The Department of Veterans Affairs is proposing a sweeping makeover of its aging health care system that includes closing 17 medical centers and building more than 30 new ones. The plan would also change the type, number, and locations of many of the VA’s hundreds of other facilities, including clinics and nursing homes.
Leaders of the nation’s largest integrated healthcare system say they're trying to adapt to shifts in where veterans are, what kinds of treatment they need, and how modern healthcare is delivered.
Most of the 171 hospitals at the heart of the sprawling VA system were put in place to serve a nation just emerging from World War II.
They’re getting decrepit and aren’t always where veterans now live. Nor were they designed for the kind of care veterans need or the way modern medicine is delivered.
"We opened in April 1953, so we are going to have our 69th birthday here pretty soon," said Pete Tillman, the associate director of the VA medical center in Durham, N.C. "That's even older than the median age of VA infrastructure hospitals like this, which is around 58 years."
The Durham hospital is among those that would be shut down and replaced with a new facility somewhere in the same region. The VA would also build a new outpatient facility in Durham, reflecting the agency's shift to more outpatient care.
The area is expected to see a 20 percent increase in the number of enrolled veterans in the next seven years.
"This is largely really good news for the veterans that we serve," Tillman said. "We will have a right sized infrastructure for inpatient services and outpatient services in our immediate area and vicinity."
The proposal emerged from a review process that began during the Trump Administration and continued after President Biden took office.
It reflects several demographic shifts. The VA is now serving a veteran population that's slightly smaller, younger, and contains more female veterans — who were all but non-existent when many of the current hospitals were built.
The veteran population also is dropping in parts of the Northeast and growing in the South and Southwest.
So some facilities wouldn’t get an exact replacement. Hospitals in such cities as Northampton, Mass. and Chillicothe, Ohio would be closed and replaced with smaller outpatient clinics.
In South Dakota, hospitals in Hot Springs and Fort Meade would be replaced with clinics, and a new medical center would be built between them in Rapid City.
"In the near term, these recommendations will have no major impact," regional VA Director Robert McDivitt said in a teleconference with South Dakota employees. "Any changes or potential changes proposed in these recommendations will be at a minimum a few years and, in many cases, more than a decade away."
The VA says that the plan would increase the number of veterans who are within an hour of VA inpatient medical or mental health care by more than 100,000. About 400,000 more would be within an hour of specialty care. The number close to VA primary care and several other types of care would also increase.
But some of the specific closures are already getting pushback from politicians in several states.
In New York, Republican U.S. Rep. Nicole Malliotakis gathered a group of veterans in front of one hospital that would be closed.
“We’re saying today that this proposal to close the Brooklyn VA hospital is dead on arrival," Malliotakis said to applause.
Other politicians, though, are on board with the plan. The top Republican member of the House Committee on Veterans' Affairs, Rep. Mike Bost of Illinois, issued a statement saying he wants to ensure the recommendations “stand up to scrutiny." He added keeping the status quo is not an option.
The changes have to go through a lengthy review process. The next step is a bipartisan commission, which will hold hearings and do site visits. Any recommendations that emerge from the commission would require approval from the President and Congress.
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans.Funding comes from the Corporation for Public Broadcasting.
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