Lawmakers Debate Bringing BRAC to VA Health Care Facilities

House lawmakers are pushing for the Veterans Affairs Department to go through a process to close down or realign underutilized medical facilities, similar to the Base Realignment and Closure process at the Defense Department.

The measure would require the VA secretary to assess the department’s current capacity to provide health care in each of its networks and ultimately recommend facilities to close, modernize or realign. The secretary would by November 2018 pass those suggestions along to a presidentially-appointed, Senate-confirmed commission. That panel would submit its recommendations on to the president the following year, who would then have have two weeks to approve of the plan in full, in part or reject it altogether. Congress would then have 45 days to vote down the plan or it would automatically go into effect.

The VA secretary would first have to post guidance on the Federal Register for the metrics by which he would determine whether facilities were underutilized. The secretary must consider whether a site is meeting VA standards, the cost savings from a closure, when those savings would occur, if it would harm VA’s ability to carry out its mission, and input from local stakeholders. The Asset and Infrastructure Review Commission would have 11 members, with each party in Congress suggesting four and the president choosing the rest. The members would have to reach certain qualifications, such as one with experience managing a large, private sector health care system and another with experience in capital asset management in the federal government.

If the president and Congress allowed the commission's recommendations to move forward, then VA would have three years to implement or begin planning for the closures and modernizations. The bill would require the department to provide “outplacement assistance” to all employees at facilities slated for closure.

At a House Veterans' Affairs Committee hearing Thursday, lawmakers acknowledged the political difficulty in moving the Asset and Infrastructure Review (AIR) Act forward.  

“The deck is stacked against the AIR Act,” said Rep. Phil Roe, R-Tenn., who chairs the committee and authored the draft legislation. “This bill is bold, transformative and controversial. Moving forward will require a significant amount of political courage and let’s face it, members are not known specifically for that.”

Democrats on the panel acknowledged Congress must do something to address VA’s excess and misaligned medical facilities, but expressed some reservations about applying a BRAC process to VA. Rep. Tim Walz, D-Minn, the committee’s ranking Democrat, called it a “top priority” to give VA more authority to assess and ultimately realign department resources. He was concerned about the emphasis on cost savings, an overly ambitious timeline and the power entrusted to the president. Many of the 1,400 buildings VA has already identified for closure are vacant—fewer than 20 currently provide medical services to veterans, Walz said—meaning the low-hanging fruit will not deliver much in the way of savings.

Veterans service organizations at the hearings voiced similar apprehensions while supporting the larger goal. Any savings, they said, should be reinvested back into the VA system.

“We do not believe the BRAC-like model is the most appropriate way to address capital asset needs,” said Joy Ilem, national legislative director for Disabled American Veterans. She said DAV supports making VA “more nimble,” but added Congress should not move forward with an asset closure plan before first determining the future of the Veterans Choice Program and the role of private care in the department’s health care delivery. She added VA should not close any facility before it opens an alternative building or it establishes a private facility partnership.

Roe said the committee will take up legislation addressing the future of the choice program, which gives veterans struggling to receive care or living more than 40 miles from the closest VA facility, access to private care on the VA’s dime, in three weeks. The pairing of the AIR Act to the new choice bill will enable the committee to identify savings while injecting new VA spending on health care.

Regan Crump, VA’s assistant deputy under secretary for health for policy and planning, said VA is currently assessing its current and future needs for veterans. Achieving its goals, he said, may require “significant capital investments” to accompany the closures of underused facilities.

While some disagreements persist, Walz pledged to work with his Republican counterparts to advance some form of the legislation.

“We are working side by side in this, but it’s a journey,” Walz said, later emphasizing the pressing-nature of the issue. “Time is not on our side. This is one of those things that must be dealt with, it cannot be kicked the can down the road. But among that, it must be done right. We’re not going to get another bite at this thing.”