Keeping Our Promise to Rural Veterans and their Families

President Lincoln declared in his second inaugural address that our country shall care for those “who shall have borne the battle and for his widow, and his orphan.”[1] The United States forms a lasting compact with our service members and their families from the moment they enter the military. In our Congressional district, which includes the Southern Tier, Western New York, and the Finger Lakes, there are over 50,000 veterans who deserve that full range of support earned through their service to our nation.[2]

Too often, our veterans are left with only empty declarations of support. Partisan politics in Congress has resulted in funding cuts and reduced benefits. Additionally, while a number of programs exist to support veterans, it is often too hard to access these programs — especially in rural communities like ours. This means that after serving our country, veterans are often forced between finding a job and moving home. That is not fair to our veterans and not fair to our rural communities who could benefit from the skills and dedication of those who have served.

I learned in the military that when you say you’re going to do something, it’s results that matter. It’s time we use that approach when it comes to taking care of our veterans. Simply having programs for veterans is not enough — we need to make sure the people who need these programs know about them and can access them. These programs should be integrated in a whole-of-person care model instead of being “stove piped” separately. To keep faith with our veterans by providing the support they need and deserve, I propose we focus on improving access and support for rural veterans in five key areas: economic opportunities; education; healthcare; mental health and well-being; and family programs.

Key Priorities:

Expand Economic Opportunities in Rural Areas: Expedite professional licensing procedures and increase access to capital for veterans so they can come back home to start businesses and build successful civilian careers in rural areas.

Align Education Opportunities with Military Experience: Recognize that returning veterans have a range of different life experiences that 18-year olds starting college straight from high school do not. Develop best practices and programs that maximize education success for veterans seeking to use the post-9/11 GI Bill. Protect veterans from predatory for-profit colleges by closing loopholes that allow exploitation of veterans and their families.

Improve Access and Quality of Healthcare: Expand collaborations and health information exchanges between VA and non-VA healthcare providers and enhance coverage of telemedicine options when appropriate. Revise 40-mile rule that handcuffs Veterans Choice program users and immediately fix the related billing problems.

Revise our approach to Mental Health and Well-being: Improve and streamline access to treatment by increasing the number of covered behavioral health providers and proactively addressing issues of stigma especially in small, rural communities. Streamline paperwork and other delays in care to ensure rapid access to support for those most in need.

Support Military Families: Protect family members’ access to key services, like TRICARE and the GI Bill. Provide immediate families and caregivers, especially those in rural communities, with information and training to better identify and respond to potential problems like opioid addiction and post-traumatic stress disorder.

As a service member and the son of a service member living in a rural area, I have a personal stake in ensuring our veterans and their families have access to the support and services they need to be successful. There are 5.3 million veterans living in rural communities like ours all across America.[3] And more and more of us are veterans who served in recent military operations like Operation Enduring Freedom, Operation Iraqi Freedom or Operation New Dawn. In fact, nearly 30 percent of new veterans move back home to rural communities like ours. [4]

Veterans in rural areas face many additional barriers when they try to access care and services in their local community. From provider and specialist shortages to limited broadband coverage (for telehealth services) to long travel times and limited economic opportunities, these additional challenges need to be specifically addressed in order to improve care for rural veterans. That is why I am committed to pursuing an integrated, whole-of-person care model focused on improving access and quality of services for veterans specifically in rural communities.

My plan includes 5 key areas: expanding economic opportunities in rural areas; aligning education opportunities with military experience; improving access and quality of healthcare; revising our approach to mental health and well-being; and supporting our military families.

Expand Economic Opportunities in Rural Areas

Serving our country in the military builds important skills which can contribute new ideas, innovation and growth critical to our rural economies. To help veterans get into the civilian workforce, we should expand the programs that expedite certain professional licensing procedures, like those in the emergency medical, health care, and education fields.[5] We should also expand programs that allow veterans with firefighting skills to continue their service to their community.[6]

Veterans who want to start or expand their small businesses, especially those in rural areas, need access to capital and investments. We should expand access to no-interest loans for veterans who are looking to start a new business and create jobs to stimulate our economy. By increasing access to capital, we can greatly expand opportunities and encourage veterans to use their skills to build a stronger private sector that helps the entire country. We should also expand incentives for employers to hire veterans, especially in rural areas. It is crucial that we continue to expand on the work being done to connect veterans to the jobs that help them start careers. Focusing these benefits on rural communities can help drive capital, investment, and growth into our small towns while allowing those who served to return home.

Align Education Opportunities with Military Experience

Over 1 million service members and their families have used the post-9/11 GI bill and there are over 2 million total post-9/11-era veterans.[7] By providing more educational opportunities to our veterans, we can greatly expand their employment opportunities. To do that effectively, we need to recognize that veterans beginning college are older and have more varied life experiences than typical college freshmen, and we need to develop best practices and programs that maximize their education success under the post-9/11 GI Bill. This includes developing best practices to help veterans adjust to college life and requirements. It also includes developing college programs for veterans who — for any number of reasons — may need more time to complete their degrees than traditional students.

I also support efforts to require colleges and universities that receive federal funds, including community colleges, to grant college credit for training gained while in the Armed Forces. States in the Midwest including Illinois and Minnesota have made progress in accepting military training as college credit, and have even gone so far as to create courses that serve as bridges to full degrees based on prior military training.[8] Moreover, too many service members and veterans struggle to understand and navigate the many educational benefits they are eligible for, resulting in potentially higher cost burdens on our veterans and raising the risk they may run out of benefits before obtaining their degree. Congress should require the VA, DoD and the Department of Education to create an integrated plan to guide veterans toward using the package of educational benefit programs with the lowest cost and highest number of credits that takes the shortest amount of time.[9] Finally, we must close the loophole in the GI-bill that allows predatory for-profit colleges to exploit veterans and their families.[10]

Improve Access and Quality of Healthcare

Reforming and managing a health care system that would serve the approximately 21 million veterans living in the United States[11] is not simple and will never be seamless, but the current issues facing the VA have to be fixed. The delays and issues with access to care at the VA are especially problematic in rural communities. Veterans in rural areas are less likely to access health services for both physical and mental conditions and often lack access to the full spectrum of quality health care services that veterans need.[12]

While the VA is being reformed, veterans should be able to receive care from providers within the private system, and the government should cover the costs. This program should remain in place until the VA has proven that the reforms instituted by the federal government are working, and we can see a decrease in the wait times and an increase in services offered. Expanding collaborations and health information exchanges between VA and non-VA healthcare providers and enhancing coverage of telemedicine options can provide life-saving care in rural communities.

Expanding collaborations should include both expanding VA clinics to more rural locations as well as technical solutions that connect non-VA providers to a system that allows viewing veterans’ records, as in Maine.[13] This also requires revising the 40-mile rule that handcuffs Veterans Choice program users. Currently, veterans must live more than 40 miles from a VA facility (hospital or clinic) in order to schedule private care, even though the clinics do not offer the full suite of care available at VA hospitals. I support efforts to expand that rule to include cases where specific or specialized medical care is not available within 40 miles, or when veterans would have to wait more than 30 days to be seen by a VA facility.[14]

Revise our approach to Mental Health and Well-being

One of the most challenging and important tests we face is how we address the issues of mental health and well-being among veterans of all ages. Measurable progress has been made among veterans within the VA system diagnosed with mental health conditions: their suicide rates have declined.[15] However, rural veterans remain at heightened risk of suicide. This is in part because rural areas face additional challenges including long distances to get care, limited mental health care availability, a lack of expertise in treating post-traumatic stress disorder, and stigma about mental health disorders.[16] We need to change how we view mental health, supporting anyone who seeks care rather than allowing outdated rules and bureaucracy to dissuade veterans who reach out.

Red tape has made it too hard for transitioning veterans trying to get into the system to promptly receive the information and care they need. Veterans seeking mental health care should not be told by their country that their only option for timely care is to check into the emergency room at the local hospital to be placed on suicide watch. Instead our system should focus on bringing veterans in, so they can start real, long-term treatment aimed at understanding and caring for their mental health and well-being. And if there are capacity issues, the government should again focus on finding potential private sector solutions to bring in outside organizations with the capacity to help. In addition, we should expand options for telemental health (mental health counseling by video conferencing over the internet). Telemental health care has been shown to be as effective as in-person care, could reduce wait times, and could greatly increase access to such care in rural communities.[17]

We also need to ensure that all veterans have access to mental health care they need. I support efforts in Congress to expand eligibility to mental health services for those with other-than-honorable (OTH) discharges, and establishing a simpler mechanism for retroactive PTSD and other mental health diagnoses, which could reverse OTH discharges.[18]

Support Military Families

Families serve alongside our service members and they deserve support too. It is critical that we solidify existing benefits in the Post-9/11 GI Bill including family transferability and protect cases where family members and dependents can access critical health care services.

I also support efforts to ensure family members have access to the support they need, especially caregivers in rural communities. This includes making veterans of all eras eligible for caregiver support services, ensuring that caregivers for those with severe service-related mental illness receive support, providing assistance with childcare, and providing mental health support when needed to the caregiver directly.[19]

I also support efforts to provide immediate families and caregivers with information and training to better identify and respond to potential problems like opioid addiction and post-traumatic stress disorder (PTSD). We should be helping families understand and recognize the symptoms of PTSD which can emerge years after discharge and give families the resources they need to get help for their loved one. Similarly, I support efforts to train and support family members and caregivers on how best to manage opioid pain relief, symptoms of unhealthy use, and options for treatment. By utilizing the first-hand experiences of older veterans and their families, we can expand rural communities and networks to teach and support each other.

John Plumb is a member of the United States Navy Reserve. Use of military rank, job titles, and photographs in uniform does not imply endorsement by the Department of the Navy or the Department of Defense.Paid for by Friends of John Plumb.

[1] “The Origin of the VA Motto.” U.S. Department of Veterans Affairs.

[2] US Census Bureau Data.

[3] http://www.ruralhealth.va.gov/about/rural-veterans.asp

[4] http://www.legion.org/veteranshealthcare/ruralhealth

[5] “Expedited Licensing: Veterans Full Employment Act of 2013.” Maryland Department of Veterans Affairs.

[6] “Licenses.” Illinois Department of Veterans’ Affairs.

[7] http://www.rand.org/content/dam/rand/pubs/testimonies/CT400/CT428/RAND_CT428.pdf

[8] “Translating military training into college credits.” Adrienne Lu, USA Today, 09/27/13.

[9] http://www.rand.org/content/dam/rand/pubs/testimonies/CT400/CT428/RAND_CT428.pdf

[10] IAVA, Defend Education Benefits

[11] “Veterans Day Data Boot Camp.” Tom Risen, U.S. News & World Report, 11/10/14.

[12] http://www.nosorh.org/wp-content/uploads/2013/07/NOSORH-Rural-Veterans-Health-Guidenhmedits-21.pdf

[13] https://muskie.usm.maine.edu/Publications/rural/Maine-Rural-Veterans-Health-Access-HIT-Strategies.pdf

[14] http://magicvalley.com/news/local/govt-and-politics/crapo-introduces-va-health-care-reform-bill/article_042e3989-6a8d-57ee-828b-5bcefa998919.html

[15] “Suicide Rates in VHA Patients through 2011 with Comparisons with Other Americans and other Veterans through 2010.” Janet E, Kemp, RN, PhD, Veterans Health Administration, 01/2014.

[16] http://www.apa.org/monitor/2014/04/rural-suicide.aspx

[17] http://www2.med.psu.edu/phs/files/2013/05/Final-Capston-Presentation-LaClair.pdf

[18] https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/28/14/51/removing-barriers-to-mental-health-services-for-veterans

[19] http://www.elizabethdolefoundation.org/bipartisanlegislation/

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