The review mandated by a 2018 law will soon kick off a year of potentially divisive
hearings in affected communities, culminating in a recommendation from President
Biden on which closures should move forward, then a vote in Congress if lawmakers
dislike the proposals. Lawmakers must accept all of the changes or none, and would
have to vote to deny the proposals to stop them. If they take no action, the plans would
take effect. The transformation on the table for Veterans Affairs Secretary Denis
McDonough — while a reconfiguration, rather than a contraction overall — will be
among the most politically sensitive of his tenure.
“Today’s veteran population is vastly different from what it was even five years ago, let
alone decades ago,” Russ Duerstine, deputy director of Concerned Veterans for America,
a group backed by the conservative Koch network, said in a statement. “A rigid system
that cannot adapt to the changing and unique needs of the veterans it serves leads to
waste, complications, and ultimately, an absence of care.”
Duerstine’s group came to prominence during the Trump administration with a
campaign to outsource more medical care for veterans and was instrumental in
muscling the review into the 2018 law, known as the Mission Act, which allowed most of
the 9.2 million veterans enrolled in VA care to see doctors outside the traditional system
of government hospitals.
The restructuring McDonough proposed Monday is driven by changing reality for
veterans, the report said: The Department of Veterans Affairs spends billions of dollars a
year to maintain crumbling facilities that impede doctors from giving veterans the best
possible care, and its hospitals increasingly are located in the wrong places.
Almost 70 percent of VA’s health-care facilities were built more than 50 years ago,
and the buildings have a median age of 60 years — compared with 8½ years for private-
sector hospitals. According to the agency’s budget submission to Congress for fiscal
2022, the health system needs $61.6 billion worth of construction today.
“These facilities were not designed to meet modern health care standards, which limits
VA’s agility and ability to meet evolving Veteran care needs, and basic environment of
care expectations,” the report said.
The population of veterans is declining in the Northeast and parts of the Midwest, and
growing in the South and Southwest, changes largely driven by the aging of those who
fought during the Vietnam era and the increasing loss of those from the Korean War and
the World War II generations. Even though the number of veterans is projected to
decline in coming years, they will need more outpatient and long-term support, such as
nursing home care — and they need more extensive mental health resources than VA
offers.
By 2029 and continuing for a decade, the veteran population will include more women
than ever and will become more racially diverse and younger. VA projects that veterans
will continue to live more in rural areas compared with the rest of the population and