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We Must All Speak Up Before VA Health Care Is Gutted

By John Ketwig

If you are a veteran who gets health care from the VA (the Cabinet-level Department of Veterans Affairs), you should become aware of the threat to that care. Elon Musk's DOGE has already fired 2,400 VA employees, and a Reduction in Force (RIF) order was issued on February 26th. The Trump administration's goal is to reduce VA employees by 80,000! The VA has long been critically understaffed.

Perhaps you've noticed the staff shortage while interacting with VA health facilities. The problem became far more acute with the passage of the PACT Act, which recognized the effects of burn pits, Agent Orange, and other toxins. Long overdue, the PACT Act seemed to be a potential lifesaver, immediately adding more than 800,000 new veterans to the VA's workload. The Veterans Health Administration (VHA) is the branch of the VA responsible for veterans' health care.

The VA contributes enormously to our nation's medical research, but those research programs have been handicapped by staff losses, hiring freezes, and funding cuts. Research projects affecting cancer, amyotrophic lateral sclerosis (ALS or Lou Gehrig's Disease), and multiple sclerosis have been forced to stop operations!

Meanwhile, powerful MAGA forces in Congress have already unveiled a plan to destroy the VA's ability to deliver health care to you! Packaged in a tidy wrapper and titled the "Veterans ACCESS Act," this legislation is designed to be misconstrued as a measure to provide better "access" to health care for veterans. Originally, The CHOICE Act and the follow-up MISSION ACT were created to help veterans who live at unrealistic distances from a VHA hospital or CBOC (Community Based Outpatient Clinic). Also, with the shortages of professional personnel or equipment, some VA facilities cannot provide some categories of health care. A few years ago, the VA had approximately 67,000 openings for doctors, nurses, psychiatrists, and psychologists. Increased hiring in 2024 due to the PACT Act has decreased that number. Firing 80,000 will affect VA healthcare, like a heart attack.

Hey, if you need care and there's no one to provide it at your local VA hospital or CBOC, it seems like a kindness that Congress has provided a plan that will allow you to be cared for in the "private sector" or for-profit health care system. Attempts to address those situations began with the CHOICE Act of 2014 and the first Trump Administration's MISSION Act of 2017. As he signed the MISSION Act into law, President Trump declared, "All during the campaign, I'd say, 'Why can't they just go out and see a doctor instead of standing in line?'" Senator Bernie Sanders predicted, "My fear is that this bill will open the door to the draining, year after year, of much-needed resources from the VA." Currently, the administration of the MISSION Act has been sublet out to a corporation called Community Care. Very few VA vets have not heard of Community Care. It has been a blessing for some, but there is a catch.

For years, the for-profit medical industry has longed to get its hands on the VA's multi-billion dollar budget ($369.6 billion in 2025). Those previous programs, especially the proposed "Veterans ACCESS Act," pay the "civilian" healthcare facilities with funds from the VA's budget! Hidden in the depths of the "Veterans ACCESS Act" like a ticking time bomb is a provision intended to dismantle the integrated VA healthcare system faster than you can say "privatization." Under this proposed act, first of all, veterans seeking care for addiction or mental health challenges would be able to walk into virtually any provider and request outpatient treatment without any VA authorization, referral, or approval. The provider would then bill the VA and be paid… No questions asked! Currently, private providers are required to keep a full staff of administrative help to coordinate and negotiate claims with insurance companies, get prior approval, and then word the actual claim so that it might be paid in full or in part. Again, under the proposed ACCESS Act, the VA would simply pay the bills, no questions asked. To make matters worse, there would be no requirement whatsoever that the private provider meet VA standards of care, training, equipment, or treatments.

That's phase one.

Then, after three years, this arrangement is intended to encompass ALL VA medical care, fundamentally transforming the VA's primary role from a healthcare provider to an insurance company that writes checks. Again, a key provision of the ACCESS Act is that the provider will not be required to meet VA equipment, training, or care standards. Perhaps you have seen how efficient that business model has been for the for-profit medical community. Recently, the murder of a for-profit insurance company CEO earned a shocking chorus of praise and support for the murderer, reflecting the American public's widespread dissatisfaction with the for-profit medical industry.

The ACCESS ACT would not allow the VA to count a telehealth visit as meeting Community Care Program standards. Still, private sector providers can schedule telehealth visits, increasing the number of CCP referrals to Community Care provider facilities. Also, veterans would NOT be restricted to VA or Community Care providers. There would be no financial penalties for "going out of network." Again, the hidden purpose of this plan is to devour the VA's healthcare budget and ultimately drive the VA system out of existence.

Will referral of VA healthcare to the private sector actually result in shorter appointment times or any improvement in the care provided? According to one government study, 77 percent of all US counties face a severe shortage of practicing psychiatrists, psychologists, or social workers! Fifty-five percent, all of them rural counties, have no mental health professionals at all. Even when private-sector psychiatrists are available, many are unwilling to accept private insurance or federal reimbursement. Under such "market conditions," not only do patients wait too long for appointments, but according to the National Institute of Mental Health, 40 percent of Americans with schizophrenia and 51 percent suffering from bipolar disorder go untreated in any given year. By contrast, data available on Capitol Hill in May 2018 showed that the waiting time to see a VHA mental health professional averaged four days! One in five VHA patients was seen the same day they made an appointment. Even though roughly 16 percent of VHA primary care facilities were then operating at over 100 percent of capacity, for the system as a whole, the average wait time to see a VHA primary care doctor was five days, and nine days for specialist appointments.

The CHOICE Act revealed severe problems with wait times that reflected the problems described above. Hence, the MISSION Act established looser standards for outside referrals regarding acceptable wait times, mileage from the nearest VA facility, or both. Private for-profit providers became affiliates under the umbrella of a reorganized and expanded Community Care Network, administered by another third-party for-profit company we vets know as Community Care. Private-sector providers are not obligated to demonstrate that their wait times are comparable or better than the VA's, and the medical professionals are not required to meet the quality standards required of VA personnel.

As the VA's budget is siphoned off through Community Care's hands, other private-sector providers rush in like pigs to the trough to get on the Community Care list. This plan is designed to suck so much money out of the VA that in a short time, the VA will have to close its hospitals and CBOCs, turning all of your care over to the "private sector" or for-profit industry. If you heard about the Project 2025 plan presented to the incoming second Trump wrecking crew before last year's election, this entire plan (or conspiracy?) is outlined in horrific detail. Perhaps you've also heard that your VA facilities won't be affected. That's a lie! Lies from politicians when billions of dollars are at stake? Hey, the biggest proponents of these plans, from the very start, were the infamous Koch brothers. Brother David died, but brother Charles has spent millions privatizing the VA. His bank account funds the anti-VA Concerned Veterans for America lobbying organization, which poses as a Veterans Service Organization (VSO).

Follow the money, which will hemorrhage from the VA to the private sector. The likely outcome is that the VA will close its inpatient services and its hospitals and become a sprawling assortment of outpatient clinics (CBOCs), not unlike "urgent care" facilities. That is exactly the plan laid out in the Project 2025 playbook. Veterans are being assured that the VA facilities they rely on won't be impacted. Don't buy it for a second.

Do you think this forecast is an exaggeration? Think again. Independent healthcare experts warned last year that the survival of the VA system is in peril if runaway Community Care spending, which has been growing 15-20% annually, doesn't slow way down. The ACCESS bill puts the pedal to the metal.

Suppose the VA turns into an insurance agency and cuts direct care. In that case, veterans will be cast out to locations where there are long-standing shortages in primary, mental health, inpatient, and emergency care providers. Nearly 200 rural hospitals have shuttered, and over 700 more—one-third of all rural hospitals in the country—are on the brink of collapse. In this healthcare desert, who exactly will treat our veterans? The ACCESS Act does not include any recognition that the VA desperately needs to expand, not shrink, its workforce. Without a substantial addition of health care personnel, the VA will need to cut back services that veterans depend on.

It is clear that this legislation is a thinly veiled attempt to divert public funds to the private sector under the guise of veterans' choice. Survey data shows that over 90 percent of veterans enrolled in VHA prefer to receive their care from it. Studies show that VA care is equal to or better than private-sector care, without even considering that the VA is the only entity suited to treat medical and psychological issues specific to military service. If the above provisions of this legislation are enacted, veterans will soon be unable to choose VHA.

While the VA is far from perfect, today, eligible veterans in America are getting proven better care at lower costs than patients served by the for-profit medical industry. Today, our national debt is more than 37 trillion dollars! (Just six years ago, it was 21 trillion.) Congress is in no mood to increase the VA's budget, so reducing who is eligible for care will soon become necessary. Once again, that is exactly the strategy laid out in the Project 2025 playbook. Eliminate eligible veterans and curtail the health care for which they are eligible. Again, DOGE has already cut VA staffing, and the second Trump Administration has only been in place less than two months! While some veterans appreciate the convenience of being referred to Community Care close to home, that is nowhere near the planned ultimate goal. The ACCESS Act is frightening, and it's just the start. At this time, it is just a Bill, a proposal. It is absolutely vital that it be defeated! Every veteran across America must contact their Congressperson and Senators about this travesty. If we don't act fast, we will lose the VA healthcare system we know and depend on.

Call the US Capitol switchboard at (202) 224-3121 and they will tell you the phone number of your Senators or Congressperson.

In closing, I must admit that most of this material came from VA data available on the internet, from an article on Military.com by Russell B. Lemle, published February 21st, 2025, and from two books and numerous articles by the Veterans Healthcare Policy Institute (VHPI), Wounds of War: How the VA Delivers Health, Healing, and Hope to the Nation's Veterans by Suzanne Gordon, and Our Veterans: Winners, Losers, Friends, and Enemies on the New Terrain of Veterans Affairs by Suzanne Gordon, Steve Early, and Jasper Craven, Duke University Press, 2022.

John Ketwig is a lifetime member of VVAW and the author of ?and a hard rain fell, A G.I.'s True Story of the War in Vietnam, and Vietnam Reconsidered: The War, the Times, and Why They Matter. He is hoping to find a publisher for his first novel.