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Hon. Jeff Miller, Ranking Republican Member, and a Representative in Congress from the State of Florida


Rural America has a strong tradition of military service.  According to the 2000 U.S. Census, rural and non-metropolitan counties have the highest concentration of veterans.  Both my State of Florida and the Chairman Michaud’s State of Maine are included in the top eighteen states with a greater than average proportion of rural veterans.

Not surprisingly, in the Global War on Terror, we continue to see a high rate of combat veterans from rural settings.  About forty-one percent of returning veterans from Operation Enduring Freedom and Operation Iraqi Freedom live in small communities.

A study conducted by VA researchers, published in the Winter 2006 Journal of Rural Health, “corroborate a concern that living at a distance from regionalized health care implicitly restricts access to and utilization of health services.  Veterans may have an additional health care option not available to the general public, but those veterans who live in non-metropolitan areas, far from regionalized high technology or specialized care, continue to experience substantial unmet needs, greater than those of veterans in metropolitan settings.”

Central to VA’s efforts to address access to health care in less populated settings has been the establishment of Community Based Outpatient Clinic’s (CBOCs).  Today, VA operates about 700 CBOCs.  The May 2004 Capital Asset Realignment for Enhanced Services (CARES) Decision Document provided a framework for prioritizing 156 new CBOCs to improve veteran’s access to care. More than half of these new CBOCs were given priority because they were located in rural areas. Yet, of these recommended new sites of care, VA has opened only twelve and expects to activate only an additional twelve in 2007.

CBOCs are important to improving geographic access to care.  However, these primary care sites alone, cannot effectively overcome all the barriers that exist for rural veterans to obtain high quality care within their home community.  Addressing the identified gaps in mental health services and specialty and acute hospital care, requires developing new approaches for delivering care.  This includes the use of emerging technologies, partnering with existing non-VA rural health care providers and enhancing the training and recruitment of health professionals in rural communities.

I thank Chairman Michaud for holding this hearing to examine how we can best ensure all veterans have access to services when and where they are neededWith our current combat operations and an aging veteran population from previous wars, we can anticipate a substantial and rapid increase in demand for VA health care in rural areas.  VA must step up to meet both the immediate physical and mental health care needs of all veterans and their families and bear in mind the special and unique rural health care delivery challenges in planning future services.