Senate Veterans Affairs Committee Considers Cramer Bill to Improve Access to Care for Rural Veterans

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WASHINGTON, D.C. - The Senate Veterans' Affairs Committee (SVAC) examined U.S. Senators Kevin Cramer (R-ND) and Tim Sheehy's (R-MT) legislation to improve veterans access to local care options, the Critical Access for Veterans Care Act. This bill would allow veterans living in rural America to seek health care services at local Critical Access Hospitals or Rural Health Clinics.

"The Community Care program literally can be a lifeline," said Cramer."[What] prevents it from being a lifeline as often as it ought to be is all of the roadblocks that get put up. […] After hearing from veterans and rural health care providers and leaders across North Dakota, I proposed a solution with Senator Sheehy to simplify access to the Critical Access network, whether it's a Critical Access Hospital [or] Rural Health Clinic."

The North Dakota Rural Health Association and a coalition of 22 rural healthcare providers across North Dakota submitted letters of support for Cramer's legislation, writing "Far too long veterans have been stuck in a system where access has been overshadowed by bureaucratic procedure. This legislation offers a streamlined, practical approach which builds on existing infrastructure and recognized designations in rural health care to meaningfully improve veteran access to care." The bill is also supported by the American Hospital Association, America's Warrior Partnership, and the National Rural Health Association.

North Dakota Veteran and Critical Access Hospital CEO Marcus Lewis similarlysubmitted a letter of support for the bill, writing, "My circumstances reflect those of many rural veterans. I live more than three hours from the nearest VA hospital and work more than two hours from that facility. Yet within 50 miles of my home are three community healthcare facilities, including the one I lead, First Care Health. Despite the availability of this high-quality local care, I am currently paying out of pocket for needed therapy because accessing services through the Community Care Network has proven prohibitively difficult."

Lewis concluded, "S.1868, the Critical Access for Veterans Care Act, is an important and necessary step toward addressing these long-standing inequities."

Many of America's veterans live in rural or highly rural areas and face major challenges to accessing quality and timely health care. North Dakota has one VA Medical Center in Fargo and eight Community-Based Outpatient Clinics (CBOCs) located in Bismarck, Devils Lake, Dickinson, Grafton, Grand Forks, Jamestown, Minot, and Williston.

There are 37 Critical Access Hospitals in towns across North Dakota, but only five of those communities also have a VA CBOC.

The bill would amend the VA MISSION Act of 2018 to create a new category under which care is required to be furnished through community providers, specifically for care sought by a veteran residing with 35 miles of the Critical Access Hospital or Rural Health Clinic.

"Our VA system effectively discriminates against our veterans compared to their neighbors, their non-veteran neighbors and friends, and family, by giving them less access to care that's readily available," said Cramer. "The goal is to give rural veterans access to local Critical Access Hospitals without the strings attached. […] I worry if the bill is watered down, quite honestly, that we turn the authority back over to the bureaucracy to decide."

At the hearing, Dr. Thomas O'Toole, Acting Assistant Under Secretary for Health for Clinical Services for the Veterans Health Administration, said the agency strongly supports the intent of this legislation as sees the need for it to meet the needs of rural veterans.

"I think the sticking point, which you noted, is really how do we create some clarity in language and direction as it relates to prior authorization versus clinical necessity," said Dr. O'Toole. "That can be achievable and we're very much looking forward to working with you on how we get appropriate language to make that work."

Prior to the hearing, Cramer published an op-ed in The Washington Times, highlighting his Critical Access for Veterans Care Act. He wrote, "The promise to our veterans was quality care, not government-rationed care, and reforms are needed to deliver on this promise."