Veterans Health Care

Floor Speech

Mr. President, I rise to speak today on behalf of our veterans. I am here to speak about both challenge and opportunity. The challenge is the problems we face with our Veterans' Administration, which is that we are not getting the care for our veterans that they need and that we all want them to have and that they so very much deserve.

We also have a real opportunity because we have been working on legislation. We have legislation on the Republican side in the Senate and on the Democratic side, and now we are working to bring those two pieces of legislation together. So I think this creates a real opportunity, and it is a vitally important opportunity--one that we grab and that we address on behalf of our veterans. We need to make sure we come together on bipartisan legislation that fixes the Veterans' Administration health care system, and it takes care of our veterans.

I believe the solution, the real key to solving the problem, is choice--or another way to put it might be access to health care. I think that not only solves the problems we have seen with the wait lists but also the problem of distance, which is also an issue, and it is a challenge we see in States such as my own. For example, in our State the issue truly is distance. In other places it is access to health care. We know, for example, in places such as Phoenix, veterans were put on wait lists and in that way denied access to care. That is absolutely unacceptable--absolutely unacceptable.

I think the Veterans Choice Act, which I am pleased to cosponsor with a number of my fellow colleagues, solves that problem, and it solves not only the access and the wait list problem but also, as I have said, the distance problem essentially by providing choice, meaning that if a vet can't get access to a veterans health care facility, then the veteran can go to another health care provider. I believe that works for the vet and it works for the health care provider. The veteran can go to a hospital or a clinic that has the service he or she needs if he can't get into the VA facility in a timely way, and then that hospital or clinic is reimbursed just as if it were for a Medicare patient. Clearly, our health care system has the facilities in place, the resources to handle that type of reimbursement just as they do for Medicare patients.

Now I wish to speak about the distance issue for just a minute because in North Dakota the distance issue is the one we face. For example, in North Dakota it is about 800 miles round trip from Williston to the VA health care system in Fargo. Some services, as we all know, are provided by CBOCs--community-based operating clinics--and we have those around the State. But where we don't have CBOCs or where they are not able to get the service they need from that CBOC or walk-in clinic, then it can be an 800-mile trip to get services.

Not too long ago I held an open forum in Williston, ND, which, as many people know, is the site of an incredible energy boon, the Williston Basin. Now in North Dakota we produce about 1 million barrels of oil a day--second only to the State of Texas. So we have a tremendous number of people moving into this region. We are the fastest growing State in the Nation. We have veterans there who are driving long distances to get medical services. So this is a different challenge than we faced in some of the centers such as Phoenix where they were waiting to get patient care. In our case they are having to drive long distances--as I said, 800 miles round trip to Williston; 400 miles to Fargo and then 400 miles back.

I recently held a forum up in Williston to discuss this issue and look for solutions on behalf of our veterans. I met with our veterans, I met with veterans service officers, as well as health care providers from the region. I talked to two vets who told me their story about trying to get health care. We have a walk-in clinic, a CBOC--community-based operating clinic--in Williston. There were two cases where veterans needed some health care services. In one case, because they couldn't--the first veteran couldn't get it at the local CBOC, that individual took a day to drive to Fargo, which is 400 miles, stayed in a hotel, the next day went in and got those services, stayed in a hotel that night, and then drove back the third day. So he had to take 3 days off of work to get services. He had to drive 800 miles round trip. He had to be put up in a hotel for 2 nights. Now, all of that is reimbursed, as far as the travel in the State, by the VA. So for a relatively straightforward procedure, the VA paid a lot more and inconvenienced that veteran terribly and cost him money because that individual had to take 3 days off from work. That doesn't make any sense.

In the second case, a veteran in a similar situation wanted to get the service at the local CBOC, wasn't able to do that, but instead of driving all the way to Fargo and doing what the first veteran did, the second individual just went into the local clinic or hospital in Williston and got the service that afternoon. Unfortunately, the second veteran is still trying to get reimbursement out of the VA for that procedure.

The individual in the second case did not have to take 3 days off from work, which is smart and, frankly, saved the VA a lot of money because it was not a case where you had to drive down, get reimbursed for that stay with over two

nights in a hotel, and then drive back. So it actually saved the VA money. But still they have not gotten a reimbursement for the cost of that medical treatment because the VA does provide that service in Fargo. But again, in that situation, unless that veteran is reimbursed, you are not truly serving the veteran and, frankly, not doing the sensible thing to save the taxpayer money.
That is why the Veterans Choice Act that I am cosponsoring with others, again, is the solution because we provide choice, we provide access. If the veteran cannot get that service in a timely way in the local community, then the veteran can access another health care facility. That is why the legislation works.

So what I have offered--and, of course, now we are working on bringing two bills together: the Veterans Choice Act, but then also legislation offered by Senator Bernie Sanders; and that legislation is the Ensuring Veterans Access to Care Act.

I think we can bring them together, and I think we can get a good solution that serves everybody, most importantly that serves our veterans. But we need to serve all of our veterans--all of our veterans--regardless of where they live. That is why I have offered simple, clarifying language--this is a technical fix--that would clarify and ensure that if a veteran cannot get service in a CBOC, then that veteran can go to a local health care provider on the same basis as an individual who lives more than 40 miles away from the walk-in clinic.

This legislation, this clarification is important to ensure that a veteran is not in any way actually disadvantaged by having a walk-in clinic in the local community, and that all vets can access services on the same basis. Again, it is because of the way this legislation is coming together that requires that if you are within 40 miles of a walk-in clinic or you have to wait more than 14 days, then you can go to another health care provider. But if either one of those criteria apply--you are within the 40-mile radius and you can get an appointment within 14 days to see a doctor--then you have to go to the VA. That works, and that is consistent only if you applied both criteria to the same clinic, to the same health care center.

What I mean is this. Remember the example I gave just a minute ago: Williston, ND, and Fargo, ND. In Williston you have a walk-in clinic. In Fargo you have a full hospital--a full VA medical center. Take the test we are applying in this legislation: If you are within 40 miles, you have to go to the VA facility, as long as you can get in within 14 days. But that 14 days has to also apply to the facility that is within that 40-mile radius; otherwise, you get an inconsistent, unfair result and actually disadvantage somebody who is within 40 miles of a walk-in clinic versus somebody who is outside that radius.

Let me give two examples to illuminate what I am saying.

You have a vet. He lives in Williston, ND. He is within 40 miles of that facility. He goes in, and he gets his shots or whatever it is in that facility--no problem. But what happens if he cannot, if that walk-in clinic does not supply the service? What does he do? Well, if the 14-day rule applies to the Fargo VA hospital, even though he is within 40 miles of the CBOC, if the CBOC--the walk-in clinic--does not provide that service, he still has to drive 800 miles roundtrip for that shot I just talked about a minute ago or that service--the two veterans I described a minute ago. So he still has to travel 800 miles to get service.

Take another individual. He lives 41 miles from that walk-in clinic. Even if the Fargo VA can take him within 14 days, he can still go get local service in Williston, can't he? Why? Because he is 41 miles away. So ask yourself, the veteran who lives within 39 miles of that walk-in clinic, he might have to drive 800 miles roundtrip to get a service that the individual who is 41 miles from that facility can go get in the local community.

Does that make sense? That is the kind of thing we have to make sure we get right so that all veterans, regardless of where they live, get the same fair and consistent treatment. That is why I am saying, as we put this legislation together, we have to be careful to make sure we get that kind of fair and consistent result so this legislation serves all of our veterans and takes care of all of our veterans, and they truly all have that access. Whether the problem is a wait list or long distances, let's make sure this works for all of them.

Believe me, they are out there. Every one of them has put their life on the line and stepped up. All of them have done that for us. Let's make sure, as we work through and file this legislation--something I know we can do; on a bipartisan basis we can get this done--let's make sure it works for all of our veterans and it works well and it works consistently and it truly solves the problem; that is, we make sure they get the health care they deserve.

I thank the Presiding Officer.

With that, I yield the floor.

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