For years, the veterans hospital at Augusta and outpatient veterans clinics scattered across the state have been swamped – too many vets are seeking medical care and there aren’t enough federal dollars in Maine to meet the need. That could change if a proposal before the federal Department of Veterans Affairs is adopted.

Retired World War II vets with pricey prescriptions to fill, aging baby boomer vets with developing health problems, recently laid-off vets looking to replace their health care benefits, and “low-priority” vets – those without service-related health conditions – all are looking to use the medical benefits promised them when they enlisted. For many, it takes months of waiting to be accepted into the program, and months more to actually see a physician.

Under the proposal, some areas of the country where veteran populations are dropping will lose facilities and funding to other regions. According to a local health care administrator, Maine is “golden” and stands to gain significantly.

The Capital Asset Realignment to Enhance Services, or CARES, plan reflects a three-year study of the VA’s health care services, according to Jack Sims, director of the Veterans Affairs Medical and Regional Office Center at Togus. Sims said interest in restructuring the system grew out of a federal report in 1999 showing the VA spends in the vicinity of a million dollars a day to maintain unused space in its medical facilities in some parts of the country.

But in some places, such as Maine, he said, facilities are overcrowded and understaffed, and vets may wait a year or more before getting the care they need.

The VA study found that only 59 percent of the 36,000 Maine veterans enrolled in the VA health care system can get the primary care they need within the distances established by the CARES commission: 30 miles or 30 minutes from their homes in urban areas and 60 miles or 60 minutes in rural areas.

In addition to maintaining existing VA outpatient clinics in Bangor, Calais, Caribou, Rumford and Saco, the CARES plan recommends new facilities in Dover-Foxcroft, Farmington, Houlton, Lincoln, South Paris and Cumberland County, and an expansion of outpatient services at Togus. These changes would increase the percentage of enrolled Maine veterans within the outpatient travel guidelines to 73 percent by 2012.

Hospital inpatient capacity for veterans also should be expanded, the study found. CARES guidelines recommend access to inpatient hospital services within two hours of travel time, but only 52 percent of Maine veterans live within that distance to Togus, the only inpatient veterans facility in the state.

The plan calls for veteran priority agreements with community hospitals in York County (six beds), Aroostook County (four beds), Cumberland County (eight beds), Androscoggin County (five beds) and Penobscot County (two beds). Capacity at Togus would be expanded by six beds. With these changes, the percentage of Maine veterans within the two-hour guideline would increase to 96 percent by 2012, the study showed.

CARES also calls for an expansion in the number of medical specialists employed at Togus, increased use of telemedicine capabilities, and contracts with non-VA providers of mental health and medical specialty services in outlying communities.

Ron Broder, an officer with the national organization Disabled American Veterans, said there are about 150,000 veterans in Maine and 25 million nationwide, “a healthy voting block.”

Although not all vets enroll in the VA health system, recent corporate and manufacturing layoffs have left many without health care coverage, he said. With servicemen and servicewomen coming back from Iraq, he said, there’s growing pressure on the VA system to live up to its obligations.

Restructuring is “long overdue,” according to Mark Carney of Newport, president of Vietnam Veterans of America Post 185. While he appreciates the changes proposed by the CARES plan, Carney can’t understand why it has taken so long to come up with solutions as simple as contracting with community hospitals and providers to decrease wait times and travel.

Carney said 43,000 Mainers served in Vietnam alone, an aging population that’s waiting “months and months” to be seen for serious conditions such as hypertension, diabetes and cancer.

A new generation of men and women now are serving under “very stressful conditions” in Iraq, he said, and are likely to develop the same service-related mental health problems suffered by many Vietnam veterans.

“We make a promise to take care of these guys as long as it’s required,” Carney said. “Our legislators are quick to send our people over there, but the price tag includes taking care of them when they get back home.”

A price tag for the proposed changes in Maine is not specifically provided in the CARES plan, but a redistribution of existing funding is promised as a beginning. The changes would be phased in over several years, according to Togus director Sims.

The plan has been submitted formally to the CARES commission for review. The commission will make its recommendation to Anthony J. Principi, secretary of the Department of Veterans Affairs, by Nov. 30. Principi must accept or reject the plan in its entirety by the end of the year.

A 60-day public comment period is in effect, and there will be a public hearing in Billerica, Mass., on Monday, Aug. 25. More information is available at the VA Web site: http://www.va.gov/CARES.