Veterans Affairs Secretary Denis McDonough speaks during a press briefing at the White House, Thursday, March 4, 2021.

Veterans Affairs Secretary Denis McDonough speaks during a press briefing at the White House, Thursday, March 4, 2021. Andrew Harnik / AP

Biden Signals He Wants to Expand VA's Footprint, Misses Deadline to Nominate Commissioners to Review It

White House is pushing big investment in veterans' medical facilities as commission initially designed to recommend consolidations takes shape.

The Biden administration is showing little interest in shuttering Veterans Affairs Department medical facilities as part of a years-long review process, instead suggesting it will modernize existing centers and build new ones. 

The White House is pushing for an $18 billion investment in VA infrastructure, most of which would go toward replacing outdated medical centers. The department is looking to take on those projects concurrently to an outside commission’s work on determining the future of VA’s physical footprint. Congress required the review as part of the 2018 VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act that created a process similar to the base realignment and closure process at the Defense Department, though there is no requirement for the VA commission to recommend consolidations. 

On the contrary, the Biden administration appears to be pushing for the forthcoming Asset and Infrastructure Review Commission to take a growth-oriented approach. C. Brett Simms, head of VA's Office of Asset Enterprise Management, said at two recent congressional hearings the White House's proposed $18 billion infrastructure investment would merely be a "down payment" on the work needed to expand health care access to veterans. That work, Simms said, would “align” with the AIR Commission’s recommendations. 

While VA met its required timeline to submit final criteria upon which decision makers will determine the future of department facilities, Biden has blown past a deadline to name nominees to sit on the commission. A White House spokesperson declined to comment on the missed date, pointing only to comments VA Secretary Denis McDonough made before the House Veterans Affairs Committee on Wednesday.

“The next thing we have to do is submit our commissioners,” McDonough said. “We are in the process of doing that. We’re waiting on a couple of people on the Hill to get their people too and we’ll put those people out there.” The MISSION Act required VA to consult with lawmakers and others on the nominees. 

Early next year, McDonough will submit recommendations on the “modernization and realignment” of department facilities to the commission made up Biden’s nominees. The commission will then have a year to review that plan, conduct its own hearings and investigations, make its own proposals and send them to the White House. Biden can then reject the plan or sign off on it and send it to Congress. Similar to previous Base Realignment and Closure efforts at the Defense Department, Congress will have to accept all of the recommendations or none of them. Lawmakers must proactively vote down the proposals to void them, however, as inaction would allow them to take effect.

The White House, VA and congressional Democrats are moving forward with investments in VA facilities ahead of that timeline, with both the House and Senate holding hearings on Biden’s $18 billion proposal. 

“Given the severity of underfunding as it relates to VA’s capital assets, we cannot afford to wait for the AIR Commission to provide recommendations to Congress and the White House,” said Rep. Mark Takano, who chairs the House Veterans Affairs Committee. “Life and safety issues must be addressed now.”

Investment proponents may encounter pushback as they move forward with the potential new funding. Rep. Mike Bost, R-Ill., the top Republican on the House VA panel, expressed skepticism about moving on spending ahead of the AIR Commission, saying the department should focus on basic maintenance through the regular appropriations process. Sen. Jerry Moran, R-Kansas, Bost’s counterpart in the Senate, said Biden’s proposal came at a “chaotic” moment. He, too, appeared to favor waiting for the commission to make its recommendations before making further investments and suggested VA’s workforce could not handle the cash infusion anyway. 

VA has since 2018 engaged in market assessments as it seeks to fully understand what and where services are available through its own facilities, other government centers (such as the Defense Department and Indian Health Services) and in the private sector. It is also conducting "listening sessions" with veterans across the country to ask about their needs and identify where facilities may have become obsolete. The department has engaged with veterans service organizations and held briefings with congressional offices. 

The MISSION Act won broad bipartisan support and backing from most veteran service organizations who saw a need for expanding VA’s capacity to send veterans to the private sector for care and to refocus the department’s resources after a nationwide scandal over secret waitlists came to light in 2014. Lately, the conversation has focused more on expansion than contraction. 

The commission process “cannot be made into an effort to blindly close facilities or scale back services for veterans,” Sen. Jon Tester, D-Mont., said on Wednesday. “Under Secretary McDonough, I don’t think that will happen.”

Darin Selnick, who worked for more than two years in the Trump administration—first in the White House as a VA adviser, where he helped usher through the MISSION Act and the AIR Commission, and later at VA itself—generally agreed with Tester. 

“It’s not about closing,” Selnick said. “The recommendations have to be focused on: how do you provide the best health care possible for veterans and what does that look like?” 

Selnick, a long-time advocate for increasing the role of the private sector in providing VA health care, acknowledged that he would not like to see all VA facilities survive. 

“It now has obsolete medical facilities that are not where veterans are," he said. "As long as there are veterans in the area, you won’t close down the place."

Selnick has returned to his former employer, Concerned Veterans for America—a group closely aligned with and funded by conservative organizations—which is lobbying to pump the brakes on new infrastructure investments. 

“While we know the VA has an outdated health care infrastructure, infusing $18 billion in new VA spending into the health care system prior to the AIR Commission process is a piecemeal approach,” Nate Anderson, the group’s executive director, wrote in a letter to the White House. “A massive spending spree at the VA will not solve the challenges the VA is facing to modernize and deliver 21st century care to a changing veteran population.”

Democrats, meanwhile, are pushing to include a hiring surge as part of infrastructure funding for VA. 

“VA can improve buildings or build new facilities,” Takano said, “but if VA does not have the workforce to staff them then it cannot deliver on our promises to veterans.” 

McDonough expressed confidence he can eventually bring all sides together on the future of VA and the fate of the AIR Commission’s recommendations. 

That agreement, he said, will come “not because we sneak it through customs and surprise everybody but because we’ve all come to some kind of consensus on this.”  He added he is taking his responsibilities seriously and vowed to “not just to do this well but do this transparently.”

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.