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Witness Testimony of Peter W. Ogden, State of Maine, Augusta, ME, Director, Bureau of Veterans' Services, and, Secretary, National Association of State Directors of Veterans Affars

Chairman Michaud, Congressman Miller, Congressman Allen and distinguished members of the committee thank you for this opportunity to speak today on three extremely important issues for Maine’s veterans; access to healthcare, women veterans, and outreach to veterans on their benefits.  My testimony today comes from three prospectives: as the Director of the Bureau of Maine Veterans’ Services, the Secretary of the National Association of State Directors of Veterans Affairs (NASDVA), and as a disabled combat veteran who uses the VA healthcare system in Maine.

We greatly appreciate the leadership of Chairmen Akaka and Filner, Ranking Members Craig and Buyer and the entire membership of the Senate and House Veterans Affairs Committees for their past and continued support of our veterans and the VA.  Because of the War on Terror, we are now serving a new generation of veterans while we are struggling to bring our elderly WW II and Korean War veterans into the VA system. The new veterans are going to need our help as they return to civilian life while our elderly veterans need primary and long-term healthcare.   We believe there will be an increased demand for certain benefits and services and the overall level of health care funding must meet that demand while continuing to serve those veterans already under VA care.

Maine is a unique state in several ways:  In 2000 Maine had the largest per capita veteran population in the nation and is still at number two or three; the Togus Medical Center is the oldest VA hospital in the nation; and Maine’s aging veteran population is geographically dispersed across a large land area.  We have a saying in Maine, “ya can’t get there from here,” while you can get to the one VA Medical Center at Togus from about any where in Maine it can take you five to six hours to travel up to 260 miles to reach Togus.

Maine presently has the distinction of being the oldest state in the nation with a median age of 40.6 years old.[1]  When you look at the age of Maine’s veterans you will find that 65% or 93,780 veterans are aged 55 and older. [2]  These are the veterans that are most likely to need and use the VA health care system.  Access for Maine’s ageing veterans is of extreme importance. 

Any conversation about aging veterans and access to healthcare should include the importance of the State Veterans Homes program and the services they provide to our veterans in long-term, residential, skilled, dementia and respite care.  Maine is fortunate that we have the Maine Veterans Homes with their six facilities spread across the state that provides the best care at the most reasonable cost.  While Maine has the maximum number of beds available by VA demographics standards, many other states do not and Congress should continue to fund the State Veterans Home Construction Program until they have the capacity to provide long-term care to their veterans.

Maine’s aging veteran population coupled with our rural geography presents problems to elderly veterans trying to access VA healthcare especially in Maine’s severe winter months.  Maine has a limited transportation infrastructure and this compounds the access issue.  The CARES market plan (Far North Market) developed in VISN 1 recognized Maine’s unique geographic characteristics, limited transportation infrastructure and rural nature.  The resulting CARES Commission Report made several points about access to VA health care in Maine (Far North Market) that are relevant to this hearing.

In the Far North and North Markets, less than 60 percent of enrolled veterans are currently within the VA’s access standards for hospital care.  The CARES standard is 60 minutes for urban areas; 90 minutes in rural areas; and 120 minutes in highly rural areas.  Inpatient medicine workload is projected to increase…The Far North Market has the largest projected increase, with 209 percent over baseline by FY 2012.”  [3] 

“…the Far North Market is currently below the standard for access to primary care.  Currently only 59 percent of the veterans residing in this largely rural area are within the CARES guidelines set for access to primary care services.”[4]  The CARES definition for “Access to Primary Care” is “70% of veterans in urban and rural communities must be within 30 minutes of primary care; for highly rural areas, this requirement is within 60 miles.”[5]  

“The VISN had proposed five new CBOCs, (Community Based Outpatient Clinics) all in the Far North Market.  These new CBOCs would be located across Maine in order to improve access to care and thus address current deficiencies in access in this market... These CBOCs are also crucial to the VISN’s plan to expand inpatient capacity at Togus, by reclaiming old inpatient space that has been converted to outpatient services.” [6]

 The following table shows the aging of Maine’s veteran population over the next 25 years.  As you can see we will continue to have the majority of our veteran population over age 55 for many years to come.

Year

Veteran Population *

Veterans > 55

% of  Veteran Population

2007

144,007

93,780

65%

2010

138,551

91,200

66%

2015

129,091

86,700

68%

2020

115,506

80,925

70%

2025

104,650

73,047

70%

2030

94,582

63,633

67%

* Based on projections from VA Demographics Program VetPop2007

Rural access to VA healthcare in Maine will greatly improve if and when the CARES Plan is fully implemented.  Even if fully implemented in Maine today, we will still face challenges as the CARES Plan only addresses 70% of the veteran population which means that 30% or 43,202 veterans (2007 numbers) will still be out side of the CARES standard for healthcare access.  New initiatives by the VA such as; home-based healthcare, tele-medicine, tele-mental health, will help alleviate the access to care for these veterans.

While we would like to see additional Vet Centers in Maine to provide the necessary readjustment counseling to the large number of returning combat veterans to the state, we applaud VA’s efforts to reach out to these individuals by establishing access points for mental health counseling outside of the Vet Centers. 

The Veterans Administration at Togus does a remarkable job of taking care of Maine’s veterans with their limited resources.  I will be the first to tell you, we do have problems that arise occasionally but in my time as State Director they been extremely responsive to resolving issues that have been identified to them.

The recent influx of new veterans from Iraq and Afghanistan are being serviced well by Togus but this does have an impact on how they can take care of the older veterans that we are identifying and enrolling in the VA healthcare system.  While the VA staffing continues to grow, it still takes a long time to credential employees and this does have an impact at the delivery of services level.  In Maine we will continue seeing an increasing number of our aging veterans enrolling and seeking assistance from the VA.  Currently we have over 52,000 or 36% of our veterans enrolled with about 38,500 who actively use the VA healthcare system in Maine.

Continued development of CBOCs has greatly improved veterans’ access to VA health care. A shining example is the Lincoln clinic that opened last year and is providing primary care to more than 800 veterans.  We continue to encourage rapid deployment of new priority clinics/access points over the next few years with the corresponding budget support to the corresponding VA Medical Centers. VA needs to quickly develop these additional clinics, to include mental health services.   We support VA contracting-out some specialty care to private-sector facilities where or when access is difficult.  CBOCs provide better access, leading to better preventive care, which better serves our veterans.

In short, to improve rural access for veterans to VA healthcare in Maine and the nation, implement CARES in Maine and other states and implement it sooner than later.   

According to the VA’s demographics program VetPop2007 Maine’s has over 10,000 women veterans with less than 1,800 using VA healthcare.  Quality or availability of types of care for women veterans does not seem to be as much of an issue as access and outreach.  Approximately 40% of the women veterans using VA healthcare receive it at the CBOC’s.  The addition of new CBOC in the Lewiston/Auburn area and the access points in Houlton, Dover-Foxcroft, and Farmington will allow more women veterans to receive care closer to home and this will increase usage numbers.

While growth has occurred in VA health care due to improved access to CBOCs, many areas of Maine and the country are still short-changed due to geography and/or due to veterans’ lack of information and awareness of their benefits.  VA and State Departments of Veterans Affairs must reduce this inequity by reaching out to veterans regarding their rights and entitlements. Maine and NASDVA supports implementation of a grant program that would allow VA to partner with the State Department’s of Veterans Affairs to perform outreach at the local level. There is no excuse for veterans not receiving benefits to which they’re entitled simply because they are unaware of those benefits.  I would encourage the committee to support S.R. 1314, Veterans Outreach Act of 2007.

As the nation’s second largest provider of services to Veterans, state governments’ role continues to grow.  We believe it is essential for Congress to understand this role and ensure we have the resources to carry out our responsibilities.  The states partner very closely with the Federal Department of Veterans Affairs in order to best serve our veterans and as partners, we are continuously striving to be more efficient in delivering services to veterans.

As I finish my testimony I would like to once again thank you for the opportunity to speak to you today and thank you on behalf of Maine’s and the nation’s veterans for all you are doing to ensure they receive the proper healthcare and benefits they have earned through their service to the nation. 

Thank you.



[1] Churchill, Chris. Maine: The gray state, Maine now has highest median age in the U.S., Kennebec Journal, March 11, 2005. Page A-1.

[2] Numbers were taken from the Veterans Administration’s Demographics Program VetPop2007 for the year ending September 2007

[3] CARES Commission Report, Chapter 5 VISN Recommendations, Page 5-15

[4] CARES Commission Report, Chapter 5 VISN Recommendations, Page 5-18

[5] CARES Commission Report, Appendix A, Glossary of Acronyms and Definitions, Page A-3.

[6] CARES Commission Report, Chapter 5 VISN Recommendations, Page 5-18, 19