Meeting VA’s infrastructure needs not a matter of piling on more money
President Joe Biden’s $4 trillion so-called infrastructure package includes $18 billion in new spending for the Department of Veterans Affairs. There is no doubt the VA can find a way to spend this 800 percent increase in its construction budget, but the proposal is short-sighted and fails to consider existing reform efforts already underway.
Congress passed legislation in 2018 to lay the groundwork to modernize the VA’s outdated health care system. June 6 will mark three years since enactment of the bipartisan VA MISSION Act, which includes a provision to realign the VA’s infrastructure. Before the White House rushes into more massive VA spending, everyone would benefit by exercising a little patience.
The solution to the VA’s infrastructure needs is more nuanced than more money and more buildings. It will require innovation, flexibility, leveraging high-quality community providers, and capitalizing on where the VA has clear expertise. This is the purpose of the Asset and Infrastructure (AIR) review process created by the VA MISSION Act: to establish a commission to examine the VA’s current and future infrastructure needs and provide recommendations to Congress and the White House.
VA leadership across the last three administrations — from Bush to Obama to Trump — agree that broad infrastructure reform is long overdue. The bipartisan Commission on Care report recommended key reforms to prevent the VA from repeating the same mistakes of decades past when managing their 6,300 buildings. The VA is struggling to manage an inventory of unused and outdated facilities on top of $51 billion in capital needs to maintain the status quo. If asset realignment happens, that gap can be narrowed by as much as $17 billion.
The veteran population is expected to decrease by 40 percent over the next 25 years. Analysis by the American Enterprise Institute projects drastic shifts in where veterans live. New York, which has 79 VA health care facilities, is expected to see its veteran population decrease by 60 percent over 25 years.
With outpatient care increasingly becoming the focus of health care delivery, policymakers should question if alternative models and a network of millions of community care providers can produce the same or better outcomes for many veterans. The AIR Commission will help the VA make better decisions regarding the right mix of services offered.
As the VA acknowledged in its 2015 report to Congress, “no organization can excel at every capability.” The AIR Commission is an opportunity for the VA to assess its strengths and, more broadly, what health care services it should start, stop, and continue delivering.
Instead of adding $18 billion in new spending to the VA’s record-breaking $260 billion annual budget, the White House should prioritize sending nominations for the AIR Commission to the Senate by end of this month. Additionally, the Senate should act to confirm bipartisan and qualified nominees so they can get to work on recommendations for realigning the VA’s infrastructure.
When the time comes to begin the realignment process after the AIR Commission releases its recommendations, the VA should consider structural reforms to provide greater agility to adapt to changing needs instead of billion-dollar construction projects that can become quickly outdated. This could include public-private partnerships, working with other federal health care facilities, leasing arrangements that shift risk off the VA, or leveraging alternative models like the “Super Community Based Outpatient Clinic.”
A VA infrastructure that delivers quality care to our nation’s veterans should leverage the key strengths of the existing system, while utilizing the Veterans Community Care Program created by the VA MISSION Act. The AIR Commission is a vital step toward creating an integrated health care system focused less on who is delivering the care and more on ensuring veterans can access quality services that meet their individual needs.
Juliana Heerschap is policy director of Concerned Veterans for America. She previously worked on Capitol Hill for nearly a decade and handled veterans’ issues for a member of the House Veterans’ Affairs Committee.
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