Military veterans in Maine and across the nation have been waiting more than a year for the announcement that came late last week from the U.S. Department of Veterans Affairs: Secretary Anthony J. Principi’s formal acceptance of a comprehensive plan to restructure the VA’s health care system.

In parts of the country where veteran populations are dropping, facilities may be closed and their funding reallocated to other areas. But in Maine, if the Capital Asset Realignment to Enhance Services, or CARES, is approved and funded by Congress, it would mean greater access to primary care services through an expanded network of community clinics and providers.

The plan also establishes a goal of creating federal contracts with hospitals throughout the state so vets needing surgery or other inpatient care are no longer solely dependent on the facilities at the VA hospital in Togus.

Maine vets could obtain care at new outpatient clinics in Houlton, Dover-Foxcroft, Lincoln, Farmington and South Paris. Clinics now exist in Bangor, Caribou, Fort Kent, Calais, Rumford, Saco and Togus.

CARES also calls for an increase in the number of medical specialists employed at Togus, expanded use of telemedicine technology in Maine’s rural areas, and contracts with non-VA providers of mental health and medical specialty services.

Only about 30,000 of Maine’s 150,000 veterans currently make use of VA medical benefits, but recent manufacturing layoffs, the aging of the veteran population and a new generation of combat-seasoned troops mean the numbers are likely to rise.

There is no specific timeline for the changes, but Togus-based VA officials said Wednesday they’re developing a plan that will address the most pressing needs first.

As part of Region One of the Veterans Integrated Service Network, Maine is also affected by plans to restructure the system in other New England states. Most notably, CARES recommends a study of the feasibility of closing four outdated hospitals in the Boston area and replacing them with a single facility. Maine vets are typically referred to Massachusetts for complex medical conditions or procedures that are beyond the scope of the Togus facility.

Ron Broder, president of the Maine chapter of Disabled American Veterans, said the changes will improve services for vets living in Maine’s rural areas. “Adding outpatient clinics and putting them close to where the people are is a really good idea,” he said. Broder said Maine veterans groups worked closely with CARES developers to identify the state’s needs and credits veterans around the country for organizing a powerful, coordinated response to the federal initiative.

Nationwide, the plan calls for closing hospitals in Pennsylvania, Ohio and Mississippi and building new medical centers in Colorado, Florida and Nevada. More than 150 community-based outpatient clinics are also recommended, as well as four specialized facilities for treating spinal-cord injuries, two for rehabilitating visually impaired vets, and increased services for veterans with mental health conditions.

“VA’s infrastructure is old,” Principi noted in his written remarks. “Congress has been reluctant to fund modernization without a coherent national plan defining the infrastructure we will need in the decades to come. CARES is that plan, and the VA will now be able to move forward to modernize and renovate our facilities.”

Principi noted that the VA spends millions each year maintaining over 8 million square feet of vacant space. Under the provisions of CARES, he said, unused space would be cut nearly in half and the cost of that maintenance reduced from an estimated $3.4 billion to $750 million for the years 2006 to 2022. The money saved, he said, can be redirected to patient care.

But what Principi calls a “watershed investment in the future of the VA health system” comes with a watershed price tag – an estimated $6 billion or more. The Bush administration has submitted a VA budget proposal for next year of $26.9 billion, only slightly more than last year’s budget and amounting to a net funding decrease when rising costs are taken into consideration. Critics say that trend means the much-needed infrastructure overhaul won’t ever get off the ground.

Maine’s U.S. Sens. Olympia Snowe and Susan Collins have requested $29.8 billion, $2.9 billion more than what they term the administration’s “modest proposal.”

Collins and Snowe also have requested $150 million for the State Veterans Homes grants account, which provides funding for Maine’s state veterans homes in Caribou, Bangor, Augusta, South Paris and Scarborough.

The legislation that would implement the CARES plan was submitted to Congress earlier this week along with related budget requests. Lawmakers have 60 days to consider the initiative.

The CARES plan can be read on the VA’s Web site, www.va.gov/CARES.