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“Beyond the City Limits: Delivering for Rural Veterans”

House Veterans Affairs Committee, Technology Modernization Subcommittee Field Hearing

July 25, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Dr. Daniel Zomchek: Director, Veteran Integrated Service Network 12, Veterans Health Administration; U.S. Department of Veterans Affairs

• Dr. Peter Kaboli: Executive Director, Office of Rural Health, Veterans Health Administration; U.S. Department of Veterans Affairs

• Dr. Staci Williams, PharmD, RPh: Executive Director, VA Illiana Healthcare System, Veterans Health Administration; U.S. Department of Veterans Affairs

• Mr. John Lawson: Superintendent, Veterans Assistance Commission of St. Clair County

• Ms. Hillary Rains: Community Engagement Manager, Illinois Office of Broadband; Illinois Department of Commerce and Economic Opportunity

• Mr. Kim Kirchner: Veteran, McCoop County Sheriff's Dept.

• Ms. Christina Schauer: President & Co-Founder, Tri-State Women Warriors

Keywords mentioned:

• Telehealth, community care, electronic health records, digital divide, mental health, rural veterans, VA access, outreach and engagement, compensation and pension exams, women veterans

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairman Tom Barrett outlined the challenges veterans face accessing VA care in rural areas, especially in districts like his without a VA hospital. He thanked Ranking Member Nikki Budzinski for hosting the field hearing and expressed appreciation to the University of Illinois and local advocates for organizing the event. He explained that the Subcommittee on Technology Modernization aims to ensure the VA uses the right technology to deliver care, particularly in rural communities where traditional facilities are less accessible. He highlighted the importance of programs like community care, telehealth, and scheduling systems, while also acknowledging gaps in performance goals, network participation, and access to mental health and women’s care services.

• Ranking Member Nikki Budzinski welcomed the Subcommittee to Illinois' 13th District and thanked the Veterans Center and the University of Illinois for their partnership. She noted the similarities between her district and Chairman Barrett’s, stressing how rural veterans often travel long distances for care. She voiced strong support for maintaining access to community care but warned that rural hospital closures and provider shortages threaten its availability. The Ranking Member also advocated for affordable, accessible broadband and digital literacy to ensure veterans can utilize telehealth, and she looked forward to discussing potential solutions during the hearing.

SUMMARY OF KEY POINTS

• Dr. Daniel Zomchek described the VA’s efforts to support rural veterans, particularly through the Illiana Health Care System, which serves 30,000 veterans in a 34-county region. He illustrated the importance of community care, telehealth, and virtual mental health services, claiming that these tools reduce travel and improve outcomes. He also discussed transportation programs, including volunteer driver networks and highly rural travel grants, that help veterans reach appointments. Dr. Zomchek articulated the VA’s commitment to expanding access and improving care for rural veterans, and he expressed gratitude to the Subcommittee for its support.

• Mr. John Lawson shared that although his county has outpatient VA clinics, they are often over capacity and unable to meet specialty care needs. He supported the Veterans’ ACCESS Act (H.R. 740) as a means to automate community care approvals and reduce delays while emphasizing the importance of maintaining direct VA care. He warned against billing confusion and called for better electronic health record (EHR) interoperability between the VA and community providers to prevent miscommunication. Mr. Lawson underlined that community care should be a supplement, not a substitute, for VA services and called it a “force multiplier” when used correctly.

• Ms. Hillary Rains focused on how the digital divide undermines rural veterans’ ability to access telehealth, with many lacking broadband, devices, or digital skills. She said that while Illinois has made progress expanding fiber infrastructure through grants like Connect Illinois, challenges remain, especially for older and low-income veterans. She explained that the now-defunded Digital Equity Act had promised targeted funding for veterans’ digital access programs, but its termination left many proposals unfunded. Ms. Rains reiterated that equitable broadband access is essential for veterans’ health and well-being.

• Mr. Kim Kirchner recounted a negative experience at a compensation and pension (C&P) exam where the provider was unprepared, disrespectful, and conducted no physical examination, leading to a claim denial. He described the situation as a waste of time and taxpayer dollars and said it required him to undergo a second exam to receive a proper evaluation. He called for greater oversight of contracted providers and emphasized the need for veterans to be treated with respect and dignity. Mr. Kirchner urged the VA to improve its outsourcing process for these exams.

• Ms. Christina Schauer pointed to the importance of outreach, well-coordinated community care, and a strong VA presence in rural areas. She praised the VA’s suicide prevention partnerships and described how they helped women veterans in her organization access care for the first time. She raised concerns about care continuity, poor communication with community providers, and cultural competency gaps, especially as rural hospitals face financial strain. Ms. Schauer concluded that telehealth should supplement, not replace, VA care and urged continued investment in the VA as a stabilizing force in rural healthcare.

• Chairman Barrett asked about the cost of extending fiber broadband to rural Illinois homes. Ms. Rains responded that connecting approximately 50,000 homes through the Connect Illinois program cost about $350 million, with most installations using fiber infrastructure. She added that fixed wireless is a useful stopgap, but it has limitations in areas with no signal or frequent weather disruptions.

• Chairman Barrett then asked whether fixed wireless could be a lower-cost solution for veterans needing telehealth access. Dr. Peter Kaboli said that while fixed wireless and low-Earth orbit satellite internet are promising, the VA lacks legislative authority to subsidize such services. However, the VA is running a pilot program to identify challenges with satellite internet implementation.

• Ranking Member Budzinski asked all three VA panelists to identify the main gaps in care and access for rural veterans, along with the feedback they receive from veterans. Dr. Zomchek stated that rural veterans face greater challenges accessing specialized services, though gaps in primary and mental health care have narrowed with the use of telehealth. Dr. Staci Williams highlighted the VA Illiana system's implementation of the ACORN screening tool to identify veterans’ social needs, including digital access and social isolation. Dr. Kaboli said that about 80% of veterans who try telemedicine prefer it, but a subset do not, and flexibility is key to meeting different needs.

• The Ranking Member followed up by asking if the Danville VA faced the same staffing shortages seen in the private sector. Dr. Kaboli acknowledged that the VA faces similar shortages, but he noted that the Clinical Resource Hub allows providers from other regions to fill gaps via telehealth. He gave the example of a nephrologist in Boston providing care in rural Illinois.

• Chairman Barrett then returned to questioning, asking Mr. Lawson and Ms. Schauer about their expectations and concerns regarding the rollout of the VA's new EHR system. Mr. Lawson responded that community providers currently cannot access VA health records directly and suggested a secure login system with limited edit privileges for providers. He stated that the goal should be to allow seamless access and input across systems to improve care continuity. Ms. Schauer added that limited EHR interoperability forces providers to rely on phone calls, which are not always feasible during nights, weekends, or holidays.

• The Chairman responded that the legislation he introduced, the Veterans Community Care Scheduling Improvement Act (H.R. 3482), seeks to ensure veterans are informed of all appointment options, including those available through community care. He agreed that improving scheduling transparency and closing referral gaps is critical to ensuring veterans receive timely care and nothing falls through the cracks.

• Ranking Member Budzinski asked about barriers to accessing VA benefits in rural communities. Mr. Lawson called for accredited veteran service officers in every county, noting that many veterans remain uncounted in the system if they have not used VA benefits. He added that services should always be free to veterans and cautioned against the use of unaccredited consultants.

• The Ranking Member asked for suggestions on improving veteran turnout at resource fairs. Mr. Lawson observed that traditional resource fairs are outdated, especially with modern access to information via smartphones. He suggested exploring digital outreach platforms and social media to reach younger veterans.

• Ranking Member Budzinski then asked Dr. Williams to compare resource disparities between rural VA facilities and urban ones like the Jesse Brown VAMC in Chicago. Dr. Williams explained that the Jesse Brown VAMC hosts the VISN 12 Clinical Resource Hub, which provides specialty care to rural sites like Illiana. She said that while urban centers often have broader academic affiliations, Illiana has a strong but distinct partnership with the University of Illinois.

• Chairman Barrett asked for an update on the External Provider Scheduling (EPS) system and how it has been implemented. Dr. Zomchek stated that no VISN 12 facilities are currently participating in the EPS pilot, but he viewed it as a promising tool for reducing delays in scheduling appointments. He stressed that both VA and community providers must actively participate by opening their scheduling grids.

• Chairman Barrett questioned whether community care providers were willing to adopt the EPS system. Dr. Kaboli confirmed that there was strong interest from rural providers and that partnerships had been developed with local health associations to facilitate buy-in. He added that around 4,000 appointments were scheduled through EPS in June and emphasized that ease of use, not reimbursement rates, was the greater barrier.

• The Chairman asked if reimbursement rates for community care were sufficient to retain provider participation. Dr. Kaboli replied that community providers are generally satisfied with the reimbursement levels but stressed the need to streamline record exchange processes to reduce administrative burdens.

• Ranking Member Budzinski asked Dr. Zomchek whether telehealth was helping to reduce stigma surrounding mental health care. Dr. Zomchek affirmed that VA mental health care offerings have improved and now include multiple modalities, reducing stigma and increasing access. He spotlighted the VA’s “Digital Divide” program, which distributes internet-connected tablets to rural veterans to facilitate telehealth access.

• The Ranking Member invited veterans on the panel to share barriers to mental health and telehealth access. Mr. Lawson advocated for educating older veterans on using technology like the VA’s mobile app, which enables communication with providers and access to benefits. Ms. Schauer mentioned that many veterans, particularly women and older individuals, are unaware they qualify for VA services. She believed that outreach must be proactive and localized.

• Chairman Barrett agreed and reflected on the importance of changing how outreach is framed, suggesting that questions like “Did you ever serve in the military?” can be more inclusive than “Are you a veteran?”

• The Chairman asked Mr. Kirchner whether his experience with community care had improved since his earlier negative C&P exam. Mr. Kirchner stated that community care had since been excellent and responsive, but he remained concerned that C&P exams were being conducted by unqualified providers who lacked relevant specialty training. He urged the VA to ensure that examiners have appropriate credentials. Chairman Barrett committed to following up with the VA on provider qualifications for outsourced C&P exams.

• The Chairman then inquired whether the VA had explored outreach to veterans’ spouses to encourage engagement with mental health care. Dr. Zomchek agreed that spouses are often key influencers in care decisions and stated that the VA does not turn away inquiries from family members, though he would follow up with more details on formal outreach initiatives.

• Ranking Member Budzinski asked Ms. Schauer to speak specifically about challenges facing women veterans in rural areas. Ms. Schauer said that military sexual trauma (MST) and past negative experiences with the VA have made many women hesitant to seek care. She explained that once women return to the VA and experience improvements, they often become advocates, but outreach and trust-building remain critical.

• Chairman Barrett voiced his support for testimonial-driven outreach to women veterans and reflected on the transformation of the VA since the early 2000s. He praised the facility and community in Urbana, Illinois, and echoed that Congress should serve as an advocate for constituents, not a messenger for bureaucratic processes. He spoke on the urgency of preventing veteran suicide and improving access to care and benefits across the board.

• Ranking Member Budzinski emphasized that the testimony provided would help inform the work ahead in Washington. She reiterated the importance of integrating technology into the rural veteran experience, especially in areas like scheduling and EHR modernization, and affirmed her commitment to continuing this critical work in partnership with the Chairman.

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