U.S. Senator Tina Smith’s staff held a listening session for veterans on April 12 at the Fillmore County Office Building. Bree Maki, southern Minnesota outreach, and Alex Schueller, veterans and military outreach, led the group in a discussion of veterans issues and concerns. Smith, through a video recording, said the objective was to hear directly from veterans. She wants veterans to receive all the benefits that they have earned and encouraged them to contact her office when they are in need of assistance.
Schueller, a Marine Corp veteran, related that he had served two tours in Iraq. He explained these listening sessions are being held to learn what support each local community believes is needed.
Fillmore County veterans service officer Jason Marquardt said he had a list of issues, but the biggest issue is emergency care.
The VA fact sheet directs veterans to immediately seek care at the nearest medical facility for emergency care when they believe their life or health is in danger. They do not need to check with the VA before calling for an ambulance. The fact sheet says ambulance transport must be preauthorized unless it is a medical emergency. The problem is that after the fact the VA may determine that it was not an emergency. Marquardt brought attention to this question asked by veterans when they are deciding whether or not to call an ambulance, “If we take an ambulance (for emergency care), are we going to get it covered?” The law states that a lay person (prudent lay person standard) can determine if it is an emergency, but then the VA may come back and say “no” it is not.
Marquardt described a heart patient that had been to the ER multiple times that was sent directly to cardiac care (bypassing the emergency room). The VA determined it was not an emergency. Rob Gross, director of Minnesota Veterans Cemetery in Preston, explained when someone has chest pain they should call an ambulance. They can’t know for sure if it is a heart attack or not.
Marquardt asked who at the VA is making these determinations and what training do they have? Also, veteran information doesn’t transfer from one VA clinic to another in the region, so a clinic may not have a particular veteran’s information.
Olmsted VSO Nathan Pike, brought up the Veterans Choice Program (VCP) which became law in 2014. Veterans were to be eligible for care through a community provider, paid for by the VA, if a veteran needs a specific care, the VA can’t provide care in a timely manner, or a VA facility is too far away. Marquardt said reimbursement amounts and timely payments for services has been a problem.
Schueller explained there are two versions of a new “choice” bill, but there is no consensus at this point. The goal is to put health care under one umbrella, simplify and include emergency care. The two chambers have not been able to match up their bills. If and when a bill is approved it will be under its own separate wing of funding.
Local veteran Stephen O’Connor brought up the issue of pain management. Because of the opioid crisis, the VA has encouraged alternative therapies like acupuncture and chiropractic care. He noted some veterans are illegally using marijuana to manage chronic pain. Schueller said doctors can’t stop veterans from using their state program (medical oils), but it is still illegal according to federal law. Maki said it helps to know this is an issue.
Marquardt spoke of other options like community based outpatient clinics. There is one in Rochester. Tele-health may be an option where a veteran can talk directly with a doctor without traveling to a VA clinic. Marquardt said there is also the issue of veteran care not crossing lines; for example, a Decorah clinic will only refer to Iowa City. The VA only pays for travel to the closest location even if a veteran has to travel further. Travel time is a problem for some veterans; it may require them to take off a day of work to visit a VA clinic.
Pike maintained it makes sense for veterans to get eye and hearing care at the closest possible location. This is especially important for elderly veterans. Pike said we (veterans) have already paid the price. “Take care of the people who take care of this country.” He noted it takes up to 70 days for a veteran to get enrolled into VA health care.
Affordable housing is another issue in southeast Minnesota. Pike said there is not a lot of opportunity for housing especially for low income veterans. Maki, who is on the rural development commission, said affordable housing will be looked at in general under the Farm Bill.
Don Gildner, co-chairman veterans home committee in Preston, explained that we are working to get a long term care veterans home in southeast Minnesota. First, we need to get state bonding money, then federal funding. One obstacle is there is just one basket of money for maintenance of existing homes and new construction. Funds are used up on maintenance and there is nothing left for new construction. He hopes to get funding put into two baskets, one for maintenance and one for new construction. There has not been a new veterans long term care home built in Minnesota in 20 years. There are about 8,000 people on a waiting list.
Marquardt noted there are contracted facilities in the region. Veterans have to be 70% disabled to get into these facilities. He said one local facility has 15 open beds, but was willing to hold only three beds for veterans. The rest of the beds are being held open for short term Medicare patients. Marquardt remarked that nursing homes operate as a business.
Rob Thoen, Houston County VSO, spoke about the need to expand the GI bill to allow it to be used for small business grants. He said he has had a lot of interest in this from veterans. He asked if the GI bill is keeping up with the cost of education. Schueller commented that the GI bill can be used for vocational education.