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Mr. Andy Behrman

Mr. Andy Behrman, National Rural Health Association, Chair, Rural Health Policy Board

It is my distinct pleasure to submit my comments for the record in regard to H.R. 2005, the Rural Veterans Health Care Improvement Act of 2007.  As the Rural Health Policy Board Chair for the National Rural Health Association (NRHA), and as a veteran, I have long been an advocate for appropriate change and improvement to our VA healthcare delivery system.  It is a priority for me and a priority for the NRHA.

The NRHA is a national nonprofit, non partisan, membership organization whose mission is to improve the health of rural Americans and to provide leadership on rural health issues. The members of the NRHA have long maintained concern for the health and mental health care needs of rural veterans. 

The members of the National Rural Health Association (NRHA) have maintained a special concern for the health and mental health care needs of rural veterans for many years.  NRHA was one of the first non-veteran service organizations to develop a policy statement on rural veterans and this policy work is evidence of our memberships’ concern for rural veterans.

Since our nation’s founding, rural Americans have always responded when our nation has gone to war.  Whether motivated by their values, patriotism, or economic concerns, the picture has not changed much in 230 years.  Simply put, rural Americans serve at rates higher than their proportion of the population.  Though only 19% of the nation lives in rural areas, 44% of U.S. Military recruits are from rural America.  And nearly one-third of those who died in Iraq are from small towns and communities across the nation.

There is a national misconception that all veterans have access to comprehensive care.   Unfortunately, this is simply not true.  Access to the most basic primary care is often difficult in rural America.  Combat veterans returning to their rural homes in need of specialized care due to war injuries (both physical and mental) likely will find access to that care extremely limited.  What this means, is that because there is a disproportionate number of rural Americans serving in the military, there is a disproportionate need for veteran’s care in rural areas.

Additionally, we must all be mindful of long-term needs. While the NRHA is pleased that both the House and Senate FY 2008 budgets call for greater increases in VA medical care spending than in past years, long-term health care planning is critical.  The wounded veterans who return today won’t need care for just the next few fiscal years, they will need care for the next half century.

In my testimony to the committee on April 18, 2007, I presented recommendations that NRHA believes to be prudent in terms of developing a new approach to serving our rural veterans. These recommendations include:

  1. Increasing Access by Building on Current Successes

Community Based Outreach Centers (CBOCs) open the door for many veterans to obtain primary care services within their home community.  Additionally, Outreach Health Centers meet the needs of many rural veterans.  NRHA applauds the success of these programs and supports their expansion.

  1. Increasing Access By Collaborating with Non-VHA Facilities

Many rural veterans cannot access VHA care simply because VHA facilities are too far away.  Linking the quality of VA services with rural civilian services can vastly improve access to health care for rural veterans.  As long as quality standards of care and evidence-based medicine guide treatment for rural veterans, the NRHA supports collaboration with:

  • Federally Qualified Community Health Centers.  These centers serve millions of rural Americans and provide community-oriented, primary and preventive health care.  And, most importantly, are located where rural veterans live.  A limited number of collaborations between the VHA and Community Health Clinics already exist and have proven to be prudent and cost-effective solutions to serving eligible veterans in remote areas.  These successful models should be expanded to reach all of rural America.
  • Critical Access Hospitals.  These facilities provide comprehensive and essential services to rural communities and are specific to rural states.   If these facilities are linked with VA services and models of quality, access to care would be greatly enhanced for thousands of rural veterans.
  •   Rural Health Clinics.  These clinics serve populations in rural, medically-underserved areas.  In many rural and frontier communities, these clinics are the only source of primary care available.
  1. Increasing Traumatic Brain Injury Care

Currently, it appears that Traumatic Brain Injury (TBI) will most likely become the signature wound of the Afghanistan and Iraqi wars.  Such wounds require highly specialized care.  The current VHA TBI Case Managers Network is vital, but access to it is extremely limited for rural veterans -- expansion is needed.

  1. Targeting Care to Rural Veterans
  1. Needs of the Rural FamilyRural veterans have an especially strong bond with their families.  Returning veterans adjusting to disabilities and the stresses of combat need the security and support of their families in making their transitions back into civilian life.  The Vet Centers do a tremendous job in assisting veterans, but their resources are limited.  The NRHA supports increases in funding for counseling services for veterans’ and their families. 
  1. Needs of Rural Women Veterans.    More women serve in active duty than at any other time in our nation’s history.  And more women are wounded or are war casualties than ever before in our nation’s history. 

Targeted and culturally competent care for today’s women veterans is needed.  Rural providers should also be trained to meet the unique needs of rural, minority, and female veterans.

  1. Improving Office of Rural Veterans

The NRHA calls on Congress and the Veterans Administration to fully implement the functions of the newly created Office of Rural Veterans to develop and support an on-going mechanism to study and articulate the needs of rural veterans their families. 

We are grateful to Mr. Salazar for introducing HR 2005 and are grateful for the Committee’s consideration of the bill.  This legislation provides important relief for rural veterans and clearly addresses our second and fifth recommendations. We hope the Committee will consider this as a strong and positive step toward addressing the many challenges - - especially access challenges - - faced by rural veterans.

To that end, we hope that this Committee will also address other ways to improve access to health care for our rural veterans.  While the VA has provided outstanding service to our veterans over the years (and I have been one of those recipients), the need to increase access to services has become a major concern to the VA, and a critical concern to veterans living in rural communities throughout the United States.

 Efforts to increase service points for rural veterans have, in large part, been hindered by the VA Administration itself.  The VA has thwarted attempts to collaborate with organizations that are located where rural veterans reside (such as community health centers, critical access hospitals, and rural health clinics) because of a false assumption that quality of care standards in rural communities are inferior.  To the contrary, the standards of health care in rural America are high.  In fact, community health centers, for example, have been rated as the number one most efficient and effective program in all of HHS. CHS must meet the highest standards of care, and in many cases, they musts also be Joint Commission accredited. All facilitates must meet federal standards of care.

We must never forget that many veterans forgo care entirely because of access difficulties to VA facilities.  Often, however, local quality care is available within a veteran’s own community.  In many cases, these rural centers, as well as critical access hospitals and rural health clinics, are the only providers in a large geographic area. Our goal is not to mandate care to our veterans, but to provide them a choice, a local choice.  We applaud Congressman Salazar and this Committee for taking steps toward providing our honored veterans with such a choice.

Thank you again for this opportunity.  The NRHA looks forward to working with you and this committee to improve rural health care access for the millions of veterans who live in rural America.