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March 18, 2020

VA's 'fourth mission' is to support America's health system in crises. Is it ready?

Daily Briefing

    With President Trump's declaration of a national emergency over the new coronavirus, the Department of Veterans Affairs (VA) is preparing to assume one of its less prominent roles: to serve as a backup to the U.S. health system in a time of crisis. But some question whether VA is ready. 

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    VA's 'fourth mission' and how it plans to fulfill it

    VA's principal role is serving the health needs of military veterans and the dependents of veterans, but the department can also be directed to treat civilians in the event of a crisis. This is called VA's "fourth mission."

    As cases of COVID-19, the disease caused by the new coronavirus, grow, it's possible that HHS could ask the department's 1,243 health care facilities and more than 350,000 HHS to back up the U.S. health system, the Wall Street Journal reports.

    Richard Stone, head of VA's health care arm, said the department is ready if needed. "We have been preparing, and do prepare continuously for it," Stone said. "Should the nation need us, we are prepared for support."

    While VA has never been directed to deliver on the fourth mission, it's provided assistance in other national emergencies, according to the Journal. For instance, when Hurricane Maria struck Puerto Rico, VA helped the federal government respond by sharing its emergency medical supplies.

    In terms of what support for COVID-19 would actually look like, officials at VA have said they'd likely provide assistance in specific regions that need help.

    Just how prepared is VA to help out?

    But while VA officials say they're prepared to help, critics have questioned how the department could deliver on the fourth mission.

    According to the Journal, VA's only pandemic plan that's available to the public is a flu response plan that was last modified in 2006. However, a spokesperson for VA said the plan has been updated more recently than that and that VA is in the process of incorporating the new coronavirus in to the plan.

    Still, Phillip Carter, a senior policy researcher at Rand, noted that VA already has challenges meeting the needs of its own patient population. According to the Journal, VA reported nearly 50,000 openings and empty senior positions last year. Moreover, patients who are older, wounded, or have chronic illnesses comprise much of VA's patient population, and those patients are at higher risk for COVID-19.

    Carter said, "VA will not be a panacea for America on coronavirus." He added that the department's budget and overall footprint are a fraction of the larger U.S. health care system.

    Separately, Bob Fetzer, a union representative of thousands of VA employees in four states, said, "VA is unprepared. Health and safety officers are totally out of the loop throughout VA."

    However, Christina Mandreucci, a spokesperson for VA, said, "VA stands ready [to] fulfill the agency's 'Fourth Mission' to surge capabilities into civilian health care systems in the event those systems encounter capacity issues, but at this time they are not encountering such issues" (Keslin, Wall Street Journal, 3/16; Horton, Washington Post, 3/17;, accessed 3/17).

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