Bush Administration Plan To Close Several VA Hospitals Could Affect Support for President

The Wall Street Journal on Aug. 27 looks how the proposed restructuring of the Department of Veterans Affairs health care system, including the closure of several VA hospitals, has drawn criticism, a sign of potential "political dangers ahead" for President Bush (Hitt/Hamburger, Wall Street Journal, 8/27). The restructuring proposal, announced earlier this month, is part of the VA Capital Asset Realignment for Enhanced Services plan, which seeks to eliminate "outdated or underused facilities" and shift the focus of the department health system to outpatient care. Under the proposal, the VA would close seven hospitals, open two others and add 48 new clinics. The VA plans to close hospitals in Gulfport, Miss.; Lexington, Ky.; Waco, Texas; Pittsburgh; Canandaigua, N.Y.; Brecksville, Ohio; and Livermore, Calif.; and open facilities in Las Vegas and Orlando. In addition, the VA plans to open centers for the blind in Biloxi, Miss., and Long Beach, Calif., and spinal cord injury units in Denver, Little Rock, Minneapolis and Syracuse or Albany, N.Y. The proposal would cost an estimated $4.6 billion over 20 years. A 15-member commission appointed by VA Secretary Anthony Principi will consider the proposal in a series of hearings nationwide this year and make final recommendations in November. Principi will decide whether to approve the proposal in December (Kaiser Daily Health Policy Report, 8/5). The plan to restructure the VA health system comes after the Bush administration cut waiting times by ordering VA facilities to stop enrolling certain veterans and give priority to veterans with service-related injuries, which could exclude about 525,000 veterans by 2005. The administration also has proposed fee and premium increases. Senate Veterans Affairs Committee Chair Arlen Specter (R-Pa.) next month will hold hearings on the department's restructuring plans, including testimony from several critics of the proposed hospital closures.

Potential Impact
Because VA facilities have become the health provider of first resort for millions of veterans and aging veterans have become "increasingly dependent" on "the sort of social spending the administration might feel compelled to rein in," the proposed changes "strike a much deeper chord" now than they would have 10 years ago, the Journal reports. In response, many veterans -- who tend to be conservative and represent one of Bush's "core constituencies" -- are now rethinking how they might vote in the 2004 presidential election, according to the Journal. In addition, the proposed changes could "stir discontent" in Pennsylvania and Ohio, two states that Bush may need to secure to win reelection, and are prompting the most vocal protests from New York and Texas, which are "magnets for media attention," the Journal reports (Wall Street Journal, 8/27).

Proposed VA Changes Draw Protest
In related news, proposed changes to the VA health system in Massachusetts and other parts of New England drew protest on Aug. 26 from hundreds of veterans and advocates, the Boston Globe reports. Under the proposed changes, the largest veterans' medical center in New England would close and be converted to an outpatient clinic. The plan also would move 435 hospital and nursing home beds from Bedford, Mass., to other parts of the state and New Hampshire. Thomas Kelly, commissioner of veterans' services in Massachusetts, said the move would displace nearly 500 of the state's "most vulnerable" patients who are in programs for people with dementia and rehabilitation programs for homeless veterans with mental illnesses. Rep. John Tierney (D-Mass.) also said that the proposal would harm health care throughout the region (Dembner, Boston Globe, 8/27).