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After years of inaction, lawmakers and advocates united in 2018 around an ambitious plan to modernize the sprawling, government-run veterans’ health care system, which still treats many patients in pre-World War II hospital wards.
A commission mandated by Congress that same year was tasked with weighing the recommendations of the Department of Veterans Affairs for each of its 1,200 hospitals and clinics across the country and holding hearings in the communities concerned. Migration of veterans south of the Northeast and Midwest, the shift from expensive hospital to outpatient care, and the age of each building will affect whether facilities are called upon to close, reduce services, or relocate patients to private care. The VA will finally catch up with modern private hospitals, saving billions of dollars in what it spends each year to support its aging healthcare facilities, proponents of the plan say.
But the country’s long-sought restructuring of the country’s largest healthcare system was killed this week by bipartisan political resistance in a brief statement from 12 senators who said they would not approve the nine nominees for confirmation of the Asset and Infrastructure Review (AIR) Commission. . And a costly four-year effort to reposition the VA in an increasingly competitive healthcare market has fallen victim to the principle that just as all politics is local, so is any decision to relocate constituency services as crucial as veterans.
Lawmakers said the VA’s politically explosive recommendations made in March made it impractical to move forward.
“We share a commitment to expand and strengthen VA’s modern infrastructure in a way that fulfills our responsibilities to U.S. veterans,” Senators, led by Senate Veterans Affairs Chairman John Tester (D-Mont), said in a statement Monday. ). “We believe that the recommendations presented to the AIR Commission do not reflect this goal and would put veterans in both rural and urban areas at a disadvantage. The statement says lawmakers have committed to “continuous pressure” to help VA invest in the “21st century [health-care] facilities ”for veterans.
Lawmakers from both parties expressed concerns about a process they believed was flawed from the start. The data the VA relies on to evaluate hospitals is several years old and was collected before the coronavirus pandemic, potentially distorting the number of patients and doctors in the community to appear lower than it actually is.
The White House also delayed nominating the nine-member commission, with the final member announced only last week. This left too narrow a window to complete his work by the start of 2023, MEPs say, as well as uncertainty as to whether the candidate will be under pressure to weigh the recommendations to be confirmed.
But with the suspension of the commission and the overall plan published by VA Secretary Dennis McDonagh with recommendations for building about 80 new clinics, hospitals and nursing homes of various sizes and closing a network of three large hospitals and dozens of clinics with unused inpatient beds, lawmakers left the agency without a plan to modernize the aging system, current and former employees said.
“President Biden insisted that our 21st century veterans should not be forced to care in early 20th-century buildings,” Melissa Bryant, VA’s assistant secretary for public and intergovernmental affairs, said in an email. . She noted that the average age of hospitals in the VA is nearly 60 years. “Whatever Congress decides to do with the AIR Commission, we will continue to fight for the funding and modernization that our veterans deserve,” Bryant wrote.
VA leaders, going back years, said they were burdened by the need to maintain up to 1,000 underused clinics and hospitals, some with more staff than patients, at significant cost. Closing them will require congressional approval.
When the commission was set up as part of the larger Mission Act, conservatives said the government would cut wasteful spending and shift more health care for veterans to the private sector. Democrats, including McDonough, have embraced the opportunity to care for more veterans in the communities where they move.
“We saw this as an opportunity,” said a VA official, speaking on condition of anonymity to discuss a sensitive issue. As a commitment to new investment, Biden asked for about $ 18 billion in new money to build the VA in an early version of its infrastructure plan, although the money was eventually missed by law.
But even before McDonough released its recommendations, members of Congress, who had been informed of possible redundancies in their areas, launched an offensive, with some holding opposition rallies and others issuing defiant statements envisioning the battle to prevent the cuts. The American Federation of Civil Servants, a union representing more than 200,000 VA employees, has pushed Democratic allies in Congress to oppose the dangerous loss of jobs. Republicans, most of whom voted for the Mission Act, became sensitive to local fears that veterans would lose access to doctors as the plan called for the closure or restoration of 35 major hospitals in 21 states.
“This is a complete lack of courage,” Robert MacDonald said of the decision to assassinate the commission, citing the November midterm elections. “It’s clear what’s behind this. Elections are coming. The elections are local. “
MacDonald, who was VA secretary for several years under President Barack Obama, tried to close a rarely used hospital in South Dakota just to see the Trump administration cancel the plan soon after taking office following Sen. Mike Rounds’ objections. , (RS. D.)
Robert Wilkie, the second secretary of President Donald Trump’s VA, also expressed disappointment with this week’s decision. “We need to build a VA where the veterans live now, not where they lived in 1945,” he said in a text message. “The VA dollar is stretching to the breaking point and dissolving the commission is not helping.”
It is unclear whether lawmakers who still support the committee have any options. Representative Mike Bost (R-Ill.), Who along with Senator Jerry Moran (R-Kan.) Opposed the decision, said in a statement Wednesday that he was still considering how to move forward “as required by law”.
“The fact remains that there is a serious and growing discrepancy between the VA health care system as we know it today and how and where it should develop for the future,” Bost wrote.
Darin Selnick, a senior adviser to concerned American veterans who led Virginia’s efforts and later the Trump White House to set up the commission, said the Biden administration had left Virginia to make recommendations without a structure to check, opening the process to political resistance.
“Every time the legislature hears that it can close a facility in its district, they become ballistic,” Selnik said, “but if you had a commission set up, it wouldn’t matter.” He stressed that the VA plan was “just a set of recommendations” that could be changed.
An employee of the American Legion predicts severe consequences of inaction.
“Veterans will lose,” said Chanin Nuntawong, executive director of the government and veterans group. “The old infrastructure needs to be repaired or replaced. Care for veterans will be exacerbated by a lack of technology and unsanitary conditions as construction costs go through the roof. “
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