The Department of Veterans Affairs (VA) is initiating a significant reorganization of its health care management system, which represents the largest overhaul in the last 30 years. This transformation will streamline operations by reducing the number of Veterans Integrated Service Networks (VISNs) from 18 to five, promoting a more unified approach to health care services for veterans.
Under the planned changes, VISNs will report directly to the VA under secretary for health, effectively eliminating the role of the VHA chief operating officer. This restructuring aims to address what VA officials describe as a “complex bureaucracy” that hinders effective decision-making and communication. VA Secretary Doug Collins emphasized the need for this change, stating, “The current VHA leadership structure is riddled with redundancies that slow decision making, sow confusion and create competing priorities.”
In a briefing earlier this week, VA officials indicated that the reorganization has been a long-overdue necessity for nearly a decade, aiming to reduce duplication, enhance accountability, and improve patient services. The department has drawn insights from national health care models to inform its new framework. According to VA documentation, “Our dedicated staff will benefit from less bureaucracy, clearer direction, and more time to focus on VHA priorities and patient care.”
Political Responses and Legislative Actions
The proposed restructuring has garnered mixed reactions from lawmakers. House Veterans Affairs Committee Chairman Rep. Mike Bost of Illinois introduced legislation this week that seeks to further reduce the number of VISNs to eight, an increase from the VA’s proposal. Bost expressed support for Collins’ initiative, stating, “Veterans and their families gave us a clear mandate last November that business as usual is not cutting it.”
Conversely, Rep. Mark Takano, the committee’s ranking Democrat from California, has called for hearings on the proposal, criticizing the lack of consultation with Congress and veterans service organizations. Takano claimed that the VA’s planning process has been conducted in secrecy, stating, “Redesigning the organizational structure of the nation’s largest integrated health care system should not be a secretive, partisan, closed-door process.”
Community Care Program Changes
Alongside the reorganization, the VA announced forthcoming changes to its community care program. New proposals are being sought from companies to provide medical treatment for veterans outside the VA system, with potential contracts valued at up to $1 trillion over a ten-year span. This plan will reduce community care regions from five to two, supported by multiple health networks.
As veteran advocacy groups begin to analyze these substantial proposals, Carl Blake, CEO of Paralyzed Veterans of America, remarked that while the changes sound promising, concerns regarding the expansion of VA bureaucracy have persisted for years. Blake noted, “If it works the way it is intended, it gives us hope that many of these administrative barriers will be knocked down.”
Similarly, Coleman Nee, National Commander of Disabled American Veterans, expressed support for improvements in VA health care, stating, “We look forward to learning more details about the department’s plans to reorganize the Veterans Health Administration.”
A blue-ribbon panel created in 2016 had previously recommended that the VA redesign its central office to ensure proper oversight of the VISNs and clarify their roles. The final report from the Commission on Care highlighted that the VISN structure lacked clearly defined roles and responsibilities, an issue that has continued to attract scrutiny.
In the context of staffing, the VA plans to eliminate 25,000 vacant positions within the Veterans Health Administration, which some critics believe could further strain an already stretched workforce. VA press secretary Peter Kasperowicz stated that these cuts involve roles that are no longer essential and have been vacant for over a year, assuring that “no VA employees are being removed, and this will have zero impact on veteran care.”
Senator Tammy Duckworth expressed concern that such cuts could exacerbate appointment wait times, arguing that the VA will struggle to manage the influx of new claims with insufficient staffing.
The implementation of the VHA reorganization is anticipated to unfold over the next two years, commencing in early 2026. As the VA moves forward with these significant changes, the impact on veterans and service providers will be closely monitored by stakeholders within the health care community.
