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

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The White House is pushing for an $18 billion investment in VA infrastructure, most of which would go toward replacing outdated medical centers.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.”