WASHINGTON, D.C. — North Dakota organizations have submitted letters of support for a federal bill that would improve veterans’ access to local health care options, which has been examined by the Senate Veterans’ Affairs Committee.

The bill – the Critical Access for Veterans Care Act – from Sen. Kevin Cramer and Sen. Tim Sheehy would allow veterans living in the rural United States to seek health care services at their local critical access hospitals or rural health clinics, a press release said.

“The Community Care program literally can be a lifeline,” said Cramer, R-N.D. “(What) prevents it from being a lifeline as often as it ought to be is all of the roadblocks that get put up. After hearing from veterans and rural health care providers and leaders across North Dakota, I proposed a solution with Sen. Sheehy to simplify access to the critical access network, whether it’s a critical access hospital (or) rural health clinic.”

Cramer and Sheehy’s (R-Mont.) bill would amend the VA (Veterans Affairs) MISSION Act of 2018 to make a new category under which “care is required to be furnished through community providers, specifically for care sought by a veteran residing within 35 miles of the critical access hospital or rural health clinic,” the release said.

The release also said a number of veterans live in rural areas and face major challenges to accessing timely and quality health care. In North Dakota, there are 37 critical access hospitals, but only five of those communities housing them also have a VA community-based outpatient clinic. The state has one VA medical center in Fargo and eight community-based outpatient clinics in total.

The bill has received letters of support from the North Dakota Rural Health Association and a coalition of 22 North Dakota rural health care providers, the release said, who wrote that the legislation will offer a streamlined and practical approach building on existing infrastructure and recognized designations in rural health care. The American Hospital Association, America’s Warrior Partnership and the National Rural Health Association have also voiced support for the bill.

Another letter of support for the bill has come from Marcus Lewis, CEO of the North Dakota Veteran and Critical Access Hospital. A veteran himself, he said he lives more than three hours from the nearest VA hospital and works two hours away from it. However, there are three community health care facilities within 50 miles of his home.

“Despite the availability of this high quality local care, I am currently paying out of pocket for needed therapy because accessing services through the Community Care Network has proven prohibitively difficult,” he wrote.

Cramer said the VA system gives veterans less access to care that is readily available, and the goal of the bill is to give rural veterans access to their local critical access hospitals without strings attached.

“I worry if the bill is watered down, quite honestly, that we turn the authority back over to the bureaucracy to decide,” he said.

Our newsroom occasionally reports stories under a byline of “staff.” Often, the “staff” byline is used when rewriting basic news briefs that originate from official sources, such as a city press release about a road closure, and which require little or no reporting. At times, this byline is used when a news story includes numerous authors or when the story is formed by aggregating previously reported news from various sources. If outside sources are used, it is noted within the story.

North Dakota lawmakers are exploring using telemedicine technology to ease staffing strains on rural emergency medical services, a potential solution to a growing shortage of paramedics and volunteer responders across the state.

Though some solutions were floated and passed during the 2025 legislative session, lawmakers are working to understand the scope of the problem before proposing additional legislative changes in 2027.

The state has been facing a societal decline in volunteerism, which strains traditional volunteer firefighter and emergency medical services that support rural communities, said Sen. Josh Boschee, D- Fargo. Adding to pressure, when a rural ambulance service shuts down, the responsibility falls to neighboring ambulance services to answer calls in the defunct ambulance service’s coverage area.

How could telemedicine ease strains on rural EMS staffing?

One idea presented to the Emergency Response Services Committee on Wednesday to potentially alleviate some of the stress on rural ambulances is expanding access to technology in the field for emergency medical personnel.

Emergency medicine technology company Avel eCare presented to the committee its system, which allows ambulance personnel to be connected by video with emergency medicine physicians, experienced medics or emergency nurses in the field wherever there is cell reception. The company already operates its mobile service in South Dakota, Minnesota, Nebraska and Kansas, according to the company’s presentation.

Avel eCare said this allows medics and paramedics to have any questions they have answered and provides a second person to help document actions taken when there is only one person in the back of an ambulance with a patient, which they say is increasingly common in rural areas. This allows one medic or paramedic to put more focus on the patient.

The company said it is innovating the ability to also bring medical personnel into the call from whatever care center the ambulance is heading to, allowing the care center to better prepare for the ambulance’s arrival.

Lawmakers said they were interested in the system and could see how it would provide a benefit to thinly stretched EMS personnel.

Boschee said the state should consider funding the system, citing its potential to support local EMS providers and help retain volunteers.

Avel eCare did not provide a cost estimate for North Dakota, but offered South Dakota as an example. That state used general fund dollars to provide the Avel eCare service free of charge to agencies. The state paid $1.7 million in up-front costs for equipment — enough to outfit 120 ambulances — and an annual subscription cost of $937,000 to provide their services to 109 ambulances serving 105 communities in the state.

“I think specifically … how affordable that type of solution is for us to not only support our local EMS providers, but also to keep volunteers longer,” he said. “Folks know that they have that support network when they’re in the back of the rig taking care of a patient. That helps add to people’s willingness to serve longer. And so I think that’s a great, affordable option we have to look at, especially as we start going in the next couple months and continue to talk about rural health care transformation.”

Rural EMS shortages go beyond pay, state officials say

There are 28 open paramedic positions in the state, according to Workforce Services Director Phil Davis’ presentation. The difficulty in filling these positions is not just about money, though that certainly plays a factor in recruiting people, his report said.

“I’ll just speak from my experience with my own agency,” Davis said. “After 18 years, it’s very hard for us to even recruit individuals into Job Service North Dakota because of the lower wages.”

Davis showed that 2024 salaries for emergency medical technicians were fairly even across the eight regions Workforce Services breaks the state into, with a roughly $6,500 gap between the highest and lowest averages. Law enforcement officer pay varied by about $8,320, while firefighter salaries were the biggest outlier, with a $20,000 difference between regions. While state wages may lag nationally, other factors are making rural recruiting particularly difficult.

Davis said it was largely a lifestyle change; people are not seeking to live rurally as often.

“We’re starting to see the smaller communities, for the most part — not all — starting to lose that population. And it is tougher to get individuals to move there or to be employed there,” Davis said.

Job Service North Dakota is holding job fairs to try to recruit more emergency services personnel, with some success, he said, and has nine workforce centers across the state working directly with small communities to help with their staffing shortages.

Davis advocated for more education in schools about career paths in emergency services and the openings that are available in the state.

© 2025 The Bismarck Tribune (Bismarck, N.D.). Visit www.bismarcktribune.com. Distributed by Tribune Content Agency, LLC.