Hawaii County has two community outpatient clinics for veterans and two vet centers, meaning veterans on the island often have to travel, schedule a telehealth visit, or seek a community care provider to access treatment in a timely manner.
Additional complications come from the impact of COVID-19, issues with Veterans Affairs infrastructure, the slow handling of referrals, and an overall shortage of health care workers.
As a result, veterans nationwide are forced to endure long wait times for medical care, averaging 22 to 43 days for primary care, 24 to 42 days for mental health care, and 30 to 41 days for all other specialties.
To address the issue, U.S. senators directed questions to Secretary of Veteran Affairs Denis McDonough at a hearing on Wednesday.
“Hawaii’s unique geography creates significant challenges for veterans when it comes to accessing care, through both the VA or in the community, especially given Hawaii’s current shortage of health care workers,” said Sen. Mazie Hirono, D-Hawaii, at the hearing. “Neighbor island veterans, not those living on Oahu, still sometimes have to wait months to get treated in the community on the island in which they live.”
VA offers reimbursements for certain veterans that are required to travel for services, but not all qualify.
“We do provide reimbursement for travel,” McDonough said. “Not in every case, but in many cases.”
McDonough confirmed emergency issues are covered, but it was unclear whether treatment for excessive pain or those looking for shorter wait times also would be reimbursed.
McDonough said he will travel to Hawaii in the near future to learn more about veteran care throughout the state and will clarify who exactly qualifies for travel reimbursements.
“We’ll be spending some time together, and we’ll figure it out, and I’ll be happy to dig into those questions with you,” he told Hirono.
Hirono made it clear there is a lot of work to be done.
“Thank you for letting our secretary come to Hawaii,” she said. “It is not just because we have a lovely state, ’cause when the secretary comes, he will be working every moment. He will not be lying around in the sun.”
Access to care for those in rural areas also was addressed by Sen. Sherrod Brown, D-Ohio.
“If the balance of care provided in the community continues on its current upward trajectory, we anticipate that certain VA medical facilities, particularly those in rural areas, including the one you visited in Ohio, may not be able to sustain a sufficient workload to operate at the current capacity,” he said. “Increasing staff in rural areas will help bring down wait times within VA.”
Staffing support for rural areas could come from the recently passed Honoring Our Promise to Address Comprehensive Toxics (PACT) Act, which authorizes workforce increases and infrastructure plans to get more veterans into VA care, as opposed to community care providers.
“We believe, and certain studies show, that vets in the direct care system do better,” McDonough said. “By using the authorities you’ve given us in the PACT Act to hire and to keep professionals … we are continuing to make VA the most attractive option.”
In addition to wait times and access, Hirono spoke in favor of supporting female servicemembers following the U.S. Supreme Court’s decision to overturn Roe v. Wade.
“The VA’s decision to provide abortion services in the instances of rape, incest and the life or health of a mother will save lives, there is absolutely no question,” she said. “I really appreciate the VA, in the context of this environment of chaos and fear as a result of the Roe decision, that you have stepped forward to provide these services for hundreds of thousands of veterans who are of child-bearing age.”
McDonough confirmed there are roughly 300,000 veteran women of child-bearing age, adding those in the medical field will be protected at the federal level from any potential lawsuits regardless of which state provides the abortion services.
“VA requested and has received now, just in the last couple of hours, an opinion from the Justice Department’s Office of Legal Council concluding that VA’s interim final rule on access to reproductive health services is a lawful exercise of VA’s authority,” he said. “States may not impose criminal or civil liability on VA employees including doctors, nurses, administrative staff who provide abortion related services in a manner authorized by federal law.”
Amid the concerns, McDonough highlighted improvements that have taken place within the VA health care system.
“Since President Biden took office, VA has delivered more care to more vets than at any other time in our nation’s history,” he said, adding in 2021, a record 33 million appointments were completed for veterans, with vet “trust scores” for outpatient VA care averaging above 90%.
“We updated the website so that the average wait times better align with what veterans experience when they make their own appointments, and give veterans localized information to choose the care that’s best for them,” he said.
Mental health care for vets also has improved with the new 988 crisis line, where veterans can dial 1 to receive additional support.
“Things like the veteran crisis line and walk-in services at VA or health care centers means that we, especially during the pandemic, have met or exceeded the two-day requirement we seek for emergency care,” he said. “We come to work every day to ensure access to timely, world-class care for American veterans, ensuring the best possible care wherever they access that care, at the VA or in the community.”