The future of veterans' health care across the U.S. may be getting its trial run up in Alaska, a state one-fifth the size of the lower 48 and with more veterans per capita than any other state.
Alaskan veterans, many of whom live in remote areas, are increasingly getting health care at hospitals and clinics operated by the Indian Health Service.
"We now have  agreements with tribal providers," Sen. Mark Begich, D-Alaska, told Senate and House lawmakers on Wednesday. "Each is a unique agreement that saves veterans from traveling thousands of miles [for care]."
Begich, one of a number of lawmakers working on a compromise bill intended to speed up health care delivery to the nation's veterans, is championing the Alaska system as a national model.
The lawmakers are working on legislation against a backdrop of scandal at the VA, where investigators have confirmed systemic abuses of appointment scheduling, including in Phoenix, Arizona, where 35 veterans on a secret wait list died before getting to see a doctor.
Among provision in legislation drafted by Sen. Bernie Sanders, I-Vt., and Sen. John McCain, R-Ariz., is one to expand the pool of providers available to veterans by enabling them to access Indian Health Service, or IHS, facilities.
Under the arrangement, non-Native American veterans could get care in the facilities and the VA would reimburse the costs.
"The Alaska experience was absolutely a factor for including [that] language" in the bill, Sanders spokesman Mike Briggs told Military.com on Thursday.
Begich told lawmakers in conference committee that when the idea of utilizing IHS care was first raised some veterans service organizations were leery, but that's no longer the case.
Gerry Glover, a state veterans' service officer for the Veterans of Foreign Wars in Alaska, called the arrangement "a great step in the right direction."
"It's been a slow process over the last couple of years to get information out there [on the agreements] but veterans are now starting to get into some of the rural native health care facilities," he told Military.com.
Begich spokesman Josh Stewart said more than 200 village and tribal health programs are included in the agreements to serve veterans.
"We have 26 total agreements, which cover the geographical area of the entire state to include the Aleutian Chain," he said. "Currently there is no specific clinic that is not covered by these agreements. The whole state is covered."
According to the VA, 62 veterans took advantage of IHS healthcare when agreements began taking effect in 2012. In 2013 the number had jumped to 279. As of June 6, 2014, the figure was 273.
As tough a time as the VA has had serving the population in the lower 48 states, Alaska has had even more challenges.
"Eighty percent of the communities are not accessible by roads," Begich said on Wednesday.
Additionally, there is no dedicated VA hospital in Alaska. The VA Healthcare System is a joint venture with the Defense Department operating on Elmendorf Air Force Base, Anchorage. There are also three community-based outpatient clinics, including on Fort Wainwright.
For an area the size of Alaska, that's not a great many resources.
That means travel and expense for a veteran who can only get his health care needs met at a VA facility.
In 2011, when Begich was trying to find new ways to get health care to veterans, he told reporters in the state of one veteran who had to spend $2,000 to travel from his home village to Anchorage for care.
It was then he came up with another idea that has found its way into the McCain-Sanders bill. Begich called it the "Alaska Hero's Card" when he put it into a bill in 2011. It would allow the state's veterans to go to community providers for their care.
The Sanders-McCain bill has a provision for a "Choice Card," that would allow the veteran user to seek care at non-VA hospitals or clinics under certain conditions.
Begich's "hero card" went nowhere. But it was out of talks with the VA on the access to care issue that then-VA Secretary Eric Shinseki was won over to the idea of the VA reimbursing ISH facilities for serving veterans, according to Begich spokesman Josh Stewart.
Begich had wanted a legislative solution, but when that failed came up with an administrative one, he said.
Should the Senate bill pass with the "Choice Card" intact, however, Begich will finally see the act approved by Congress.
During the conference committee meeting, Begich was bullish on offering the Alaska system as a model.
"If it can work in Alaska it can work anywhere in the country," he said.
-- Bryant Jordan can be reached at firstname.lastname@example.org