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On The Hill - Realignments & Closures For The VA?

Reprinted from PN/Paraplegia News January 2018

Many facilities are now in serious decline simply because they weren’t upgraded or modernized and because Congress continues to provide inadequate funding for the VA’s infrastructure needs. Now, many of those facilities face the possibility of closure because of that neglect.

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Last fall, the House Committee on Veterans’ Affairs presented a new plan for reviewing the physical infrastructure of the Department of Veterans Affairs (VA). Properly titled as the VA Asset and Infrastructure Review (AIR) Act for 2017, the legislative proposal is really an idea that only the Department of Defense (DOD) has been subject to — Base Realignment and Closure (BRAC). The idea of BRAC provokes a strong reaction from those who have participated in the process. Interestingly, the House VA Committee has repeatedly tried to draw the conversation away from this proposal being described as BRAC, despite the fact that the legislation very closely mirrors the original BRAC statute for the DOD. 

Assessment Needed

There’s no doubt the VA capital infrastructure footprint needs assessment and realignment to properly meet the demand for health care across the
entire system. 
As emphasized in The Independent Budget Policy Agenda for the 115th Congress, coauthored by Paralyzed Veterans of America (PVA), Disabled American Veterans and Veterans of Foreign Wars and released in January 2017, the VA must make a concerted effort to right-size its infrastructure, in light of the amount of unused and underutilized capacity in the system. It’s important to note that the Commission on Care addressed the need for an asset review process in its final report released in 2016. In fact, the commission report explicitly stated:

“Congress should enact legislation, based on DOD’s BRAC model, to establish a VHA [Veterans Health Administration] capital asset realignment process to more effectively align VHA facilities and improve veterans’ access to care.”

However, PVA has serious concerns that a BRAC-modeled process isn’t the most effective way for the VA to realign its capital footprint. This is the position PVA took on the commission’s recommendation in 2016 and that position has not significantly changed since then.

That being stated, PVA generally supports the intention of this proposal, assuming the purpose is to right-size the VA and not simply use the opportunity to reduce the footprint of the VA for the goal of fulfilling a promise for greater community care access and cutting spending. 

Fundamental Differences

PVA is also concerned that fitting a BRAC model to the VA presumes that the nature of the VA health care system isn’t fundamentally different from the DOD base alignment that was considered during its own process. This proposal ignores the fact that the DOD BRAC addressed a static military population and simply consolidated and moved units to fit its planned infrastructure alignment. It was relatively easy, though not politically, to simply move military families to new locations to support the force realignment. This fact doesn’t apply to the VA health care system and the population it serves. Decisions to close or downsize a VA medical facility will have a direct impact on the veteran population being actively served in that select-ed community. 

PVA also questions what the impact of initiating a BRAC process will be on current major and minor construction activities at the VA. When the VA initiated its Capital Asset Realignment for Enhanced Services (CARES) process nearly 15 years ago, the most devastating result of this process was the moratorium placed on virtually all construction for a two-year period while the process was conducted. Arguably, the VA’s infrastructure is in the condition it is in now because no new resources were invested in the system during that time. Additionally, Congress has compounded that problem every year since that time by woefully underfunding the major and minor construction requirements of the VA. Many facilities are now in serious decline simply because they weren’t upgraded or modernized and because Congress continues to provide inadequate funding for the VA’s infrastructure needs. Now, many of those facilities face the possibility of closure because of that neglect. 

SCI/D Consideration

While this process will almost assuredly focus on areas that can be targeted for closure, serious consideration must be given to the spinal-cord injury and disease (SCI/D) system of care at the VA and particularly long-term care capacity. While there are some in the VA leadership who would like to get the VA out of the business of long-term care, this isn’t an acceptable proposition for PVA and its members. The aging SCI/D veteran population will live longer than past generations and is overwhelming the VA system, forcing veterans to live in institutional nursing facilities that aren’t designed to safely accommodate their special needs. PVA wonders what will become of SCI/D projects currently underway while this process is executed across the VA. In the end, quality, accessible health care continues to be the focus for PVA and its partners in the veterans service organization community. In order to achieve and sustain that goal, large capital investments must be made where appropriate. PVA hopes this will be one of the key outcomes of this asset review process.

On The Hill is written for PN by the PVA Government Relations Department in Washington, D.C.

 

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On The Hill - Realignments & Closures For The VA?

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