, 120 miles from a VA hospital, or 240 miles from a VA 
specialized care facility when they're seeking that kind of health 
care. To ensure the continuity of care, the legislation requires the VA 
to develop the functional capabilities to exchange veterans' medical 
information between the VA and non-VA providers in this pilot, and the 
VA will be required to report to Congress annually on the cost, upon 
the quality of care, and upon patient satisfaction.
  Forty-four percent of our military recruits are from rural areas, as 
are many Guards and Reserves that our Nation has increasingly called 
into service. This means that rural veterans are more likely to 
increase in number. Allowing the most underserved of these veterans to 
take advantage of the existing rural health care infrastructure is a 
commonsense approach. This is good for the veteran. It's good for the 
community. It's good for the health care provider. In many of the 
hospitals and clinics that I represent, in the communities that I 
represent, an additional patient is a very important thing. Hospitals 
in many instances are like schools. One more student matters to the 
viability of our school system just as one more patient matters to the 
viability of the private health care providers. We have approved this 
concept in our appropriation bill earlier this year. In July the VA 
military construction spending bill approved an additional $200 million 
to increase access to fee-based care for veterans in areas where the VA 
does not offer services. And with the high price of gasoline and its 
impact upon our rural veterans, it's even more important that this 
legislation pass.
  We must fully consider this practical reform for highly rural 
veterans living outside the VA's ability to care for them, and I urge 
my colleagues to support H.R. 1527.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FILNER. Mr. Speaker, I yield 2 minutes to the gentleman from 
Colorado (Mr. Salazar).
  Mr. SALAZAR. Thank you, Mr. Chairman, and thank you, Mr. Moran, the 
gentleman from Kansas.
  Today, Mr. Speaker, I rise to support H.R. 1527, the Rural Veterans 
Access to Care Act. I want to thank Congressman Moran for introducing 
this bill, and I want to thank him for being a champion for rural 
veterans. I have never once in my career here in Congress ever seen him 
make a veterans issue a partisan issue.
  I want to thank you for that.
  Mr. Speaker, I am proud to represent a district similar to Mr. 
Moran's to over 69,000 veterans. These are hardworking people who 
inspire future generations to serve our Nation. Many of our veterans 
live in rural and low-income communities. In big cities veterans are 
located closer together. In rural districts like mine, we have veterans 
that are spread out over a wide area. This makes it difficult for them 
to get the resources they need.
  The Rural Veterans Access to Care Act will allow highly rural 
veterans to see a non-VA health care provider. It establishes a 3-year 
pilot program. Part of it will be in Colorado as well. The pilot 
program is a great opportunity to see the potential impact of this 
program on the quality of veterans and the care for veterans. This bill 
is important because of unique travel challenges in rural areas. Long 
distances, dangerous terrain, unpredictable weather can make it very 
difficult to get to a VA facility.

                              {time}  1630

  H.R. 1527 will take the necessary steps to making health care more 
accessible to our Nation's rural veterans. I encourage my colleagues on 
both sides of the aisle to support our rural veterans, and support this 
bill.
  Thank you to the gentleman from Kansas (Mr. Moran) for allowing me to 
speak on this bill. Thank you, Mr. Chairman, for your bipartisan effort 
in trying to make sure that we address veterans' issues in a 
nonpartisan way.
  Mr. MORAN of Kansas. Mr. Speaker, I appreciate the comments from the 
gentleman from Colorado and acknowledge his tremendous efforts on 
behalf of veterans across the country, but especially those who live in 
rural America, and extend to him today my appreciation for his comments 
and his friendship.
  I yield 2 minutes to the gentleman from Montana (Mr. Rehberg).
  Mr. REHBERG. Thank you, Mr. Moran, for your leadership. I want to add 
my kudos. Whenever we talk about rural issues, it's the same people 
that usually stand up: Somebody from Colorado, South Dakota, Idaho, 
Montana, Wyoming, Kansas, and Nebraska. We have certain issues 
confronting us that other places do not.
  Let me real briefly describe my district to you. My district spans 
the distance of 147,000 square miles. The distance of my district is 
Washington, D.C. to Chicago, and I have 104,000 veterans living in that 
area. It's very difficult for them to access and, kid no one, we ration 
health care in the veterans' system. This is a perfect bill for showing 
what can be done if we would just use a little initiative within the 
United States Congress.
  Mr. Filner, thank you for bringing this forward. Everyone knows that 
nothing moves without the chairman's blessing, and we thank you for 
bringing this forward so we would have the opportunity to explain it a 
little bit.
  Montana is surrounded by some wonderful States, like Idaho and 
Wyoming and South Dakota, but when we have major medical, there are no 
facilities within those States, so we have to travel to Denver, Salt 
Lake City, Minneapolis, and Seattle. The distances are great, and 
usually the illnesses are so great, it's very difficult for our 
veterans to travel that distance.
  I want to take issue with one of the comments from CBO. They suggest 
that local health care providers would hesitate to invest in expanded 
facilities to accommodate veterans. Clearly, the

[[Page 18207]]

CBO does not understand the plight of rural health care because my 
rural health care providers are doing everything they can to keep their 
doors open in the first place because of a diminishing population; not 
a population of seniors or veterans, but a population of youth. And so 
the veterans and the seniors are staying in the community and it's 
going to be harder for my facilities to stay open.
  If these veterans are having to ride on buses for many, many miles to 
get to Fort Harrison, and I want to say I am not suggesting that we 
don't have tremendous veterans' health care in Montana. We do. We have 
Fort Harrison in Helena. But it's not adequate when it comes to the 
distances they are having to travel.
  Please support this bill. Thank you, Mr. Moran.
  Mr. FILNER. Mr. Speaker, I would like to yield such time as he may 
consume to our hardworking Chair of our Disability Assistance and 
Memorial Affairs Subcommittee, the gentleman from New York (Mr. Hall).
  Mr. HALL of New York. I rise today in strong support of H.R. 1527, 
the Rural Veterans Access to Care Act, and I would first like to take 
this opportunity to commend Congressman Moran for all of his work on 
this legislation. I used to live in Manhattan, New York, and I am glad 
that veterans from Manhattan, Kansas, and Manhattan, New York, will be 
served better by this Congress and by the VA.
  We can illustrate the fact that issues relating to veterans can, and 
should be, and I believe in this Congress and in this committee, are a 
truly bipartisan effort. I can't recall a single critical remark of 
this bill as it passed through the committee process, because it is 
truly a needed piece of legislation.
  Veterans have consistently been calling on the VA to develop a plan 
to address the needs of those veterans who live in rural areas at great 
distances away from the nearest VA hospital. When these brave men and 
women served our country honorably, they expected the same service in 
return once they retired. When they signed up, nowhere, at no time, did 
it say that they would get the health care they need only if they 
wanted to drive for hours and hours to get it.
  Moreover, with the recent increases in the cost of gasoline, travel 
for rural veterans is placing an even greater financial burden on them 
and their families. Hours of driving and a hefty gas bill is not the 
kind of treatment our veterans deserve for their selfless sacrifice to 
our Nation.
  I am confident that the pilot programs erected in H.R. 1527 will 
begin to bring relief to our veterans who live at great distances from 
the nearest VA hospital. It is our duty to reward the veterans of our 
Nation with this treatment befitting their sacrifice. I believe this 
bill takes the necessary steps to do just that, and I urge my 
colleagues to support this bill.
  Mr. MORAN of Kansas. I continue to reserve the balance of my time.
  Mr. FILNER. Mr. Speaker, I would yield such time as he may consume to 
our great new Member, who worked on these issues for many years, not 
only as a Congressman, but as a staff member for Mr. Lane Evans, our 
former ranking member, the gentleman from Illinois (Mr. Hare).
  Mr. HARE. I thank the chairman for his kind words. I rise in strong 
support of H.R. 1527, the Rural Veterans Access to Care Act, and I want 
to commend my friend, Representative Jerry Moran, for his outstanding 
leadership on this issue.
  I represent a district in Illinois that is very rural. I hear often 
not only from the veterans but also from the critical access hospitals 
in my district about the frustrations that they feel from the inability 
to access or provide the care that our veterans so desperately need. We 
often see our disabled and elderly veterans driving hundreds of miles 
to the nearest VA facilities in Freeport, Illinois, or Bettendorf, 
Iowa, some of them having to wait 6 hours just to be seen.
  To highlight this point, I recently received a phone call from 
Illinois State Senator Deanna Demuzio of Carlinville, Illinois, in the 
southern part of my district. She expressed a tremendous amount of 
frustration and concern at the fact that one of her constituents, a 
World War II veteran, was told by the VA that he had to drive 200 miles 
to get a simple chest x-ray. Like Senator Demuzio, I feel that it just 
doesn't make sense for anyone to drive 200 miles for an x-ray, one they 
can get locally.
  I have been working with the VA, Chairman Filner, Ranking Member 
Buyer, and the appropriators, to authorize the community-based 
outpatient clinic in Whiteside County in my district to address the 
hardships that veterans face from the distances they have to travel to 
access health care. Until that happens, I believe this bill will 
provide the data we need to best serve our rural veterans while also 
paying attention to the quality of care our veterans receive, and the 
VA patient enrollment numbers.
  Specifically, H.R. 1527 requires the Secretary to conduct a pilot 
program in four Veteran Integrated Service Networks that would allow 
the ``highly rural'' veteran to elect to receive covered health 
services through a non-VA health care provider. Many of the veterans of 
my district fit under the ``highly rural'' definition, and I am very 
proud to be a cosponsor of this legislation.
  Again, I want to thank Senator Demuzio for her help and support, and 
to my friend Congressman Jerry Moran for introducing this incredibly 
wonderful piece of legislation. I believe this information we gather 
from the pilot program will go a long way in helping our veterans 
access health care.
  Mr. Speaker, I urge all my colleagues to support this legislation.
  Mr. MORAN of Kansas. I ask the gentleman from California if he has 
other speakers.
  Mr. FILNER. Mr. Speaker, I yield 3 minutes to the distinguished 
gentleman from Texas (Mr. Rodriguez).
  Mr. RODRIGUEZ. It is with great pleasure that I rise today in strong 
support of H.R. 1527, the Rural Veterans Access to Care Act. This 
bipartisan legislation, which I have cosponsored, is something that the 
veterans of my district have been seeking for some time.
  This bill is in no way an indictment of the services of the VA 
facilities. Rather, it acknowledges that even health care networks as 
far-reaching as the VA can meet the needs of our veterans. This bill 
will provide the rural veterans from the western rural portions of my 
district the ability to seek health care in their communities rather 
than having to travel hundreds of miles to El Paso and sometimes even 
Albuquerque, although, as a pilot program, I am confident that the 
merits of bringing care closer to the veterans will prove to be 
revolutionary in the way that this Nation cares for its servicemembers 
and will be adopted nationwide.
  I am pleased with the definition in the bill of ``highly rural 
veterans'' as one who resides in a location that is more than 60 miles 
driving distance from the nearest Department health care facilities 
providing primary care services, more than 120 miles for acute hospital 
care, and more than 240 miles for tertiary care.
  Many of the veterans who reside in the 20 counties that I represent 
fall into this category. The Audie Murphy Hospital in San Antonio and 
the Brooke Army Medical Center in San Antonio serve a large portion of 
my district's veteran community. About 600 miles to the northwest to 
the opposite end of my district is the El Paso VA Clinic and the 
William Beaumont Army Medical Center that serves a portion of the 
western part of Texas.
  They provide quality health care for our veterans. However, neither 
the Audie Murphy VA, nor the El Paso VA Clinic, are within my district. 
As a matter of fact, my district has no VA facilities at all, and it's 
one of the largest in the Nation. It spans 785 miles to the Mexican 
border, 650 miles straight from San Antonio to El Paso. Needless to 
say, extending current services into these areas are essential. This 
bill will allow that opportunity to make it happen.

[[Page 18208]]

  I want to thank Chairman Bob Filner, and I seriously mean this 
sincerely. I spent 8 years on this committee and we have been trying to 
get these types of pieces of legislation out. I want to thank him for 
his leadership and allowing us to be able to make this happen.
  So I strongly urge my colleagues to vote in favor of H.R. 1527, to 
allow rural American veterans to be able to have access to health care 
in this country. Thank you very much.
  Mr. MORAN of Kansas. Mr. Speaker, I am prepared to close and then 
yield the balance of my time, if the gentleman from California has no 
other speakers
  Mr. FILNER. I would yield 2 minutes to the gentleman from Texas (Mr. 
Al Green).
  Mr. AL GREEN of Texas. Thank you, Chairman Filner, and thank you, 
Congressman Moran. I live in Houston, Texas. I live across the street 
from the DeBakey Medical Center. My district is such that you can 
traverse it in 1 hour. But this is America that we are talking about, 
not just the cities, not just the rural areas. All veterans in America 
ought to have access to a facility, and they ought to have immediate 
access. It is not enough for me to have the DeBakey Center in my 
district and have other veterans who have to travel 5 hours to receive 
medical attention.
  I am here to ask my colleagues to please, let's support veterans. 
What we do today will say to them what we think about the work they 
have done for us. If they can be there for us, willing to sacrifice 
their lives, we can be there for them to make sure that they have a 
good quality of life when they return home to the United States of 
America.
  Mr. FILNER. Will the gentleman yield?
  Mr. AL GREEN of Texas. Yes, sir.
  Mr. FILNER. I just want to thank you not only for speaking out for 
rural veterans who, as you said, are not in your district, but in your 
State and in our Nation. But your bill that expanded opportunities for 
affordable housing for our veterans was also a great step forward, and 
we greatly admire your work here, although you've only been here a 
short time. Thank you so much.
  I yield back.
  Mr. AL GREEN of Texas. I thank you. I am so honored, sir, that you 
gave me this opportunity to have a word on this most important piece of 
legislation. It really is something that we must do for our veterans. I 
thank you, and may God bless you.
  Mr. MORAN of Kansas. Is the gentleman from California prepared to 
close?
  Mr. FILNER. Yes.
  Mr. MORAN of Kansas. Mr. Speaker, first of all, let me thank the 
gentleman from Texas (Mr. Al Green) for his comments, his ecumenical 
attitude, and his understanding for the needs for all American 
veterans, and I am hopeful that that is demonstrated today by all 
Members of the House as we approve this legislation.
  Let me also take this moment to thank all of the employees, the 
staff, the medical providers within the VA system in Kansas and across 
the country who work hard on a daily basis to make certain that our 
veterans are cared for and also for all those who have volunteered 
their time, their automobiles, their days, and their driving skills, as 
we have had many veterans who have helped other veterans get to a 
medical facility, often miles and distance away.

                              {time}  1645

  These kinds of volunteer activities have been important and it is a 
way that some veterans have been able to access health care. But this 
legislation takes us in a very positive step, one that we have worked 
on for a long time to achieve, and I am very pleased by the efforts 
that we see, the culmination of those efforts that we see today.
  Finally, let me thank the staff of the Veterans' Committee, both the 
minority and majority. I appreciate the approach and attitude, the 
diligence with which we have addressed this legislation. It has had its 
false starts as recently as a month ago. I am very grateful for the 
efforts that all made to make certain that this legislation is before 
us today, and in particular I thank the gentleman from California, Mr. 
Filner, who gave me his word back in early August that this legislation 
would be on the House floor this week, and I very much appreciate Mr. 
Filner's efforts.
  With that, Mr. Speaker, I support this legislation and appreciate the 
consequences that arise from its passage.
  Mr. Speaker, I yield back the balance of my time.
  Mr. FILNER. Mr. Speaker, I yield myself the balance of my time.
  Again, I want to thank Mr. Moran for his leadership over so many 
years on these issues and I just want to make a couple of points in 
closing.
  Next year when we come back, Mr. Moran, I hope that we could even 
refine what you have done here a little further. You have made a very 
important leap forward in dealing with our rural veterans, and you have 
used the mileage as the distinguishing characteristic.
  In part of my district, for example, in Imperial County, California, 
our veterans are within probably this 120 miles, and yet it is not just 
the distance, it is the isolation. There is a mountain between two 
counties in my district. It is not easy to cross over that. So the 
mileage is not just the only factor. We have got to get some measure of 
isolation, I would think.
  In addition, that county is a very poor county. Many of our veterans 
do not even have cars. They have to rely on what you so appropriately 
mentioned, and that is the volunteer efforts of some van drivers. But 
they are not always there, and they are not always on the day that is 
needed. So, without cars and being particularly isolated, I think we 
have to refine that definition of the highly rural veteran.
  Let me make just one more point. What you have done here, Mr. Moran, 
is very specifically designate criteria for which people are eligible 
to go outside the VA system. I think you have done that very 
appropriately, and we have been fighting for that for many years.
  The Presidential candidate on the Republican side, Mr. McCain, takes 
that too many steps further. He has advocated a credit card for every 
veteran to use in any facility. I think that is the wrong approach.
  I had the honor over the last month, Mr. Speaker, of going to the 
national conventions of the Disabled American Veterans, of the American 
Legion, of the Jewish War Veterans, of the Military Order of the Purple 
Heart; and I would say unanimously they objected to this so-called 
credit card for veterans. It supposedly is to increase access, but I 
think its effect would be to undermine the whole VA health care system.
  So while we can I think make sure that access is guaranteed for 
people in some very specific situations, like the bill that Mr. Moran 
has before us, I think we have to keep the integrity of the VA system 
by not allowing that credit card proposal of Mr. McCain to go forward.
  Having said that, Mr. Speaker, I would ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and include extraneous material on H.R. 1527, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. FILNER. I urge my colleagues to unanimously support Mr. Moran's 
bill, H.R. 1527, as amended, as a great step forward for our country's 
heroes.
  Mr. BUYER. Mr. Speaker, I rise in support of H.R. 1527, as amended, 
the Rural Veterans Access to Care Act.
  I also want to thank my colleague, Jerry Moran, for his efforts and 
work on this very important bill he introduced to improve access to 
care for veterans living in highly rural areas. Veterans in rural areas 
are challenged by long commutes to VA facilities, and the limited 
number of providers in rural areas.
  H.R. 1527 as amended would require VA to conduct a three year 
demonstration project to allow highly rural veterans in four Veterans 
Integrated Service Networks (VISNs) with large rural populations to 
receive covered services through non-VA providers. It would give those

[[Page 18209]]

who live the furthest from VA facilities the choice to receive care 
closer to home at a local hospital or physician's office. To qualify, a 
veteran must live at least 60 miles from a VA clinic, 120 miles from a 
VA hospital or 240 miles from a VA specialized care facility when 
seeking that care. To ensure continuity of care, the legislation would 
require VA to develop the functional capability to exchange veterans' 
medical information between VA and non-VA providers in the pilot. The 
VA will be required to annually report to Congress on cost, quality, 
and patient satisfaction.
  I urge my colleagues to support H.R. 1527.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I stand in support of our 
veterans and in support of H.R. 1527, the Rural Veterans Access to Care 
Act by my colleague from Kansas, Representative Jerry Moran and the 
Members of the Veterans' Affairs Committee.
  Ladies and gentlemen, as we come upon the anniversary II of that 
fateful day in September this Thursday, it is important to remember our 
men and women currently serving and our veterans who have returned 
home.


                               WAR COSTS

  Since the terrorist attacks of September 11, 2001, the United States 
has initiated three military operations:
  Operation Enduring Freedom (OEF) covering Afghanistan and other 
Global War on Terror (GWOT) operations ranging from the Philippines to 
Djibouti that began immediately after the 9/11 attacks and continues;
  Operation Noble Eagle (ONE) providing enhanced security for U.S. 
military bases and other homeland security that was launched in 
response to the attacks and continues at a modest level; and
  Operation Iraqi Freedom (OIF) that began in the fall of 2002 with the 
buildup of troops for the March 2003 invasion of Iraq and continues 
with counter-insurgency and stability operations.
  According to CRS estimates, with enactment of the FY2008 Supplemental 
and FY2009 Bridge Fund on June 30, 2008, a total of about $859 billion 
has been approved for military operations, base security, 
reconstruction, foreign aid, embassy costs, and veterans' health care 
for the three operations initiated since the 9/11 attacks.
  This $859 billion total covers all war-related appropriations from 
FY2001 through part of FY2009 in supplementals, regular appropriations, 
and continuing resolutions.
  Of that total, CRS estimates that Iraq will receive about $653 
billion (76 percent), OEF about $172 billion (20 percent), and enhanced 
base security about $28 billion (3 percent), with about $5 billion that 
CRS cannot allocate (1 percent) or readily determine where it was 
allocated.
  As of April 2008, DOD's monthly obligations for contracts and pay 
averaged about $12.1 billion, including $9.8 billion for Iraq, and $2.3 
billion for Afghanistan.
  The recently enacted FY2008 Supplemental (H.R. 2642/P.L. 110-252) 
includes a total of about $160 billion for war costs for the Department 
of Defense (DOD), State/USAID and Veterans Administration medical 
programs for the rest of FY2008 and part of FY2009.
  In February 2008, the Congressional Budget Office projected that 
additional war costs from FY2009 through FY2018 could range from $440 
billion, if troop levels fell to 30,000 by 2010, $1.0 trillion, if 
troop levels fell to 75,000 by about 2013. Under these scenarios, CBO 
projects that funding for Iraq, Afghanistan and the GWOT could reach 
from about $1.1 trillion to about $1.7 trillon for FY2001-FY2018.
  As of August 2008 in the Marine Corps alone we have lost over 1,060 
young men and women give the ultimate sacrifice for our country, (OIF 
1,001 and OEF 59). This does not even include our men and women in the 
Army, Air Force, Coast Guard, and National Guard.
  With all that we are spending to send our armed forces overseas, we 
need to be keeping in mind what they will need when they return.


                               HEALTHCARE

  It is our duty to take care of those who have risked life and limb to 
secure our freedom and the freedom of others around the world. The 
World Health Organization ranked the U.S. health care system 37th in 
the world for quality and 55th for fairness. We are the only 
industrialized country that does not have universal health care.
  That is why I have supported Congressman John Conyer's Universal 
Healthcare legislation (H.R. 676). We need all Americans--parents, 
children, veterans--to receive healthcare. H.R. 1527 ensures this kind 
of access to care for our Rural Veteran's and I can only hope that we 
continue to look at this type of legislation for everyone in this great 
Nation.


                             TEXAS Veterans

  In Texas, we have the Texas Veterans Commission (TVC) that was 
created in 1927. We have 9 medical centers and two regional centers 
with one in my great city of Houston, TX and one in Waco, TX. The Waco 
Regional Office serves over 942,000 veterans, as well as their family 
members, in the 164-county area that comprises the northern two-thirds 
of Texas. Each year, they process more than $1.9 billion in VA benefit 
payments are issued to Texas veterans.
  This is why I fought to get $1 million to Riverside Hospital in 
Houston to help our veteran's with their health care and their mental 
health issues. At this historic African-American hospital they work 
with our veteran's and assist with care for Post-traumatic stress 
disorder (PTSD).
  Our Veteran's in our urban and rural areas deserve the best care we 
can give. We should not hesitate to care for the men and women who 
fought so courageously for us.


                               CONCLUSION

  We are facing rising food, gas, and energy costs. Our housing markets 
are still reeling and we are at high levels of unemployment. We must 
ensure that the Securities markets are secure and able to withstand our 
current economic climate. Mr. Speaker, I urge my colleagues to support 
this important legislation.
  Mr. FILNER. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from California (Mr. Filner) that the House suspend the rules 
and pass the bill, H.R. 1527, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. FILNER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

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