VA Asset and Infrastructure Review (AIR) Commission

When Congress passed the MISSION Act in 2018, it required that VA undertake the Asset and Infrastructure Review (also known as AIR) – an initiative to study the current and future health care needs of Veterans across America, and to evaluate VA’s health care infrastructure to ensure VA is ready and able to continue to provide Veterans with world-class access and outcomes.

As part of the congressionally mandated AIR process, VA submits recommendations to the AIR Commission that:

• Cements VA as the primary, world-class provider, and coordinator of Veterans health care;
• Builds a health care network with the right facilities, in the right places, to provide the right care for all Veterans, including underserved and at-risk Veterans;
• Ensures VA infrastructure reflects the needs of the 21st century Veterans; and
• Strengthens VA’s role as the leading health care training institution.

Nine members sit on the AIR Commission, three of which must represent congressional chartered, membership-based veterans service organizations. Each member is appointed by the President and confirmed by the Senate.

Nominations for this year’s AIR Commission were to be sent to the Senate by May 31, 2021. The President has submitted eight of nine nominations to the Senate for confirmation, including PVA's Executive Director Carl Blake.

Once confirmed, the work of the AIR Commission will begin.

The AIR is a three-step process.

• First, VA conducted 96 market assessments – studies of every VA market across the country designed to understand the makeup of our Veterans by health care needs, age, race, gender, era they served, and where they live.
• Second, VA uses those market assessments to make recommendations for the future of VA’s health care infrastructure.
• Third, the AIR Commission (a bipartisan, presidentially appointed and congressionally approved group), the President, and Congress then review those recommendations and determine whether they will be accepted and implemented.

During the AIR Commission’s review, the Commission will hold public hearings, visit VA facilities, meet with employees and partners—and most importantly, listen to Veterans—to assess those recommendations. At the conclusion of that work, the AIR Commission will transmit the recommendations, with any changes it deems necessary, to the President.

The President will then determine whether or not he wants to submit those recommendations to Congress. If he does submit them, Congress can then accept those recommendations as a whole by inaction, or reject those recommendations as a whole by passing a joint resolution of disapproval.

If the President approves the recommendations, then they are submitted to Congress. Congress has 45 days to stop the process by passing a joint resolution of disapproval. If Congress does not disapprove the recommendations, then VA must implement them.

Market assessments use a variety of data to inform the analysis, including but not limited to information regarding market geography and demographics, current and future market demand, Veteran access, quality of care, facility conditions, and health care resources—such as federal and community provider data—that exist in the broader market. Analysis is also significantly informed by input from local VA medical facilities, including site visits and more than 1,800 interviews with field staff.

The median age of VA’s hospitals is 58 years old, with nearly 70 percent over the age of 50. In contrast, the median age of U.S. private sector hospitals is 11 years. The AIR process will ensure that VA infrastructure reflects the needs of today’s Veterans.

Additionally, the last major comprehensive review of VA’s health care facilities was completed under the Capital Asset Realignment for Enhanced Services (CARES) in the early 2000s. The final plan was announced in May 2004 – that’s 18 years ago.

VA must begin implementation by March 2026. In carrying out the recommendations, VA is authorized to alter, lease, acquisition, construct, or dispose of property.

VA Secretary McDonough submitted VA’s recommendations to the Air Commission on March 14, 2022. To read the recommendations, please visit https://www.va.gov/aircommissionreport/