The Department of Veterans Affairs (search) announced a plan Monday to close seven VA hospitals, open others and retarget services in a broad restructuring of its health care services.

The plan includes major mission changes at 13 facilities, Veterans Affairs spokeswoman Karen Fedele said.

The VA wants to close hospitals in Canandaigua, N.Y.; Pittsburgh (Highland Drive); Lexington, Ky. (Leestown); Brecksville, Ohio; Gulfport, Miss.; Livermore, Calif.; and Waco, Texas.

The proposal also would open new hospitals in Las Vegas and in Orlando, Fla.; add centers for the blind in Biloxi, Miss., and Long Beach, Calif.; and place new spinal cord injury centers in Denver; Minneapolis; Syracuse or Albany, N.Y.; and Little Rock, Ark.

The proposals are part of a VA restructuring begun last year to shift the agency's focus to outpatient care, place services where they are needed most and save money by eliminating underused and outdated services and facilities.

"This is probably the most comprehensive assessment of VA infrastructure since World War II," VA Secretary Anthony Principi (search) said.

A 15-member commission, appointed by Principi, will consider the proposed changes and hold hearings in about a week. After the hearings, the commission will make its recommendations to Principi.

As with military base closings, the secretary must accept or reject the plan as a whole. His decision is expected by the end of the year.

Principi said the proposed restructuring is not only about closing and realigning facilities but also about expansion and modernization. The objective is to meet the needs of veterans for the next 20 years, he said.

"I'm not trying to save money. I'm trying to transform an infrastructure that has been built or acquired over the past 50 years," he said.

Joy Ilem, assistant national legislative director for Disabled American Veterans (search), questioned the need for closures and other cutbacks.

"Everyone is aware of the difficulty VA has meeting demand," Ilem said. "When we have hundreds of thousands of veterans on waiting lists (for medical appointments), we don't want to see facilities closed due to fiscal problems."

Rick Weidman, government relations director for the Vietnam Veterans Association (search), agreed that strategic planning is important. But he said a General Accounting Office (search) study that helped trigger the facilities overhaul failed to consider that many are vacant because veterans health care is underfunded.

The restructuring is estimated to cost $4.6 billion over 20 years, with some costs offset by closing hospitals or leasing out unused facilities.

Principi has pushed for other VA changes, some to improve veterans' health services and others to deal with a burgeoning population. Last month, VA temporarily allowed veterans to get medicines prescribed by private doctors from mail-order pharmacies.

In January, Principi suspended health care services for higher-income veterans to reduce veterans' waiting times for doctor's appointments.

The restructuring has triggered opposition, including legislation sponsored by Florida Sen. Bob Graham, a Democratic presidential candidate, that would give Congress 60 days to review proposed hospital closings. A House version sponsored by Rep. Dennis Moore, D-Kan., has 163 co-sponsors. Neither bill has been acted on.

Graham criticized the latest proposal Monday, saying the VA manipulated the process earlier to achieve the results it wanted.

Protests already have occurred at VA hospitals considered possible targets for closure.

"At a time when many troops are overseas and will need these services when they come home, you want to bolster our veterans' health care, not gut it," Sen. Charles Schumer, D-N.Y. said.