VA eyes major changes in health care system as veterans flock to the South, Southwest

WASHINGTON — The U.S. Department of Veterans Affairs on Monday began the years-long process of restructuring its nationwide health care network, an endeavor that will require the president and Congress to sign off before it could begin. 

The restructuring would mean the closures or consolidations of some medical facilities, likely provoking opposition from communities and members of Congress.

Montana Democrat Jon Tester, chairman of the U.S. Senate Veterans’ Affairs Committee, said Monday that “any effort to kneecap our veterans’ health care is a non-starter for me.” 

“I will fight tooth and nail against any proposals that blindly look to reduce access to VA care or put our veterans at a disadvantage,” Tester said. 

Illinois Rep. Michael Bost, the top Republican on the U.S. House Veterans’ Affairs Committee, said he looks forward to the work the “commission will do in the coming months to ensure the recommendations VA released today stand up to scrutiny.” 

“For far too long, VA’s infrastructure has been slowly crumbling. Veterans in every corner of the country deserve better,” Bost said. 

A report from the VA secretary, broken into two volumes and released Monday, predicts the number of veterans in the Northeast and Midwest will decline in the coming years while those settling in the Southeast, South and Southwest would grow. 

“These changes are largely driven by the aging of the Veteran population and the predicted pattern of military separations near military bases,” the report states. 

The VA will likely continue struggling to address the number of veterans living in rural or highly rural areas — a group that currently makes up 33% of VA’s enrollee population, according to the report. 

The Asset and Infrastructure Review looks at the dozens of ways veterans’ health care needs will change during the coming decades and expectations about where they’ll live, so the VA can try to set up facilities, staff and programs in the best locations. 

“In some markets, the Veteran population is rapidly increasing, so we are adding new medical centers, community-based outpatient clinics and other facilities to meet that ever-growing demand,” VA Secretary Denis McDonough wrote. 

“In other markets, the opposite is happening — the number of Veterans is decreasing — but even in those markets, we are investing in new facilities that better address the needs of the Veterans who live there.”

If President Joe Biden and Congress approve the final set of recommendations, which will come from the Asset and Infrastructure Review Commission in about a year, the VA would start implementing them no later than February 2026.

But if Biden or lawmakers, through a joint resolution of disapproval, reject the plans, the entire process comes to a halt. 

Veterans in rural areas in U.S. need health care, too

“While VA and community providers alike will continue to have difficulty recruiting and retaining staff in rural areas — 136 rural community hospitals have closed between 2010 and 2021 — VA is committed to providing accessible VA health care through new points of care, partnerships, telehealth and virtual care, and other modalities,” the report states. 

The VA will likely continue facing strong competition with the private health care market to secure doctors and nurses, especially as nationwide shortages are expected to begin. 

According to the report, the VA expects that within two years there will be a “shortage of between 14,280 and 31,091 psychiatrists, and 77% of counties” will have a severe shortage of mental health providers.

By 2033 there will be a “shortage of between 21,400 and 55,200 primary care physicians and between 33,700 and 86,700 non-primary care specialty physicians,” according to the report.

“The projected shortages will affect rural areas more than urban areas.”

VA will need to treat more women, people of color

But the report, required by Congress to “to modernize and realign VA’s aging health care infrastructure,” also looks at how the people the VA treats will continue to evolve, as will the types of services the VA provides to those veterans. 

Within the next seven years, the VA expects it will see an increase in the proportion of women and people of color, as well as a decrease in the average age of veterans. 

“The Veteran enrollee profile is growing more diverse. For example, the lifting of laws that had previously led to a pre-Vietnam U.S. military that was under 2% women, has resulted in women comprising over 19% of active duty military today,” the report says.

 “As the population shifts, VA’s Veteran enrollee population’s health care needs may vary based not only on service-connected conditions but also on demographic differences and social determinants of health.”

The VA, however, warns that not every health care need can be predicted, with many future needs dependent on how combat changes in the years ahead. 

For example, the VA says that the use of improvised explosive devices in the wars in Afghanistan and Iraq combined with improvements in medicine meant that many soldiers who would have died during previous wars were able to survive. Those troops, however, were living with “amputation, [traumatic brain injury], infertility, genitourinary injuries, 47 and other conditions that strained VA capacity.”

“VA cannot foresee the service-connected conditions for future Veterans,” the report says. “Given this uncertainty, VA must be able to rapidly innovate and adapt to care for Veterans regardless of the health concerns they face.”