For veterans in need of medical care, 40 miles now means 40 road miles, not magical leaps over mountain peaks.
The Department of Veterans Affairs announced earlier this week that it will alter its “40-mile rule” that allows vets to seek care at a non-VA clinic if they live more than 40 miles to a VA facility.
That was the apparent intent of legislators who passed the Veteran’s Choice Act last July, permitting veterans to access non-VA community care if they live more than 40 miles from a VA medical facility or if their wait time for a VA appointment is more than 30 days. The legislation seemed clear and sensible, but until this week’s change, the VA measured the distance between a veteran’s home and a VA facility using in a straight line.
Straight-line travel works well for planes in the air and ships at sea, which is not how most veterans get to their clinic appointments. Whether they drive themselves, use public transportation, or depend on friends and veterans’ organizations, if the 40-mile rule is relevant, it is a safe bet that they are traveling by road.
In the rural West, straight lines are not feasible. Mountain ranges are the obvious impediment. For example, residents of Rico technically may live within 40 miles of the Durango VA clinic, but the drive is more than 80 miles each way — a big difference. Other problems are river without bridges and vast empty spaces that lack roads.
For that matter, 40 miles seems like an arbitrary distance anyway, especially for someone who may not be able to drive. Public transportation is not widely available in rural areas. Veterans groups do an admirable job of providing transportation to appointments, but an important question remains: Do veterans receive better care from VA clinics than they would in their communities?
In some cases the answer is definitely “yes.” Providers familiar with the specific problems veterans experience will indeed be better equipped to treat them. In other instances, though, the inconvenience of distance outweighs the benefit of a VA clinic, and a relationship with a familiar local provider carries its own advantages. Veterans, of all people, should be able to choose their medical providers.
Furthermore, the VA system is not all it could or should be. The cost of the new VA hospital in Aurora is now estimated to be five times the original proposal, and construction has stalled because the contractor was not paid. Will it provide cost-effective care? And the VA system is hugely backlogged — thus the 30-day exemption.
The Department of Veterans Affairs has declined to address a second issue raised by Sen. Michael Bennet, D-Colo., allowing veterans access to non-VA care if they live within 40 miles from a VA facility but the services they require are not offered at that facility. Bennet, along with his Colorado Republican colleagues, Sen. Cory Gardner and Rep. Scott Tipton, is pushing for the legislative solutions the VA says are required. But should an act of Congress be needed to solve that practical problem?
It may be time for the federal government simply to pay veterans’ bills wherever they decide to seek care, rather than inflicting long drives, long waits and sometimes poor care on patients at high costs to taxpayers.
Until that discussion can be had, it is important for the VA to remember that one value upon which almost all Americans agree is that the country’s veterans deserve top-quality, convenient care for their service-oriented health issues. For that to happen, the government needs to use common sense, not magical thinking.