Reaction to the plan, the largest such effort in 30 years, has been mixed. Some critics, like Sen. Tammy Duckworth, insist that staff cuts will, in fact, threaten the quality of veterans’ care. “Not only is Trump guaranteeing that our VA won’t have the number of staff needed to handle the influx of new claims, but he is also ensuring that our Veterans will wait even longer to get treated—if they can get treatment at all.”
Lots to unpack
One part of the plan focuses specifically on VISNs, which are the VA’s regional management structures that oversee VA facilities and coordinate community care programs to meet local needs.
The plan will cut the number of VISNs from 18 to 5 and centralize their management. VISN staff will report directly to the VA undersecretary for health, rather than the Veterans Health Administration’s chief operating officer.
That operating officer position will be eliminated. In addition, the plan will cut as many as 35,000 vacant positions from its workforce rolls before the end of the calendar year.
A second part of the plan will affect Community Care Networks (CCNs). CCNs are how the VA buys care from local private providers. The reorganization initiative will reduce the number of networks from five to two, but it will expand the number of private providers included in those remaining CCNs. Currently, the program is managed by just two health networks, TriWest Healthcare Alliance and Optum Serve. The VA seeks proposals for contracts from additional companies to provide medical treatment for veterans outside the VA system. The agreements could be worth up to $1 trillion over 10 years. Proposals on the new community care contracts are due to the VA by March 16.
The plan is complex, but the emerging themes are familiar:
- First, centralized management and authority and staff cuts done in the name of efficiency; and
- Second, lucrative government contracts that will effectively privatize segments of VA healthcare.
Back to the days of DOGE?
The reaction to the VISN cuts has largely fallen on partisan lines.
Rep. Mark Takano, Ranking Member on the House Veterans Affairs Committee, accused Republican committee members of working in secret, behind closed doors. He noted that they failed to gather input from veterans’ service groups and refused to brief Democratic committee members until the beginning of the new year.
Senate Veterans’ Affairs Committee Ranking Member Richard Blumenthal and other members of the Senate Committee on Veterans Affairs have expressed concern that the plan would eliminate tens of thousands of unfilled mission-critical health care positions at VA, including for doctors, nurses, and support staff. This, he noted, was in addition to the exodus of more than 40,000 VA employees in fiscal year 2025. Committee Members issued the following statement:
“At a time when veterans are already facing widespread cuts in their access to health care from H.R. 1, skyrocketing health insurance premiums from expiring enhanced premium tax credits, and forced closures of rural hospitals, VA needs to be expanding its capacity and staffing levels, not reducing them. Veterans deserve a VA staffed according to their needs and a Secretary who works to fill needed positions, not abolish them.”
READ MORE VETERANS MALPRACTICE LEGAL NEWS
Similarly, changes to the VA community care system have been met with skepticism by some veterans organizations that oppose expansion of community care if it comes at the expense of VA hospitals and clinics. Kyleanne Hunter, a Marine veteran and CEO of Iraq and Afghanistan Veterans of America, testified in July before Congress, noting that veterans who are seen at VA facilities face shorter appointment wait times and often receive better care for exposure-related illnesses and mental health conditions. “We need to be clear that the evidence does not bear out that community care is a meaningful replacement for all direct VA care,” she said.
While support for the goals of efficiency and quality healthcare has been unanimous, reaction to the VA reorganization scheme has been shaped by recent experience with the now defunct Department of Government Efficiency – “Big Balls”’ and on. Few are likely to forget that adventure so soon.
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