With President-elect Donald Trump’s victory in the November elections, the former and next occupant of the White House is expected to shake up “business as usual” in Washington. The president’s plans include the Department of Veterans Affairs (VA), where he will work to provide veterans with more health care options and clean up the staffing bureaucracy.
These policy proposals represent a microcosm of Trump’s commitments to tearing down regulation and going after inefficiencies in government. With the new administration wanting to make an impact quickly, expect action from the VA. Especially if the nominee to lead the department, former Rep. Doug Collins (R-GA), receives swift confirmation (which is likely), stakeholders should be prepared for a renewed focus on choice in VA care options for veterans.
Personnel
On Nov. 14, 2024, President-elect Trump announced his selection of former Rep. Doug Collins to lead the VA. Collins is a Navy veteran and currently an Air Force reservist. He served as a chaplain for both branches and was deployed to Iraq in 2008. As a member of Congress, Collins was known for his strong loyalty to President Trump. He sat on the powerful House Judiciary Committee, where, as the ranking member, he stood with the president during oversight inquiries of the first Trump White House, including his first impeachment.
Collins is widely considered a noncontroversial candidate and is expected to face a relatively smooth confirmation. He is expected to pursue similar policies to those emphasized in the first Trump term, to include veteran choice in health care delivery, swifter accountability for poor-performing employees, and continued work on modernizing the VA’s electronic medical record system. Although Collins did not serve on the House Veterans’ Affairs Committee, he has general familiarity with many of the major laws passed through the House and signed by Presidents Obama and Trump during his time in office. They include the Veterans Access, Choice and Accountability Act of 2014, the VA Accountability and Whistleblower Protection Act of 2017 and the MISSION Act of 2018. These laws, with their emphasis on greater veteran care options and employee accountability (among other important provisions), contain the policies upon which Collins is likely to build and rigorously enforce. Collins will likely have some familiar faces from the first Trump presidency at his side, most notably former VA Under Secretary for Benefits under President Trump’s first term, Paul Lawrence, who was announced as the nominee to be VA deputy secretary.
Issues
Veteran Choice
As during his first administration, signs are pointing toward Trump favoring allowing veterans enrolled in the VA health care system to pursue greater choice in how they receive their medical care, whether that choice is VA’s direct care system or private options in the community if the care they are getting in the VA system is untimely or too far from where they live. The president-elect was critical of the Biden administration’s handling of veterans’ care options, a sentiment echoed by many congressional Republicans. The stage is therefore set for the Republican Congress working with the new administration to focus on ensuring proper implementation of the bipartisan MISSION Act of 2018, the Trump-era law making veterans’ choice to seek care in the community permanent, and to likely build on that law’s emphasis on greater community case.
In contrast, congressional Democrats echo the Biden administration’s concern that too many veterans seeking care in the community puts the existence of a quality VA health care system in jeopardy. Notwithstanding this concern, under Biden’s VA Secretary Denis McDonough, community care spending has increased significantly each year, standing as one of the fastest-growing components of the VA’s budget. The competing viewpoints between the parties—one arguing greater freedom for veterans to seek care elsewhere, the other arguing that the VA health care system is at risk without a proper balance between care in the community and VA-provided care—will likely dominate veterans’ policy in the 119th Congress.
VA Staffing and Accountability
One issue Collins has been vocal about is “root[ing] out corruption” from the VA. He has criticized Biden’s VA Secretary Denis McDonough for following a court order to rehire employees fired during the first Trump administration. McDonough also abandoned practical use of disciplinary tools included in the VA Accountability and Whistleblower Protection Act, which Trump signed in 2017 and intended to make it easier to discipline poor performing VA employees. McDonough and VA officials were convinced that firing/disciplinary actions made pursuant to the law would not be upheld on appeal in federal court. Decisions from administrative panels like the Merit Systems Protection Board and contradictions to due process rights contained in union agreements with the VA were among the reasons cited for not using the law’s provisions. Democrats have generally pushed back against abridging due process rights connected with government disciplinary actions, setting the stage for another policy clash between the parties with big implications on the VA’s workforce and potentially the entire federal workforce. One might expect a diminution in the role the employees’ union plays in protecting and insulating the workforce at the VA.
Technology Issues
Two technology issues will dominate discussion within the VA sphere this Congress. First, attention will remain on the longstanding effort to implement a new electronic health records system. Launched in 2018 under a contract with Oracle-Cerner, VA’s Electronic Health Record Modernization (EHRM) project is over budget and behind schedule. Originally envisioned at $16 billion and 10 years to implement, new estimates put the price tag north of $20 billion with a longer horizon ongoing from the six sites where it is currently fielded to all 171. Whether to proceed or change course will be an early decision point for the new VA secretary, one Congress will be watching closely.
Second, greater utilization of Artificial Intelligence (AI) as a tool to solve service delivery, budget forecasting and quality of care problems at the VA will come into play. How President-elect Trump’s promise to lower guardrails on AI development leads to greater use of AI as a problem-solving tool for VA’s benefits, health care and administrative functions will be a fascinating one to watch.
Next Steps and Early Focus
Shortly after inauguration day, the Senate will begin confirming Trump’s nominees. Collins’ confirmation should not be contentious. His confirmation hearing is set for Jan. 21. That hearing will provide an early view of his plans regarding the top policy issues that will be central to veterans policy discussions in the 119th Congress
Funding for the VA will also be a focus in the early part of the 119th Congress. In July of 2024, the VA claimed a shortfall of funds in benefit and health accounts. According to VA officials, the shortfall was caused by demand for benefits and health care created by the PACT Act of 2022, a nearly $300 billion bill making it easier for veterans exposed to toxic substances during military service, e.g., chemicals/fumes from burn pits, Agent Orange in Vietnam, etc., to receive health care and benefits from the VA. The shortfall’s initial estimate—$3 billion for benefit accounts and $12 billion for health accounts—turned out to be false, but was realized only after Congress provided money for the benefit account shortfall. The $12 billion for VA health care was then subsequently revised to $6.6 billion. These revisions have shaken confidence in the VA’s ability to accurately convey what its resource needs are, a topic likely to be addressed at Collins’ confirmation hearing. That said, whether and when to supplement the VA’s budget with $6.6 billion to address the stated shortfall will be an early priority and focus of authorizers and appropriators.
Implementation of the Elizabeth Dole Act—enacted in the waning days of the 118th Congress—will also be a priority in the 119th Congress. That law, containing over 80 provisions touching on veterans’ community care, caregiver support, educational assistance and myriad other programs, represents nearly the entirety of the 118th Congress’ body of work on veterans’ policy. Proper implementation and congressional oversight of that law will be a major focus.
In addition, the PACT Act of 2022, given its breadth of provisions, cost, ongoing impact on VA benefits and health care service delivery and the resultant costs necessitated by those impacts will be another major area of focus by the congressional oversight committees. Look for early and ongoing focus on PACT Act implementation and budget issues.
Finally, another heads up is to expect a review by the Collins-led VA into the real estate (facilities) portfolio of the VA with a mission to rightsize the vast array of its physical holdings, which could result in huge savings and much greater efficiency in offering convenient care to a changing veteran demographic. A component of the MISSION Act of 2018 called the Asset and Infrastructure Review (AIR) Act may provide a template for action in this area.
Brownstein will continue to monitor these developments and track new VA issues as they arise. If you have any questions on the content of this alert, please reach out to the authors.
THIS DOCUMENT IS INTENDED TO PROVIDE YOU WITH GENERAL INFORMATION REGARDING THE DIRECTION OF THE VA UNDER THE TRUMP ADMINISTRATION. THE CONTENTS OF THIS DOCUMENT ARE NOT INTENDED TO PROVIDE SPECIFIC LEGAL ADVICE. IF YOU HAVE ANY QUESTIONS ABOUT THE CONTENTS OF THIS DOCUMENT OR IF YOU NEED LEGAL ADVICE AS TO AN ISSUE, PLEASE CONTACT THE ATTORNEYS LISTED OR YOUR REGULAR BROWNSTEIN HYATT FARBER SCHRECK, LLP ATTORNEY. THIS COMMUNICATION MAY BE CONSIDERED ADVERTISING IN SOME JURISDICTIONS.