Biden Administration Punts on Deadline to Recommend Sweeping Changes to VA Health Care

The Biden administration is delaying its recommendations to “modernize and realign” the Veterans Affairs Department, punting for six weeks required proposals that could drastically reshape the agency’s footprint and workforce. 

VA announced the postponement Friday, citing the more than 10,000 employees currently unable to work due to COVID-19. The recommendations required under the 2018 VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act are ready, VA officials said, but Secretary Denis McDonough does not want to make them public until he and his team can spell out the details to the workforce. VA will eventually send its proposals for where to expand health care options for veterans and potentially close existing facilities to the Asset and Infrastructure Review (AIR) commission. 

Given the potential impact on the workforce, a VA official said, McDonough is delaying the announcement until senior staff can safely communicate the plans through town halls in each of VA's regions. The department has a statutory deadline to post its recommendations in the Federal Register by Jan. 31, but will push that into mid-March due to the surging COVID-19 cases. The proposals are also supposed to go to the commission by that time, but the panel does not yet exist as all of the nominees have yet to be submitted to the Senate for consideration and approval. 

Once it is stood up and receives VA’s suggestions, 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. President 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.

In making recommendations, VA and the commission will consider whether a site is meeting VA standards, the potential 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 department has held listening sessions around the country to solicit feedback from veterans on their current and future needs and since 2018 engaged in market assessments 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.

The nominations for the AIR commission were due months ago, but VA has said the last few slots are out of its hands. 

A VA official on Friday stressed that VA wants to do all it can to retain its employees regardless of how the commission shakes out. Given that it is the "biggest look at VA health care since World War II," the official said, it is critical that "the first blush of this is heard by the workforce." Regional leadership told headquarters those efforts were not possible right now, due to the focus on the pandemic.