By blocking AIR Commission, Congress ensures veterans get the best care

America’s veterans earned the best in health care through their service to our country. 

Yet 17.4 million veterans nearly lost their access to quality care under a set of recommendations that would have closed large segments of the VA health care system through a process called the Asset and Infrastructure Review (AIR) Commission, created by the MISSION Act. Thankfully, at the urging of veterans groups, independent experts, community advocates, and my union, AFGE, a bipartisan group of 12 senators, including a majority of the members of the Senate Veterans Affairs Committee, announced late last month that they would not allow the AIR Commission process to move forward. 

The VA’s recommendations to the AIR Commission would have closed or radically downsized dozens of full-service VA medical centers across the country. If that had happened, hundreds of thousands of veterans who need surgery, inpatient mental health care, intensive or emergency care, or substance abuse treatment would have had to fend for themselves in an already strained private health care market where veterans pay more for worse outcomes.

AFGE opposed the MISSION Act because we have seen the negative effects of this type of privatization on the veterans our members serve. Since the MISSION Act became law, over one-third of all veterans’ medical visits have been sent outside the VA system, and more than one-fourth of VA health care dollars have been diverted to the private, for-profit sector. 

But the private sector is not delivering better outcomes for veterans. A study conducted by Stanford University found that veterans had a 46 percent lower mortality rate at VA emergency rooms compared to private sector ERs. Studies consistently show VA facilities deliver better health outcomes at lower costs than the private sector. And all too often, the veterans who are pushed into the private sector cannot find timely, specialized medical or mental health care. 

Still, proponents of closing hospitals for veterans and sending our nation’s heroes into the private health care market to fend for themselves argue that older VA facilities are simply not worth renovating. They say those hospitals are too old and renovations too costly. 

However, as the studies previously cited show, those same hospitals, outpatient clinics, and nursing homes are currently providing quality care to veterans despite being historically underfunded and understaffed. Investing in modernization and full staffing for existing VA facilities is clearly a more cost-effective strategy for delivering world class care to our nation’s veterans than closing VA hospitals that, despite years of neglect, are already providing high quality care at prices that the for-profit private sector will never match.

Likewise, the VA claimed that its closure recommendations were meant to “modernize” the VA. But modernizing does not mean closure and outsourcing. It means assessing the true needs of veterans and investing in facilities and staff to meet those needs. The MISSION Act, and thus the VA recommendations, had no authorization or funding for upgrades or new construction. However, it did require that all recommended closures begin within three years, regardless of whether recommendations for new facilities were set to move forward. 

Allowing the VA to shutter vast sections of its infrastructure with no replacement would have been calamitous for veterans. Senators who acted to halt the AIR Commission process understand this.

The senators who rejected the fast-track AIR Commission process understood the VA secretary’s recommendations were based on flawed, outdated health care market data collected prior to the COVID-19 pandemic. The Government Accountability Office, a VA expert panel, and the VA Office of Inspector General all agreed that the data behind the VA’s recommendations were now invalid. The market assessments also failed to consider the imminent need to care for the more than a million additional veterans over the next nine years who will begin receiving VA health care under the bipartisan burn-pit legislation Congress is about to enact. The market assessment data also failed to account for already significant pre- and post-pandemic health care shortages in rural areas and the challenges private health providers have faced during the pandemic that limit their ability to accept an influx of new patients when VA facilities close.

Even VA Secretary Denis McDonough has admitted that he was “skeptical of the market assessments.” McDonough said in his testimony to the Senate Veterans’ Affairs Committee that because private care is more costly than VA care, it threatens to eat up the whole VA budget, despite large proposed increases. 

In the end, the MISSION Act and the Air Commission Process it spawned were deeply flawed. That is why my union held rallies around the country opposing the VA’s AIR Commission recommendations and helped lead a coalition of veterans, advocacy groups, lawmakers, and union members who all understood that modernizing our VA health care system begins with investment, new facilities, and adequate staffing, not hospital closures. 

Congress can put a final stop to the fatally flawed AIR Commission by enacting the bipartisan McGovern-Fitzpatrick amendment to the 2023 National Defense Authorization Act. The amendment would repeal the AIR Commission process entirely and allow Congress to focus on the essential work of funding and rebuilding VA’s infrastructure.

As we move forward, our coalition is ready to join the conversation about how we can continue to improve services at the VA. I hope that our leaders look to these voices on the ground, rather than to another AIR-type privatization process driven by high-priced consultants, to understand what makes our VA health care system truly great and how we can improve upon it further. 

Everett B. Kelley, P.hD., is National President of AFGE.