Videos & Speeches

40 Mile Amendment

Mr. President, I would remind the Presiding Officer of the hearing we had yesterday dealing with veterans affairs and the opportunity we had to discuss the implementation of something we now refer to as the Choice Act.

One of the successes and, in my view, one of the few successes we had last term--in fact, with Senator Sanders being on the floor as well--was the passage of the Choice Act. That legislation was Congress responding to scandal within the Department of Veterans Affairs--the fraudulent wait lists, the lack of services available to veterans who were waiting, and a number of veterans falling through the cracks. Congress responded and passed legislation now referred to as the Choice Act.

What that choice act said in simple terms is that if you are a veteran and you are unable to receive the services you need from the Department of Veterans Affairs within 30 days or if you are a veteran who lives more than 40 miles from a VA facility, the Choice Act allows you--in fact, requires the Department of Veterans Affairs to provide you with services at home if you so choose. It is your choice.

That bill was passed by Congress in August of 2014, signed by the President in September, implemented since then beginning in November, and it is now March of 2015. What we have discovered during that period of implementation is there are a number of pitfalls by which veterans are not receiving the care we indicated they would receive following the passage of that legislation. A lot of that problem is related to the 40-mile provision. Again, if you live more than 40 miles from a VA facility, the law says the Department of Veterans Affairs will provide you with service, if you so choose, with a local provider.

A couple of things have happened. The interpretation by the Department of Veterans Affairs of a couple of provisions has precluded a significant number, in my view, of veterans from being able to utilize this choice program.

Yesterday, the Department of Veterans Affairs, to their own credit, decided that they had been interpreting the law incorrectly. That provision related to “as the crow flies,” meaning that the 40 miles was to be computed “as the crow flies,” and that was the way the VA determined they were required to interpret that provision. Yesterday, the Department of Veterans Affairs decided they had the authority to make that 40 miles highway miles. So if you happen to live on one side of a lake or one side of a mountain, it is no longer as the crow flies. That is a piece of good news.

But here is the issue I have raised numerous times, and here is the issue that still remains a problem for many veterans. I smile when I say this because there are not many lakes in Kansas and there are no mountains in Kansas, so “as the crow flies” is not a significant issue to most Kansans as it is in many other places in the country. But yesterday's decision by the Department does increase the number of veterans who may qualify for the Choice Act.

Among other things, what is still missing is the idea of a facility within 40 miles. The problem is this: The Department of Veterans Affairs has interpreted and continues to interpret that to mean even though there is a VA facility within the 40 miles that does not provide the service the veteran needs, it is still a facility within 40 miles, and thus the veteran will be required to transport themselves to a hospital 2, 3, 4 hours away.

I have said this before on the Senate floor. As a House Member before coming to the Senate, I represented a congressional district made up of tens of thousands of square miles, larger than the state of Illinois. There is no VA hospital within that congressional district. We worked hard to create outpatient clinics where routine services could be provided closer to home for those veterans. Now we are saying: If you can't access the care that is more than 40 miles from your home, the VA is going to give you the option of seeing your hometown doctor, being admitted to your hometown hospital. But here is one of the problems: If there is an outpatient clinic within that 40 miles, even though it doesn't provide the service you as a veteran need, the VA says you don't qualify for the Choice Act.

I am of the view that they have the ability to interpret that law differently. They say it takes a legislative change. I am not sure there is a lot of value in continuing to have the debate about who is right about that. What I do know is there are many veterans in Kansas and across the country who are not receiving the services promised by the Choice Act because there is an outpatient clinic within the 40 miles, but it doesn't provide the service they need.

To give folks an understanding of what I am talking about, most outpatient clinics don't provide colonoscopies. So we have a veteran who needs a colonoscopy. The VA is to provide that service. Yet, in the case of where I come from, my hometown, the VA hospital is 3 hours away and the outpatient clinic is half an hour away, and because there is an outpatient clinic half an hour away, that veteran can't utilize the Choice Act. But the outpatient clinic doesn't provide colonoscopies, so that veteran is told by the VA that he or she has to drive the 3 hours to the hospital in Wichita to get the colonoscopy. Well, there is a community hospital within that area, within that veteran's hometown that provides colonoscopy.

That situation is what the Choice Act was designed to accomplish--service provided at home. So this amendment creates a deficit-neutral reserve fund that requires the VA to utilize its current authorities to offer community care to veterans who are currently unable to receive the health care services they need from a VA medical facility within 40 miles of where they live because the facility they have won't or can't provide the services they need. This is something we ought to be able to resolve. This amendment is widely supported.

There is legislation--S. 207--which I have introduced and which has many cosponsors, Republicans and Democrats, and we will continue to push this legislation. In fact, the Committee on Veterans' Affairs has indicated they will not only have the hearing we had yesterday on this topic, but also the chairman and the ranking member and their staffs will work over the recess to get this legislation front and center in our committee and, presumably, on the Senate floor.

This amendment is cosponsored by Senator Collins and Senator King of Maine. Senator Tester, Senator Blunt, Senator Toomey, Senator Hoeven, and Senator Vitter--Republicans and Democrats from states across the country--realize this is something which needs to be resolved.

While I believe the Department of Veterans Affairs should resolve this, they haven't. While the Department of Veterans Affairs believes Congress should resolve this, we haven't. What I do know is veterans who are entitled to care are not receiving it, and, in a sense, false promises were made until we get this issue corrected and the VA then implements the Choice Act as intended.

This is an important issue. I would say to my colleagues, particularly those who served in the Senate with me in the last 4 years, in my view, we haven't accomplished much in those 4 years, but one of the areas in which we did come together and did pass significant legislation was the Choice Act. Now we need to make certain that accomplishment results in those who are entitled to those benefits receiving them.

Who, I would ask, in this country would we expect to have the best quality health care? Who would we expect? I think it would be those who served our country--our military men and women, those who retired and became veterans. And I would say that the employees and Members of Congress have the opportunity of choosing a hospital or a doctor, and our veterans ought to have the same opportunity.

Mr. President, I appreciate the opportunity to explain this amendment. I ask for support when it is considered during the budget consideration. I would ask my colleagues to join me in cosponsoring the underlying legislation that will follow.

I thank my colleagues on the Committee on Veterans' Affairs, particularly the chairman, the Senator from Georgia, Mr. Isakson, and the ranking member, the Senator from Connecticut, Mr. Blumenthal, for their commitment to seeing that this is accomplished.

I appreciate the opportunity to explain one more time why this is something of significance and how the quality of life of our veterans is affected not because we don't want to care for them but because we lack common sense to implement a law when we know how it should work, we know what it should say, and yet we are impeded from accomplishing what matters so much. This is not a Republican issue; this is not a Democratic issue; this is an American issue that mostly calls for common sense.