Improving health care access for rural veterans
By U.S. Sen. Susan M. Collins
(R-Maine)
Increased access to health care for our veterans, especially those in rural areas, must be among our nation’s priorities. The men and women who have served America deserve no less, regardless of where in America they live.
We have made significant progress, and Maine has led the way. Twenty-eight years ago, Caribou was the proving ground upon which the Department of Veterans Affairs has built a nationwide system of Community-Based Outpatient Clinics to provide primary care close to home. More recently, Northern Maine was selected by the VA as one of five pilot sites for the Access Received Closer to Home, or ARCH, program. The program allows veterans to seek VA-covered services through providers outside of the VA network if they have to wait more than two weeks for an appointment or if travel to a VA center would be too long, burdensome, or detrimental to their health.
Congress took another important step forward last year by passing legislation to create the Veterans Choice program. Established in response to the nationwide crisis of veterans’ access to care and building on the success of ARCH, this program allows veterans who live more than 40 miles from the closest VA facility, or who face a significant delay in scheduling an appointment, to access non-VA care.
Unfortunately, the VA has yet to implement Veterans Choice as it was envisioned by Congress. Since November 1, 2014, the Choice Card, which enables veterans to obtain care outside of a VA facility if the distance and time criteria are met, has been distributed to approximately 8.5 million veterans nationwide, yet far less than one percent of card recipients – 0.37 percent – have been authorized to access non-VA care through this program. This extremely low approval rate is occurring because the VA is interpreting the 40-mile rule so narrowly that it is excluding many veterans who are far away from the care that they need.
The VA’s definition of the eligibility criteria is too narrow in two important respects. First, the VA does not consider the type of care available within 40 miles of where a veteran lives. In many areas across the nation, the effect is that those who need services only available at a VA medical center, such as Togus, but who live near a Community-Based Outpatient Clinic, are prevented from using the Choice Card to access specialty care in their local community. While the Clinic may be within 40 miles, the VA hospital offering the required care is often much farther and many hours of travel time away.
Second, the VA measures the 40 miles “as the crow flies” and not the actual distance that the veteran would have to travel. That is an unrealistic, even absurd, interpretation of a key provision of our legislation. Congress’ intent was to establish a program that would allow veterans to access non-VA care when they face an obstacle to care. It is unacceptable for VA to be creating new obstacles with an interpretation of the law that defies common sense.
It also is dismaying that, according to the President’s 2016 Budget Request, the VA intends to submit a legislative proposal that would reallocate part of the funding for the Veterans Choice Program to other programs within the VA. It is deeply disturbing that the Administration would try to reduce funding for this program before it has even been allowed to work – being in existence for only a few short months – and as barriers to care continue to exist. The VA should make certain that funding provided by Congress is being used to implement the Veterans Choice Program to the fullest extent possible.
I recently led a bipartisan group of my Senate colleagues in urging Veterans Affairs Secretary Robert McDonald to use his authority to change immediately the way that the distance criterion is calculated so that the Choice Program is implemented as Congress intended. We also called upon the Secretary to stop any attempt to propose a reallocation of funds designed to kill the Choice Card program in its infancy.
In addition, Senator Angus King and I have introduced bipartisan legislation that would correct by force of law the VA’s flawed interpretation by stipulating that the 40-mile rule must be based upon driving distance. Our bill also makes clear that the distance measured must be to a VA facility that offers the precise health care services the veteran requires.
Maine veterans often face barriers to accessing care, including long drives in dangerous winter weather. The VA should have implemented the Choice Program as Congress intended, which was to allow veterans to seek care within their local communities if the VA cannot provide the services they need within 40 miles. Our veterans have sacrificed so much for our country. We owe them all that we can do to ensure they receive the best care possible as conveniently as possible.
