WASHINGTON — Veterans Affairs Secretary Denis McDonough is expected today to recommend the closure of hospitals and outpatient clinics from Massachusetts to South Dakota in the biggest effort to reconfigure the nation’s largest health care system since its created after the First World War.
The proposal calls for the closure of three major VA hospitals, McDonough said last week. Although he did not give specifics, the sites are in the Brooklyn neighborhood of New York; Northampton, MA; and Chillicothe, Ohio, according to congressional aides and published reports.
In addition, 174 outpatient clinics would close, according to Veterans of Foreign Wars, who were briefed on the plan. But the VA would replace some of the closed facilities with 140 clinics offering specialized care, two dozen nursing homes and a dozen residential facilities specializing in substance abuse issues.
The effort aims to address a major shift in the veteran population from the Northeast, Midwest and parts of the rural West to warmer areas of the Sun Belt and Southwest. It also aims to advance a long-sought realignment by some VA leaders and conservatives that would radically reshape a health care system that serves 9 million veterans but has failed to modernize alongside its counterparts. from the private sector.
But the plan is also expected to spark a politically explosive battle over which closures are ultimately approved and extensions are allowed, similar to fights over military base closures in the 1990s that turned into power skirmishes. Rep. Nicole Malliotakis, RN.Y., held a rally on Sunday outside the Brooklyn Medical Center, which the plan said would consolidate services with the Manhattan hospital and eventually contract with private providers, the official said. legislator’s office.
South Dakota’s Republican congressional delegation has pledged a fight to save three underused clinics that, if approved, would close or have their services reduced.
“I will fight like hell to make sure South Dakota veterans get the care they deserve,” Sen. Mike Rounds said in a statement released with two fellow South Dakota Republicans, Sen. John Coin and Rep. Dusty Johnson. Former VA secretary Bob McDonald had decided to close one of the clinics in Hot Springs, but the Trump administration reversed the decision.
Details of the plan, some of which were first reported by the Military Times, will be officially published today in the Federal Register. Any closures and new construction will take years and must be approved or modified by a new congressional commission that will hold hearings in affected communities over the next year.
The VA has come under sustained pressure in recent years for having relied for generations on an expensive model of inpatient care, while private hospitals have shifted to much more outpatient treatment as medical advances reduce the need for hospital stays. the hospital.
In some places, VA hospital wards have empty beds and more staff than patients on any given night, and many buildings are so old that fixing them would cost more than replacing them. The Chicago VA hospital’s heating system is so old and poorly regulated that on a visit in December, McDonough said, it was so hot he thought he had contracted the coronavirus. A vacant historic building on the Chillicothe campus has a sapling growing through the walls.
VA officials recognize that while the medical needs of older veterans will increase in the coming years, much of the system’s health care is delivered in the wrong places. Veterans are leaving New England, for example, where its population is expected to drop 18% over the next decade. At the same time, their presence in the South West is expected to increase by 25%, without enough facilities to process them.
Part of the drive to realign how and where the government-run system cares for veterans is ideological. The agency has already redirected billions of dollars from veterans’ hospitals to private health care providers in a controversial transformation that has accelerated under the Trump administration; about a third of veterans enrolled in the system are now seen by private doctors. The proposals released today are seen as likely to stoke tensions between advocates for more private care and wary unions who fear that care at some closing facilities will instead be provided by non-VA doctors, the government paying the bills – at a cost to federal jobs.
McDonough, presenting his plan late last week at a Rand Corp. veterans policy center, said the changes would meet the “needs of 21st century veterans, not the needs of a veterans’ system.” health built 80 years ago”. He called the proposals “investment in VA, not retirement” and said 150,000 more veterans would have tighter access to primary care and 370,000 more to specialty care than they currently have.
“Across the board, we’re embracing the idea that health care has evolved,” McDonough said, “and VA needs to lead the evolution.” He promised that his management team is “actively working” to retain healthcare jobs and predicted that “we are looking at more jobs over time, not fewer”.
Opposition to the plan has already come from lawmakers in both parties, many of whom voted for a 2018 law, known as the Mission Act, which included the review as part of a broad expansion of alumni access. combatants to private doctors. The law passed Congress with wide margins in both parties, but that didn’t stop lawmakers whose districts could lose their service from preparing for a long battle.
“These are sacred cows,” said Louis Celli, a former executive director of the American Legion who now co-hosts a podcast focused on veterans’ issues with former VA Secretary David Shulkin. “Every lawmaker is proud to have a big, shiny veterans hospital in their district.”
The American Federation of Government Employees, which represents 280,000 healthcare workers from doctors to physical therapists, decried what it said would be a dangerous shift towards more private care.
“Closing VA facilities will force veterans to rely on uncoordinated, private, for-profit care, where they will suffer long wait times and be deprived of the unique expertise and integrated services that only the VA provides,” said union national president Everett Kelley. , said in a statement.
Some veterans groups said they were keeping an open mind about the proposed changes
“A lot of people see this as a way to reduce VA,” said Patrick Murray, legislative director of Veterans of Foreign Wars. “We knew there would be closures, but we also think it will be a net gain.”
Earlier this month, the White House released a list of nominees for the commission to review the proposal. The nine-member panel, known as the Assets and Infrastructure Review Board, once confirmed by the Senate, will have one year to review the plan, hold nationwide hearings in affected communities and send its proposals to the White House. Biden can sign them and send them to Congress, or reject them. Congress must accept all or none of the changes. Lawmakers should vote to reject proposals to stop them; no action means they would come into effect.