The Independent Budget
Veterans Agenda for the 116th Congress

Infrastructure

Capital Infrastructure

Background and Justification

For more than 100 years, the government’s solution to provide health care for our military veterans has been to build, manage, and maintain a network of hospitals across the nation. This model allows VA to deliver care at 1,753 facilities, but has left it with more than 5,600 buildings and 34,000 acres, many of which are past their building lifecycle. Many of these facilities need to be replaced, some need to be disposed of, and others need to be upgraded and expanded. All buildings being utilized need to be regularly maintained. The current process to manage this network of facilities is SCIP. SCIP identifies VA’s current and projected gaps in access, utilization, condition, and safety. Then it lists them in order based on the gaps priority.

Major Construction

Congress must enact legislation and VA must promulgate regulations to facilitate public-private partnerships and sharing agreements to support VA’s upcoming Asset Infrastructure Review (AIR) process. Additionally, Congress and VA must fully fund the projects that are currently partially funded, and begin the advanced planning and design phases of those projects it knows it will need to fund through the traditional appropriations process, regardless of the outcome of the AIR process.

Currently, VA has 24 major construction projects that are partially funded, some of which were originally funded in fiscal year (FY) 2004, that need to be put on a clear path to completion. There are also numerous additional projects that are in the design phase and have already received large expenditures in planning time, resources, and fees. Outside of the partially funded major projects list are major construction projects at the top of the FY 2018 priority list that are seismic in nature. These projects cannot take a strategic pause while Congress and VA decide how to manage capital infrastructure long-term.

Of those 24 partially funded projects, VA will need to invest more than $3.5 billion to complete them all. Of the top five projects on the priority list, none of them are seismic corrections. Only one is core to the mission of VA – a spinal cord injuries and disorders center.

A significant time and cost-cutting measure the VA should use is moving its construction entirely to an Integrated Design Build (IDB) model for the less technically demanding facilities such as outpatient clinics, administrative areas, parking structures, and other similar needs. This will allow the VA to shorten the overall length of major construction projects, by overlapping the three phases of the project. However, the IBVSOs recommend continuing to utilize the Design-Bid-Build” process for complex medical areas and inpatient healthcare units.

The largest added benefit of the IDB process is that it saves time over the entire length of the project. Currently, the three phases of building — the design, the bidding, and the building — happen sequentially. Integrating the three phases allows for some overlap of the different phases and shortens the entire length of the project, sometimes by as much as years. Another added benefit of the IDB is bringing the contractors on board during the design phase of the project. Allowing the builders and the designers to interact as a team helps to prevent future conflicts during the building phase. Teamwork in the design phase alleviates problems up front, which saves time and ultimately money.

The IBVSOs recommend VA explore using a more standardized modular design and building model. There always needs to be room for different buildings or layouts to be utilized in individual cases, but moving towards a standardized layout and construction could lead to a faster and more streamlined building of facilities. There is no need for VA facilities to be designed based on aesthetics. Facilities should be built with the patients in mind- meaning getting from ground-breaking to ribbon- cutting in the most effective and simplified manner possible. The example of the Rocky Mountain Regional VA Medical Center must never be repeated. The impractical design of that facility did not have the patients in mind. This type of mistake can be avoided by simplifying the design and construction of medical facilities.

Minor Construction

Currently, there are approximately 600 minor construction projects that need funding to close all current and future year gaps within 10 years. To complete all of these current and projected projects, VA will need to invest between $6.7 and $8.2 billion in minor construction over the next decade. In FY 2019, Congress requested $706,889 million for minor construction projects. This amount was supplemented by $2 billion in funding, mainly directed for minor construction projects and repairs impacted by natural disasters in the southern region of the country.

While the supplemental funds have helped, there are still hundreds of minor construction projects that need expedited funding for completion. Congress must continue to provide adequate annual appropriations for minor construction and should consider additional supplemental appropriations as necessary to ensure VA’s facilities remain safe.

Leasing

Historically, VA has submitted capital leasing requests that meet the growing and changing needs of veterans. In recent years, decisions by Office of Management and Budget (OMB) and Congressional Budget Office (CBO) have required that the 10-year cost of VA leases be considered as the “score” for Pay-As-You-Go (PAYGO) purposes for the first year of the lease, requiring enormous offsets to remain PAYGO compliant. As a result, many VA Community Based Outpatient Clinics (CBOCs) have been unable to sign new, or renew existing leases. When VA requests adequate resources, Congress must find a way to authorize and appropriate leasing projects in a way that precludes the full cost of the lease being accounted for in the first year. Delays in authorization of these leases has a direct impact on VA’s ability to provide on time care to veterans in their communities. Congress must adjust the leasing process in which leases are authorized.

Nonrecurring Maintenance

Even though non-recurring maintenance (NRM) is not funded as part of one of its construction accounts, NRM is critical to VA’s capital infrastructure. NRM embodies the many small projects that together provide for the long-term sustainability and usability of VA facilities. NRM projects are one-time repairs, such as modernizing mechanical or electrical systems, replacing windows and equipment, and preserving roofs and floors. NRM is a necessary component of the care and stewardship of a facility. When managed responsibly, these relatively small, periodic investments ensure that the more substantial investments of major and minor construction provide real value to taxpayers and veterans alike.

As VA works to close these gaps, they and Congress must make it a priority to maintain what we have, finish what has been started, and chart a long-term plan to effectively close future gaps.

Although VA’s Strategic Capital Investment Planning program clearly identifies the current and projected 10-year gaps in delivery of health care, historically VA has lacked a long-term funding strategy to effectively close these gaps in the most veteran-centric and cost effective way. With passage of the VA MISSION Act, Congress is now required to begin an Asset and Infrastructure Review (AIR) over the next 5-6 years. The IBVSOs recommendations on AIR are included in The Independent Budget’s Critical Issue section.

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