In addition, 174 outpatient clinics would close, according to the Veterans of Foreign Wars, which was briefed on the plan. But VA would replace some of the shuttered facilities with 140 clinics offering specialty care, two dozen nursing homes and about a dozen residential facilities specializing in substance abuse issues.
The effort aims to address a massive shift in the population of veterans from the Northeast, Midwest and parts of the rural West into warmer locales in the Sun Belt and Southwest. It also is meant to advance a realignment long sought by some VA leaders and conservatives that would dramatically reshape a health-care system that serves 9 million veterans but has failed to modernize alongside its private-sector counterparts.
But the plan also is expected to set off a politically explosive battle over which of the closures are ultimately approved and where expansions are allowed, akin to fights over military base closures in the 1990s that devolved into power skirmishes. Rep. Nicole Malliotakis (R-N.Y.) organized a rally Sunday in front of the Brooklyn medical center, which under the plan would consolidate services with the Manhattan hospital and eventually contract with private providers, the congresswoman’s office said.
South Dakota’s Republican congressional delegation promised a fight to save three sparsely used clinics that, if the plan is approved, would close or have services reduced.
“I’ll fight like hell to make sure veterans in South Dakota receive the care they’ve earned,” Sen. Mike Rounds said in a statement issued with two other South Dakota Republicans, Sen. John Thune and Rep. Dusty Johnson. Former VA secretary Bob McDonald had moved to close one of the clinics, in Hot Springs, but the Trump administration rescinded the decision.
Details of the plan, some of which were first reported by the Military Times, will be formally released Monday in the Federal Register. Any closures and new construction would be years away and must be approved or modified by a new, congressionally mandated commission that will hold hearings in affected communities over the next year.
VA has come under sustained pressure in recent years for relying for generations on a costly model of inpatient care while private hospitals turned toward much more outpatient treatment as medical advances reduced the need for hospital stays.
In some places, VA hospital wards have empty beds and more staff than patients on a given night, and many buildings are so old that repairing them would cost more than replacing them. The heating system at the Chicago VA hospital is so old and poorly regulated that during a visit in December, McDonough said, he was so hot he thought he had contracted the coronavirus. A vacant historic building on the Chillicothe campus has a sapling growing through the walls.
VA officials acknowledge that while the medical needs of older veterans will grow in coming years, much of the system’s health care is offered in the wrong places. Veterans are leaving New England, for example, where their population is projected to drop by 18 percent over the next decade. At the same time, their presence in the Southwest is projected to surge by 25 percent, without enough facilities to treat them.
Part of the push to realign how and where the government-run system cares for veterans is ideological. The agency already has redirected billions of dollars from veterans’ hospitals to private health-care providers in a controversial transformation that accelerated during the Trump administration; about a third of the veterans enrolled in the system now are seen by private doctors. The proposals released Monday are likely to inflame tensions between advocates for more private care and wary unions that fear that care at some facilities that close would be provided instead by non-VA doctors, with the government…
Read More: VA chief Denis McDonough to propose details of veterans hospital closures