AS WE HONOR our nation’s veterans, there are important developments on the horizon regarding how and where Massachusetts’ veterans will access health care and medical services.
In 2018, the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act was passed by Congress and signed by President Trump. The law set up a framework for veterans to receive community-based health care outside of the Department of Veterans Affairs’ Health Administration network and established the Asset and Infrastructure Realignment Commission (AIR).
This independent, nine-member commission is charged with designing, approving, and implementing a comprehensive long-term plan that will modernize and realign VA’s health care infrastructure to the projected future need. It will also formalize criteria to determine which VA facilities should be “modernized, expanded, realigned, reduced, and/or potentially closed.”
Once fully appointed, the AIR Commission will be holding public hearings, reviewing all VA health facilities nationwide and developing a list of recommendations for these sites, based on local market assessments and the capacity and ability of VA and non-VA providers to meet health care demands in those areas. This effort is scheduled to culminate in 2023 when the president and Congress will review and decide to either approve or reject the commission’s recommendations.
Nationally, the total percentage of the veterans’ population is declining. According to the VA, the number of veterans in all states and territories is projected to decrease by 7 million over the next 27 years. In the Commonwealth alone, we have seen a 42 percent decline of our veterans population since 2000, with estimates that the number of Massachusetts veterans will further decline from its current level of 287,000 to a projected 120,000 in the next 24 years.
It seems counterintuitive that our veteran population is decreasing in the aftermath of America’s longest war. Yet, that is exactly what is happening and this trend is not lost on those in Washington who have oversight responsibility for veterans’ health care and its annual $78 billion accompanying price tag.
The VA New England Healthcare System oversees and operates 11 medical centers and 45 community-based outpatient clinics over six states, including Massachusetts. As the AIR Commission examines this market, a rapidly shifting veterans population opens some of these facilities to the possibility of realignment or outright closure.
Even if recommendations of this type could be justified considering the under-utilization of certain facilities, the potential outcome may leave some Massachusetts veterans without reasonable access to the care and services they require and have, most assuredly, earned. This is especially true for women veterans and veterans of color, who despite the overall declining trend, are actually growing in numbers and have, in many cases, confronted geographic and cultural barriers to accessing needed health services.
We have dealt with similar challenges in the past. In 2012, when faced with possible cutbacks to our military bases, Gov. Patrick created the Commonwealth’s Military Asset and Security Strategy Task Force. This innovation, which has successfully continued under Gov. Baker, is made up of leaders from multiple state agencies, authorities and the Massachusetts National Guard. Among its core responsibilities is engaging and working with public and private sector entities to protect and expand missions, jobs and economic investments at our military installations. The task force also analyzes and identifies steps the Commonwealth can take to remedy problems or deficits at these facilities in advance of future infrastructure decisions.
Using this model, it would be prudent to consider establishing a similar entity led by the Commonwealth’s Veterans and Health & Human Service leaders to plan for any proposed remodeling, realignment, or closure of area VA health care facilities. The analysis and input gained by such an entity would be critical in advance of the commission’s report, as the MISSION Act calls for establishing local private-sector care options for veterans affected by any closures and requires consultation with the governor and the heads of the local governments for repurposing any former VA properties. At the very least, Massachusetts would be better positioned to support a future veterans’ health care framework that will, in all likelihood, look different than the one in place today.
President Dwight D. Eisenhower once said in a speech, “In preparing for battle, I have always found that plans are useless, but planning is indispensable.” We should take heed of this wisdom from one of our greatest military leaders if we want to ensure that high-quality care and support remain available and accessible to those who served and sacrificed for this country and Commonwealth.
Coleman Nee served as Massachusetts secretary of veterans’ services from 2011 to 2015. He is a member of Disabled American Veterans’ Department of Massachusetts and receives his health care through the Boston VA medical system.