Congressional Record Statement of Senator Daniel K. Akaka

Mr. President, I am today introducing legislation to make various improvements to VA rural health care. I am pleased to be joined in this effort by Senators Max Baucus and Mark Begich. The legislation is designed to bring more doctors into small communities; promote the use of volunteer counselors to help with mental health issues; expand telemedicine services; and create incentives for VA's community partners to provide high quality services to veterans.

As the drawdown of forces in Iraq begins, VA must be prepared to meet the health care needs of veterans upon their return.

Many veterans live in small towns and communities. This includes a large number of Guard members and Reservists who have served in such an integral role in Iraq and Afghanistan. Members of the Guard and Reserve face challenges that are different than those faced by their active duty counterparts, who return to military bases with the support of their unit and programs geared toward re-acclimating them to life outside of the combat zone. When members of the Guard or Reserves return home, they often are isolated from their units, leaving them to reintegrate back into their communities without a strong VA or DoD presence or support system.

When health care is needed, a rural community may not have providers who offer mental health services, such as group counseling, and may not be familiar with treating combat-related disorders.

I believe strongly that there is an obligation to care for all veterans in need, regardless of where they live. We must ensure that adequate resources are available to serve those who live in rural communities, and that VA works closely with local health care providers to help meet the need for care. It is critical that VA reach out to veterans living in rural communities so that they receive the care they need. Every resource must be united in the effort to care for wounded warriors, whether in a community hospital or VA clinic. When there is no VA presence in a community, VA may need to pay community providers for the reasonable costs of care.

Last month, the Committee on Veterans' Affairs held a hearing on health care for veterans in rural areas. We heard from the chief executive officer of a community hospital, from a former director of a rural health clinic, and from outreach organizations who work to bridge the gap between VA and community health care systems. These witnesses testified about how hard it is for veterans who live in rural areas to find health care in the communities where they live, and about how difficult it is for community hospitals and clinics to provide quality services with the limited resources available to them.

Committee on Veterans' Affairs staff also conducted an oversight visit to Hawaii and saw firsthand the needs of veterans living in rural communities on the neighbor islands. Many of those veterans find it hard to access VA health care because of travel restrictions and a shortage of services in their communities. Committee staff found that technology was not being used to bridge this gap; indeed, the use of telemedicine is actually declining in Hawaii.

The legislation we are introducing today would help address the needs of veterans living in rural communities in a number of ways.

First, the bill would bring more doctors to targeted communities by repaying their student loans while they work for VA. Currently, VA's loan repayment program is capped at an amount that is less than 1/3 the average cost of medical school. This bill would remove the cap, allowing VA to offer full loan repayment so as to provide a much more effective recruitment tool.

In addition, this bill would encourage VA and HHS to use the National Health Service Corps Scholarship Program to recruit physicians for VA facilities located in underserved areas. The National Health Service Corps pays for medical school up front in exchange for a doctor's agreement to work in an underserved area after graduation.

To address the shortage of mental health providers in many communities, this legislation would also allow VA to shorten the credentialing and privileging process for licensed volunteer counselors who could provide mental health services to our veterans.

The legislation would also create a pilot program to place VA doctors in community hospitals so as to enable them to provide more continuous care for veterans. Under this pilot, VA doctors working in communities without a VA hospital would be able to follow their patients when admitted to the local hospital. Participating VA doctors would earn additional compensation for assuming these responsibilities, thereby creating financial incentives for doctors to stay within VA. Since many non-VA hospitals do not have mental health providers or other providers experienced in the treatment of conditions such as post-traumatic stress disorder that disproportionately affect veterans, this would also bring needed expertise into other care communities.

This bill would also allow VA to monitor the quality of care provided in non-VA facilities. Currently, there is no way for VA to do such quality assurance in a systematic way. This bill would encourage VA's community partners to participate in quality programs like peer review, or to seek accreditation by an outside organization.

This bill also would bring new technologies to rural communities. By modifying VA's internal mechanism for distributing funds, the legislation would provide incentives for VA hospitals and clinics to use telehealth technologies. VA currently bases the distribution of funds to its facilities on workload and does not currently count all telehealth visits in a facility's workload. By requiring VA to give hospitals and clinics credit for telehealth visits, this bill will promote the natural expansion of these services to our veterans.

Finally, for those veterans who must travel by air to obtain their health care--because of their health status, geography or other barriers--this bill would allow VA to pay beneficiary travel benefits for airfare to those veterans who cannot afford it. In recognition of the cost of airfare, a different income eligibility standard from that used for ground transportation would be used in connection with reimbursement of the costs of air travel.

I urge our colleagues to work with me and the other members of the Veterans' Affairs Committee to improve access to health care for veterans who live in rural areas.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

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March 30, 2009