Senators from Rural States Trying to Stop Wave of VA Hospital Closures Before They Start

Senators from four states have introduced legislation to dismantle a commission tasked with studying the Department of Veterans Affairs' hospital system and making recommendations on consolidation and closures of facilities.

West Virginia Sens. Joe Manchin, a Democrat, and Shelley Moore Capito, a Republican, joined senators from New Mexico, South Dakota and New Hampshire to support a bill that would eliminate the VA Asset and Infrastructure Review Commission, saying the process favors suburban and urban areas over rural sections of the country.

According to a report released in March, the department recommends closing 17 medical centers and dozens of aging or underused clinics and rebuilding or constructing 30 new hospitals and 225 clinics, rehabilitation centers and nursing homes.

The medical centers slated for closure include areas where the veteran population is expected to decline, while new facilities would be built in regions where veterans are relocating, largely in the South and West.

The $2 trillion proposal calls for the VA to reduce services in West Virginia, close two VA hospitals in South Dakota, and shutter three outpatient clinics and two additional facilities in New Mexico.

"The VA MISSION Act and its BRAC-style process called the AIR Commission were bad public policy when I voted against them in 2018, and they have not improved with age," said Sen. Mike Rounds, R-S.D., in a press release Tuesday, referring to the Defense Department's commissions that closed or consolidated military installations between 1988 and 2005. "The AIR Commission should be called the ERROR Commission."

"Our veterans have put their lives on the line to protect our nation and deserve easy access to the healthcare they have earned," Manchin said in a statement. "The VA's recommendations to the AIR Commission are skewed against rural states like West Virginia."

The commission was created in 2018 as part of the VA Mission Act, an audit to determine which of the VA's facilities and programs are underutilized or inefficient and which ones need expansion or other improvements.

A nine-member commission is due to hold public hearings on the proposal and review the VA's plans as part of the process. An updated set of recommendations from the commission including acceptance or rejection of the VA's plans as they stand are due in February 2023.

The process has been delayed, however, with the Biden administration in March nominating eight people to serve on the commission, at least three months later than originally planned. The ninth member, who is supposed to be nominated by Senate Republican leaders, has not yet been named.

All must be confirmed by the Senate.

VA Secretary Denis McDonough has said the reforms are needed to provide top-of-the-line health care to veterans in updated, state-of-the-art facilities to "meet the needs of 21st century veterans, not the needs and challenges of veterans in a health care system built years ago."

He also has expressed concern, however, that much of the review was conducted before the pandemic and does not take into account the past two years of VA health care utilization.

"I have no pride of authorship here. If the data has moved in an appreciable way, I think the commission should update the recommendations to reflect it," McDonough said during a hearing before a Senate Appropriations Committee panel May 4.

Once the commission makes its recommendations to the White House, President Joe Biden has until Feb. 15, 2023, to approve or reject them. If they are not approved, the commission may revise them and submit them back to the president by mid-March 2023.

If the president approves the recommendations, Congress has 45 days to block them.

Rounds and Manchin introduced a similar bill to eliminate the Asset and Infrastructure Commission in 2019, but it never was considered by the Senate Veterans Affairs Committee.

Democratic Sen. Maggie Hassan of New Hampshire joined the senators in supporting the bill to eliminate the commission. Hassan, whose state does not have a full-service Veterans Affairs medical center, sent a letter to McDonough in March asking the VA to refrain from altering its health services in New Hampshire and Vermont.

"When we spoke a few months ago in this committee, you supported VA facility upgrades in New Hampshire," Hassan told McDonough during a Senate Veterans Affairs Committee hearing March 29. "But the VA's recommendations to the AIR Commission risk moving in the opposite direction."

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