Republican architects of the VA MISSION Act want to fast-track a commission that would have expansive authority to close VA hospitals.
By Suzanne Gordon & Russell Lemle for The American Prospect
At a June 20 House Committee on Veterans’ Affairs hearing, legislators considered H.R. 3083, sponsored by ranking member Phil Roe (R-TN). One of the architects of the VA MISSION Act of 2018, Roe is an ardent supporter of shifting the care of veterans from the Veterans Health Administration (VHA) to the private sector.
H.R. 3083 will accelerate privatization of the VHA by changing the launch date of one of the most problematic parts of the VA MISSION Act—the Asset and Infrastructure Review Commission.
The VA MISSION Act mandates the creation of an Asset and Infrastructure Review Commission whose nine members are appointed by the president. These appointments are supposed to include at least three members of veterans service organizations (VSOs), as well as health-care industry representatives and other key stakeholders. At the signing ceremony for the MISSION Act, President Trump insisted he would not be bound by this provision, while simultaneously praising the legislation.
The president is expected to submit nominations for Senate approval by May 2021, and the commission is supposed to meet during 2022 and 2023. Whatever its composition, the commission will compile a list of facilities to “modernize or realign”—shorthand for closing, consolidating, or reconfiguring VHA facilities. It resembles the Base Realignment and Closure process for military facilities. The entire list of facilities to be “modernized or realigned” must be voted up or down quickly by Congress, leaving legislators with no input about which facilities should be closed. Because of its dangers, Senators Joe Manchin (D-WV) and Mike Rounds (R-SD) introduced legislation to do away with the commission entirely.
Roe, who is opposed to the Manchin-Rounds legislation, instead proposes that the AIR commissioners be appointed and meet before 2021. In so doing, he is reneging on promises made to veterans service organizations like the Disabled American Veterans (DAV) assuring that he would “greatly expand the entire AIR timeline to allow VA sufficient time to gather needed data, complete local capacity and commercial market assessments, and stabilize community care efforts.”
Roe’s failure to stand by this commitment is easily explained. If the start and meeting dates set out in the legislation are maintained, the commission could—depending on the outcome of the 2020 elections—be nominated by a Democratic president and its deliberations determined by newly elected legislators committed to improving rather than dismantling the VHA.
Veterans service organizations like the DAV, Veterans of Foreign Wars (VFW), and Vietnam Veterans of America (VVA) are opposed to any acceleration of the AIR Commission. In written testimony for the hearing, the Deputy National Legislative Director of the DAV, Adrian Atizado, stated that “if H.R. 3083 were enacted, and Secretary Wilkie were to accelerate the AIR process as he has repeatedly indicated his desire to do, it would fundamentally undermine the dynamic structure of the VA MISSION Act by forcing premature decisions on infrastructure before decisions on health care delivery have been finalized.”
Ironically, Congressman Roe himself has articulated how critical deliberations about the VHA’s future should be conducted. The process, he recently commented, should be a “bipartisan, objective, data-rich, and veteran and community-driven process to provide VA with critical recommendations about how VA’s medical centers and clinics can be brought into the 21st century to ensure that veterans receive the best possible care from their government.”
The passage of H.R. 3083 would assure precisely the opposite. Premature—and even reckless—closure decisions will take away health-care choices from veterans, send them to more expensive private-sector providers who lack the expertise to treat veterans, decimate affiliated medical schools, and have huge economic impacts on local communities.
Decisions about closures may also be made biased by misinformation put out by VA leadership itself. In a recent Senate Veterans’ Affairs Committee hearing, the Trump administration’s acting administrator of the VHA, Richard Stone, gave us a preview of the kind of “objective, data-rich, veteran-driven” process that would result if President Trump is given the opportunity to appoint the AIR Commission. Responding to a question about which facilities should be improved, Stone spotlighted the San Francisco VA Medical Center at Fort Miley, where, he said, “we have a beautiful site on the top of a mountain but there’s not a veteran in San Francisco in that area. They have to drive about two hours to get to us. Are we in the right location?”
In fact, the San Francisco VA Medical Center is not located on some remote mountaintop but right in the city. It serves thousands of veterans who live in San Francisco or just a short distance away, and is a hub of VHA research, teaching, and clinical care.
If facilities like this are closed, testimony by the Veterans Healthcare Policy Institute points out, “veterans receiving care at a closed facility would not transfer to another VA. In nearly every case, other facilities are too far away. … Instead, veterans at the closed facility would be automatically given vouchers for Veterans Community Care Program (VCCP) services, without any assurance or knowledge about whether waits are shorter or quality equal or higher than that provided in the VHA.”
As Atizado respectfully reminded the House Committee on Veterans’ Affairs: “Decisions on how VA will ensure the delivery of health care to millions of veterans must be made first, and only after new demand patterns have stabilized should decisions be made about the future alignment of VA infrastructure to deliver that care.”