[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
OPPORTUNITIES WITH
VHA REORGANIZATION
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
SECOND SESSION
__________
WEDNESDAY, FEBRUARY 11, 2026
__________
Serial No. 119-48
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
64-342 WASHINGTON : 2026
=======================================================================
COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman Member
JACK BERGMAN, Michigan JULIA BROWNLEY, California
NANCY MACE, South Carolina CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa SHEILA CHERFILUS-MCCORMICK,
GREGORY F. MURPHY, North Carolina Florida
DERRICK VAN ORDEN, Wisconsin MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern KELLY MORRISON, Minnesota
Mariana Islands
TOM BARRETT, Michigan
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
official version. Because electronic submissions are used to prepare
both printed and electronic versions of the hearing record, the process
of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
current publication process and should diminish as the process is
further refined.
C O N T E N T S
----------
WEDNESDAY, FEBRUARY 11, 2026
Page
OPENING STATEMENTS
The Honorable Mike Bost, Chairman................................ 1
The Honorable Mark Takano, Ranking Member........................ 2
WITNESSES
Panel I
The Honorable Douglas A. Collins, Secretary, U.S. Department of
Veterans Affairs............................................... 4
Accompanied by:
The Honorable John Bartrum, Under Secretary for Health, U.S.
Department of Veterans Affairs
Mr. Mark Englebaum, Assistant Secretary for Human Resources
and Administration, U.S. Department of Veterans Affairs
Mr. Gregory Goins, Acting Chief Operating Officer, Veterans
Health Administration, U.S. Department of Veterans
Affairs
APPENDIX
Prepared Statements Of Witnesses
The Honorable Douglas A. Collins Prepared Statement.............. 53
Statements For The Record
Kenneth Kizer Prepared Statement................................. 55
Letter to The Honorable Douglas A. Collins from The Honorable
Timothy Kennedy, U.S. House of Representatives, (NY-26)........ 72
The Honorable Douglas A. Collins Response to The Honorable
Timothy Kennedy, U.S. House of Representatives, (NY-26)........ 74
American Podiatric Medical Association Prepared Statement........ 76
Questions for the Record Submitted by The Honorable Mark Takano,
U.S. House of Representatives, (CA-39), The Honorable Debbie
Wasserman Schultz, U.S. House of Representatives, (FL-25) and
The Honorable Bobby Scott, U.S. House of Representatives, (VA-
03)............................................................ 79
OPPORTUNITIES WITH
VHA REORGANIZATION
----------
WEDNESDAY, FEBRUARY 11, 2026
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The committee met, pursuant to notice, at 10:15 a.m., in
room 360, Cannon House Office Building, Hon. Mike Bost
(chairman of the committee) presiding.
Present: Representatives Bost, Bergman, Mace, Miller-Meeks,
Van Orden, Luttrell, Self, Kiggans, Hamadeh, King-Hinds,
Barrett, Takano, Brownley, Pappas, Cherfilus-McCormick,
McGarvey, Ramirez, Budzinski, Kennedy, Dexter, Conaway, and
Morrison.
Also present: Representatives Scott, and Wasserman Schultz.
OPENING STATEMENT OF MIKE BOST, CHAIRMAN
The Chairman. Good morning. The committee will come to
order. Without objection, the chair may declare a recess at any
time.
Now, before we begin today, I want to thank my friend
Secretary Collins for being here today. Secretary Collins, you
have testified before this committee on a few times and we
appreciate your appearing here again. He is accompanied by Hon.
John Bartrum, undersecretary for Health; Mr. Mark Englebaum,
there we go, assistant secretary of Human Resources and
Administration; and Mr. Gregory Goins, the acting chief
operating officer (COO) for the Veterans Health Administration
(VHA).
This is the significant purpose of reorganization of the
Veterans Health Administration and I know that members of this
committee have serious questions about how it will be
implemented and how it will affect veterans with the workforce.
Because of that, I want the committee members to have as much
time as possible to engage directly with the Secretary, but
understand that we are in a situation where it looks like they
are going to call votes around 12:15. We will want to make sure
that each member, when we go to questions, that they will get 5
minutes, but 5 minutes only and I will gavel you down because
we have got to stay on the time schedule so that the questions
can be asked.
Also know that if we are--votes are called at 12:15, the
Secretary has a hard stop at 12:30 and everything must stop by
12:30, so.
Mr. Takano. Mr. Chairman, I understand that since he has to
leave at 12:30 that you will ask him to come back in this.
The Chairman. That is later on in my script, yes.
Mr. Takano. Okay, great.
The Chairman. I will, therefore, keep opening statements
brief and ask members to direct their question to witnesses
regarding the proposed reorganization. I will also want to
ensure a productive hearing today, so I ask that we all be
respectful of each other's members and the witnesses.
Before we proceed, however, I want to ask for a clear
comment. Secretary Collins, as the reorganization moves forward
and as additional changes occur within the U.S. Department of
Veterans Affairs (VA) more broadly, will you commit to making
yourself available to testify before this committee as
developments occur, not just during the annual submission of
budget?
Secretary Collins. I will.
The Chairman. Thank you, Mr. Secretary. With that, we would
look forward to your testimony and a productive discussion.
At this time, I will recognize Ranking Member Takano for
his opening statement.
OPENING STATEMENT OF MARK TAKANO, RANKING MEMBER
Mr. Takano. Thank you, Chairman Bost. Yesterday I had the
opportunity to speak at the American Federation of Government
Employees (AFGE) Legislative Conference, and I met with
colleagues of Alex Pretti, who shared stories about his service
to veterans. I listened to testimonials from veteran patients
for whom Alex provided care. It is clear that Alex was exactly
the type of employee that VA needs and exemplified the values
of a true public servant.
I am outraged that Alex was taken from us by the hands of
the lawless Trump regime. My heart is with the Pretti family,
Alex's VA colleagues in Minneapolis, and across the country,
and the many friends he leaves behind.
I would ask Mr. Chairman, that we have a moment of silence
for Alex Pretti.
The Chairman. So granted.
[Moment of silence.]
Mr. Takano. Thank you. In addition to the many testimonials
from his colleagues and veteran patients about Alex's service,
I have received a mountain of complaints about the lack of
leadership, Mr. Secretary, in response to this tragedy. Your
employees are hurting. They have looked to you for leadership,
but what they received instead is hostility. The foundation of
VA is its people. Delivering world-class care to veterans
depends on the strength of that foundation, the workforce that
keeps VA standing strong.
Mr. Secretary, your foundation is cracking. When you moved
in, the house was in good shape. VA had strong bones. It was
functioning at record levels, serving millions of veterans
every day. Under your leadership, the house is falling into
disrepair from neglect. When a house like VA needs repairs or
renovation, responsible owners do not tear it down. They fix
what is broken while preserving what works by reinforcing the
structure, upgrading outdated systems, and addressing real
problems deliberately and carefully. That requires a plan, a
fully baked plan, not just concepts of a plan. No one would
undertake a major home remodel without architectural plans,
engineering assessments, and a clear sequence of work. Yet VA
is attempting a total reorganization of one of the largest
integrated healthcare system in the country with little more
than a half-page notification right here, half-page, what we
got, and a 10-page slide deck. Ten-page slide deck.
In contrast, when VA was reorganized in 1995, this is the
book that was prepared to explain and justify its plans called
The Vision for Change. This 134-page book includes detailed
analyses of how care would be improved for veterans. It also
contains significant input from Congress, input from Congress
in the plan that they submitted back in the 1990's, input from
veterans, input from Veterans Service Organizations (VSO),
input from VA employees and other stakeholders. These do not.
You are tearing down the walls before determining whether
they are load-bearing and veterans will be the ones to be
crushed if the structure collapses. Like most home renovations,
organizations are disruptive--reorganizations are disruptive
and time-consuming. Yet VA is attempting this massive
reorganization while simultaneously deploying an unproven
electronic health record rife with problems, executing a
trillion-dollar community care contract, and grappling with
severe staffing shortages and turnover across the system. Any
one of these projects would strain an organization and taken
altogether, they will overwhelm it.
This reorganization is the third in a series of attempts to
shrink and destabilize VA since the beginning of the Trump
administration. First came the chaos of Department of
Efficiency (DOGE) with its reckless keyword searches, data
munching, and indiscriminate slashing of contracts for
essential services. Over 2,000 VA employees were carelessly
fired overnight by email without an understanding of the
consequences for veterans.
Then came the second attempt to shrink VA with a plan to
conduct a Reduction in Force (RIF) to lay off 83,000 employees,
a plan you tried to convince us was somehow about putting
veterans first. Remember this, Mr. Secretary? Remember this?
These actions were clearly performative and in service to
an extreme ideology. They provided absolutely no benefit to VA
or veterans, only harm. Both of these attempts failed because
courts and Congress held VA accountable. The disruption was
real. The damage was done. Institutional knowledge and valuable
employees walked out the door. Veterans are now left feeling
the consequences in terms of access and continuity of care.
Now, this reorganization marks the third attempt to
dismantle VA. Despite this record, you are coming to us with
nothing more than a slide deck and asking Congress to trust
you. You are asking for deference while withholding basic
information about staffing levels and the real-world impact on
veteran care.
Now, this lack of trust in your leadership is not
theoretical and, frankly, you have earned this distrust.
Veterans are the center of what we do in this committee, but
veterans are clearly not the center of this reorganization
effort. VA leadership has not proven that a reorganization,
especially this reorganization, is the best solution for
addressing their stated goals.
Now, streamlining care does not require a massive and
disruptive reorganization of the agency. At a very basic level
streamlining requires--streamlining care requires having enough
clinical and support staff to get veterans in for appointments.
However, Mr. Secretary, since you took the helm, the agency has
shed a net 20,400 employees across VHA alone. Let me say it
again, VHA alone. We are not even talking about what happened
at Veterans Benefits Administration (VBA) and the other parts
of VA. This represents centuries' worth of experience. These
losses include over 1,100 doctors, 100 left VA in December
alone, over 2,300 registered nurses, nearly 700 medical support
assistants, and nearly 700 social workers, nearly 650 licensed
practical nurses, and nearly 300 psychologists and over 250
police officers. Yet today we are going to be told that this
plan, which includes making it even more difficult for VA to
hire more staff, will streamline care for veterans?
Now, I listened to the Senate hearing 2 weeks ago and your
remarks on FOX News the other day where you claim that you are
doing more with less staff. The veterans who call our offices
beg to differ. They tell us every day that they cannot get VA
appointments or that the provider with whom they had a strong
trusting relationship left. VA whistleblowers bravely contact
us and share how their facilities are being pushed to the
brink, trying to meet patient demand with less staff and fewer
resources. You are not doing more with less. You and VA are
doing less with less.
There is a lot at stake, not least the health and lives of
the veterans we serve. The reorganization materials also failed
to consider the impact on VHA's vital role in the health
professional training, research, and Federal emergency
response. Lives are on the line. You have the chance to course
correct today, and let us see if you seize the opportunity.
With that, I yield back.
The Chairman. Thank you, Ranking Member.
Secretary Collins, I will swear you and your group that is
accompanying you in at this time, if you would. I ask the
witnesses to please stand and raise their right hand.
[Witnesses sworn.]
The Chairman. Thank you. Let the record reflect the
witnesses have answered in the affirmative.
Now I would like to recognize Hon. Doug Collins for 10
minutes for his opening remarks.
STATEMENT OF DOUGLAS COLLINS
Secretary Collins. Thank you, Mr. Chairman, Ranking Member.
I appreciate being here with the rest of the committee.
The Chairman. Will the gentleman suspend----
Secretary Collins. Yes.
The Chairman.--for purposes of--the chair is in accordance
with the committee rules, is asking unanimous consent that
Representative Scott from Virginia be permitted to participate
in today's committee hearing. Without objection, so moved.
Mr. Secretary, I am sorry for interrupting you.
Secretary Collins. No problem, Mr. Chairman. Chairman,
Ranking Member, thanks to you and the committee for having us
here today to present the VA's plan to improve our VHA
management structure to strengthen care for veterans
nationwide. As you have already mentioned, our undersecretary
of Health, John Bartrum is here, Mark Engelbaum from our
personnel is here, and also Greg Goins, who is our COO, who is
also a career employee of over 14 years in the VA system.
Before I start, though, I want to begin as already been
expressed, but again by expressing my deepest sympathies to the
family and colleagues of the Minneapolis VA Medical Center
(VAMC) nurse Alex Pretti. As you know, his death is currently
being investigated. VA is not involved in that investigation,
and neither I nor my fellow panelists are able to provide any
additional details at this time. I am here today to address the
focus of this hearing, our planned reorganization in the VHA.
Let me start really with what I just heard, and it is
pretty amazing, addressing some of the misleading and
inaccurate descriptions of the hearing about what we are having
this effort about today. It is not a reduction in force, it is
not diminished care. It is not anything that I have just heard
over the last few minutes that--as accused of performative as I
just saw.
What we are here for today is that we are the largest
healthcare system in the country, but we have never acted like
it. We have never done it the way it needs to be done because
we have, frankly, allowed the system to build on itself. We
have allowed the system to come in. We have allowed the system
to be riddled with redundancies, slow decision-making sows
confusion, has competing priorities, all of which reduce
quality of care for veterans. There is no one as a veteran, who
is more concerned about veteran healthcare in this country.
When you look at it from my perspective, I look at it as
brothers and sisters in arms taking care of each other. We have
got to make some honest assessments here.
What is interesting to me is only in Washington, DC, and I
have been in this town a long time, sitting where you sat,
sitting in other places, only in this town can you say
something that is been talked about for 30 years, complained
about by both Democrats and Republicans, who U.S. Government
Accountability Office (GAO) Inspector General (IG), every other
person, including VSOs, of which we have been meeting with over
20-plus on multiple occasions already explaining a lot of what
we are doing, we have had multiple meetings with all members up
here, only in this town can it be called rushed. Only in this
town can it be called not thought about. Only in this town can
it be thought of as an issue that somehow has never had
anything thought about.
There is a difference, though, Mr. Ranking Member and Mr.
Chairman. This administration decided to do something about it
instead of just gripe about it. That is the difference. Instead
of having hearing after hearing after hearing on saying the
reorganizations and the governance structure of VA under both
Republicans and Democrats for the last 30 years, we have taken
your input. We have taken congressional input. You know how I
know that? All I got to do is look at testimonies before this
committee.
I have already looked into the Office of Inspector General
(OIG) reports, the GAO reports, the multiple VSO reports, and,
by the way, hundreds of VA employees who had input into the
beginning of this process, careers and politicals, and also
consultants who have to let us look at who we are as the
largest healthcare system in the country. Only in Washington,
DC, can you come to a position of saying that something is
rushed or done when over 9 months of work has went into it.
By the way, also in a different setting as well, and I will
just go ahead and address this now, the reorganization, fully
allowed under statute and fully allowed under our appropriated
processes, was introduced to you over right now 2 months ago to
begin this process of discussion. We have moved no one. When we
do get ready to have our reorganization, we will follow all
rules of statute that tell us in what we need to report and how
we report it.
You know what? We actually did something a little
different. Unlike some other agencies and some other times I
have been here before, we actually came to not only VSOs, but
Members of Congress and began to outline the plan on what we
were looking at and did the issue up front. We are here today
to talk about it. I would encourage you to make use of not only
myself, but the ones that I brought with you.
This idea of slashing, cutting, and burning I have to
address because since 2019 to last year, the VA has increased,
and this is across the board, Full-Time Equivalent (FTE) count
of 14 percent across the board. Some areas is as high as 30
percent in some locations, 2 and 3 in other locations. Here is
the kicker to that. That is great in any other issue you want
to look at in Federal Government or in private enterprise, but
a 14 percent FTE increase, we have only had a 6 percent
increase in veteran encounters.
Some of our organizations, some of our VAMCs, have had
actually 30 percent FTE increases and decreased in the number
of encounters they had with patients. I do not think any of you
would go to any local hospital that you have in your community
and find a hospital that operates that way. They do not. We are
the largest.
It is time we start putting the resources where they need
to be. Not in some amorphous Veterans Affairs Central Office
(VACO), not in some amorphous Veterans Integrated Service
Network (VISN) level structure that, by the way, started in
this committee, Mr. Ranking Member, in the 1990's with about 10
in each VISN. They have now morphed over 10,000. Yet our wait
times were going up, yet our customer service was not
happening. We decided to do something a little unique in this
town. We decided to do something about it.
We have actually seen over the past year our wait times
stabilize or go down. We have actually seen VBA, which is not
part of VHA, but I just needed to say this, we had 260,000.
When you talk about workforce, we had 260,000, one of the
largest workforces in the country in the Federal Government,
260,000 backlog claims of 125 days-plus for disability claims
when I walked in last year this month. It is now under 100,000.
By the way, before anybody says, well, the quality is
there, the quality is in line with when we were doing far less,
the percentage of people who appeal it is about the same. Do
not hand me that quality is bad. We are just doing it better,
faster with the people that we have. That is what a leadership
organization does.
As we look ahead today to this, and quoting the chairman of
this committee, simply put, the outdated structure created in
the mid-1990's no longer aligns with the complexity, geographic
demands, performance management requirements of the modern VHA.
It just does not.
As we look at this, we can nitpick, we can go different
places, we can disagree and we can agree, and I am sure we will
today. I have been there before. We will talk about it. We are
going to give you answers and we will follow up with answers if
you need more follow up. We are committed to making this
process because, at the end of the day, I noticed, as always,
you have the Prisoners of War/Missing in Act (POW/MIA) chair
here, but in my office I have another chair that says we make
every decision for the one not sitting there. The one not
sitting here today is the veterans out in the community who
need community care, who need direct care, who need their
benefits paid, who need to have a workforce that understands
that the workforce is committed to one thing and one thing
only, veterans first. For us, I will stand on the successes we
have had. You can talk about rushed, you can talk about other
things, but the one thing you cannot deny is what we have done
have helped get care in the communities, 25 new clinics opened,
hiring.
Let me say one last thing, Mr. Chairman. I said this when I
was here a year ago and I am going to say it again. Let us also
take care because I am sure we are going to hear about staffing
and we will talk about that and we will talk about where we
are. By the way, we are still up over staffing over the past 5
years, as I said just a few minutes ago. Also, please remember
the VA is just like any other healthcare system.
When I was in New Hampshire, we talked about this. I have
to compete with the same hospitals in private and public for
doctors, nurses, and everybody else. You know what I have that
they do not have? I have a salary cap which I have asked this
committee and other committees to look at because that keeps me
from hiring doctors. Because when you have starting salaries of
600,000 for anesthesiologists in the community, and I cannot
pay that, I do not blame them for going somewhere else. That is
not a workplace issue. That is the fault of this body and us to
not fix it.
When we look at this going forward, we are the largest
healthcare system, but sometimes we run as if we have one hand
or one leg tied behind our back. It is now time to change that.
It is now time to modernize it and it is time to get on with
it.
Mr. Chairman, I yield back.
[The Prepared Statement Of Douglas Collins Appears In The
Appendix]
The Chairman. Thank the Secretary for his opening
statement. The written statement of Secretary Collins will be
entered into the hearing record.
We will now proceed to questions. Before I proceed to
questions, I want to--because not all members were here, we are
on a time schedule. 12:30 is a hard out for the Secretary.
There is also a possibility that votes will be called at 12:15.
Every member will receive in the order that they come in, the
normal we do, 5 minutes, if you can keep it less than that, but
I will gavel you down at 5 minutes because other members do
need to ask questions. I will try to lead by example to get my
questions out.
With that, I recognize myself for 5 minutes.
Mr. Secretary, your team received a written legal opinion
from the Office of General Counsel defining the Title 38
Section 510 applies to this reorganization. Will you provide
that opinion to this committee?
Secretary Collins. I can provide what we have, the back
setup, yes. Again, as I said in my opening statement, Mr.
Chairman, every targeted requirement of 510(b) will be followed
when those targets are met. At this point, they have not been
met.
The Chairman. Well, that will bring up my other part of
this question, which was asked, if VA begins implementation
before Congress receives the detailed plan, how does VA ensure
it is not effectively circumventing that statute?
Secretary Collins. I follow the law, Mr. Chairman.
The Chairman. Mr. Secretary, I commend the Department for
proposing this reorganization to better the VHA with how care
is going to be delivered. Do you agree that as a veteran needs
healthcare delivery continues to change, VHA's structure will
need to keep evolving as well?
Secretary Collins. Yes, Mr. Chairman. It is got to evolve
because what we have right now is not a system that actually
works. We are a top down system. I had this unbelievable
conversation the Senate 3 weeks ago that they believe that this
plan was a top-down plan. You cannot read this plan or hear
about it and say it is top-down. We are putting our VAMC
directors and our leaders on the field, clinic directors in
charge. They are actually having to be senior leaders now. They
have never had to be senior leaders before. They just put
everything up and, no, they never got answered.
Can I also on that part? Greg Goins was a VISN director as
well, hospital director. Real briefly, can you explain how this
actually affects that, what we just talked about right there?
Mr. Goins. Yes, sir. What Secretary Collins is referring to
is our oversight structure and the bodies that ultimately
support the field operations, the medical center directors, and
the staff that actually are delivering direct care has been
created over the years to really be kind of a self-fulfilling
prophecy. We set up oversight requirements and then we hire a
bunch of people to do it. In reality some of that stuff is
important, much of it is, but we have created far too much
resource intensity at the top and we have taken away resources
in doing so from the very front lines of being able to deliver
care to our veterans.
As an example, in the VISN, oftentimes we have a compliance
requirement, which is good, but there is also a similar
compliance requirement in DC and a similar one at the facility
level. Why do we need three people checking the exact same
process? In fact, what should happen, like everywhere else, is
we have an evaluation for self-inspection at the front line and
then we have someone removed from the process, typically at a
VACO level to do compliance. Right now we have three or four,
in some cases even parties doing that. That is an incredibly
resource-intensive oversight that ultimately is not
contributing to quality execution.
The Chairman. Mr. Secretary, I have got one more question.
As a former Member of Congress, do you support Congress'
reauthorization and modernization of VA's statutory structure,
including VHA and other major functions, like construction,
procurement, and research, so that the law reflects the needs
of today's veterans?
Secretary Collins. Oh, Mr. Chairman, and I know that we
have talked many times before, but you are singing out of my
choir book hymnal here. We have got to have some of that
reorganization help from this body. I can only do--and I
promise this, we only going to do what we statutory can do.
Look, when it gets to construction, now I am just going to
hit construction, I have mentioned it before, this group, this
committee needs to set aside some time to discuss this. For
those of us who are here, when we had to pass the construction
issues about a dozen years ago, which I was voting on this,
this was out of the disastrous rebuilding Aurora, Colorado,
Phoenix, Arizona, where the ballooning cost, 10 years. I hate
to tell you this, but you are not going to be shocked, after
this passed and we are going up on 10 years now at least when
we passed this, we are still looking at 10 years to build a
VAMC. We are still looking at times it takes. There is a--in
the budget which you just approved, the St. Louis VAMC should
be built in 2-1/2 years minimum. It is going to take almost 6
to 7 years under the current structure because, frankly, the
Corps of Engineers needs to be out of this process. They got
other issues they need to deal with. You had to put in
structure at the time, I get it, but now we have got to change
it.
Anything structurally that I will come back with you with
that we need to change, I would appreciate it. We will give you
any help we can because, one, we are not being very good
stewards of taxpayer dollars by building a billion-six VAMCs
that could be built for 800 million in 2 years in the private
sector.
The Chairman. Thank you.
Leading by example, I yield back my time and recognize the
ranking member.
Mr. Takano. Thank you. Thank you, Mr. Chairman. Mr.
Secretary, is not it true that you, sir, created the widespread
belief that VA is conducting massive employee cuts, what
Federal agencies call a reduction in force, or RIF?
Secretary Collins. When I came before this committee last
year, we were discussing an overall reduction in force across
the government as a whole. At that point, as I told you in this
committee that we were that--our target would have been 83,000.
Mr. Takano. So----
Secretary Collins. We ended up with about 30--you either
want an answer or you do not.
Mr. Takano. Is that a yes or no?
Secretary Collins. Do you want an answer?
Mr. Takano. It is a yes or no question.
Secretary Collins. I do not do yes-noes, and you know that.
If you want an answer----
Mr. Takano. Well, Mr. Secretary----
Secretary Collins [continuing]. yes-no is not it.
Mr. Takano. Mr. Secretary, reclaiming my time. On March 4,
2025, your former chief of staff, your chief of staff,
Christopher Syrek, put out a RIF memo saying that VA was
initiating plans to cut 83,000 employees. You yourself posted a
video on X saying that quote, ``Our goal is to reduce VA
employment,'' not employment across the government, but VA
employment levels. That is pretty clear here and here.
After spending the last year pushing out thousands of
employees, stifling hiring, and eliminating vacant positions
that medical facilities will never recover, you are now asking
us to suspend belief about the true nature of this so-called
reorganization and to disregard what happens to thousands of VA
employees and the workforce that cares for veterans. I am not
going to do that.
Now, let us go on to priorities. You went on to Fox &
Friends and said that VA needs to do more with less. I do not
even know why you are talking about doing less--talking about
less when it comes to veterans.
Are you aware that the U.S. Immigration and Customs
Enforcement (ICE) has been recruiting thousands of new
employees and offering up to $50,000 in signing bonuses? Why is
not VA doing the same for nurses?
Secretary Collins. I will be happy to let Mark talk about
our recruiting.
Mr. Takano. The buck stops with you.
Secretary Collins. Yes, the buck stops with me, but really
there is not a question in there, and I am glad you watched
me----
Mr. Takano. That is the question.
Secretary Collins [continuing]. on FOX News. I appreciate
that.
Mr. Takano. Why is not VA doing the same for nurses? Why
are not you doing a signing bonus for nurses? We do not have
enough nurses.
Secretary Collins. We already have it. Quit yelling at me.
Mr. Takano. We have enough. Oh, we already have it. Okay.
Yes, we did pass the VA Nurse and Physician Assistant Retention
and Income Security Enhancement (RAISE) Act. Are you here to
ask us for more money for doctors, signing bonuses for doctors?
Are you asking us for that?
Secretary Collins. I am asking you to raise the cap. Will
you commit right now to putting in a bill and raise the cap?
Mr. Takano. You want us to raise the cap? Are you asking
for signing bonuses?
Secretary Collins. Will you commit to raising the cap? Will
you commit to raising the cap?
Mr. Takano. Okay. Your testimony----
Secretary Collins. No, no, no. Will you commit to raising
the cap?
Mr. Takano. If you are asking us to.
Secretary Collins. Yes, I am. I asked a year ago.
Mr. Takano. Are you asking us to raise--okay. I will be
glad to author legislation to get you more money to hire more
doctors.
Secretary Collins. Done. We are good.
Mr. Takano. Okay. You do not----
Secretary Collins. We found an agreement.
Mr. Takano. Do we have enough doctors at VA?
Secretary Collins. Oh, we always can hire more doctors.
Mr. Takano. Do we have enough doctors at VA? Yes or no?
Secretary Collins. We can always hire more doctors.
Mr. Takano. Your testimony----
Secretary Collins. Do we need more doctors? Yes.
Mr. Takano. Your testimony today is that VA is not fully
staffed?
Secretary Collins. Who come up with that question? No, we
are not fully staffed, and we have not been for 50 years.
Mr. Takano. Okay. We need more people.
Secretary Collins. Yes, we hire every day. Do you realize
how many we hire?
Mr. Takano. Okay. Let us move on. Mr. Secretary----
Secretary Collins. I do not think you understand that we
hire people every week.
Mr. Takano. Mr. Secretary, so----
Secretary Collins. Whatever.
Mr. Takano. You know, Alex Pretti worked for you. I just
want to know something. Alex Pretti worked for you. Can you
just tell me, was he a good employee?
Secretary Collins. As far as I know everything about it, I
have already said what I am going to say about Alex Pretti and
I am not going to be brought into anything else about it.
Mr. Takano. Well, did you----
Secretary Collins. I provided you the reports that you have
asked for. You make this what you make of it.
Mr. Takano. Did he do a good job caring for sick veterans
in the VA Intensive Care Unit (ICU)?
Secretary Collins. I have heard nothing to the contrary.
Mr. Takano. You are saying he did?
Secretary Collins. I have heard nothing to the contrary.
Mr. Takano. You cannot tell me as the head of the VA.
Secretary Collins. I have heard--I have answered your
question. I am not going to get pulled into--you want to talk
about reorg?
Mr. Takano. Then why do not you stand up for him and
correct your Cabinet colleagues when they call him an assassin
and a terrorist?
Secretary Collins. I am here today to talk about VHA reorg.
I have expressed my condolences to the family. We have made
every available asset----
Mr. Takano. It seems to me you are unwilling to defend the
reputation of a VA nurse who dedicated his career to veterans.
Mr. Secretary----
Secretary Collins. That is your opinion.
Mr. Takano [continuing]. when you are Secretary, I just
think you just--it is not my opinion. It is what you just
showed us.
Secretary Collins. No, it is your opinion.
Mr. Takano. When your employee, Alex Pretti was attacked
publicly and falsely by your own colleagues, you had a choice
to defend him or stay silent. You chose silence and that
silence is deafening. Leadership is who you defend when it
costs you something. You did not defend him when it mattered,
and you still will not.
Mr. Goins, you have been called the face of the VA
reorganization, but you are the VHA chief operating officer,
not a Senate-confirmed official. Who among the four of you is
the accountable official? Is it Mr. Bartrum?
Secretary Collins. Hold on just a second, define the
question.
Mr. Takano. Well----
Secretary Collins. I mean, this is--I mean, if we want to
get cute here, I am the Senate-confirmed. John's Senate-
confirmed. He does not have to be Senate-confirmed because he
is appointed out.
Mr. Takano. I just want to know----
The Chairman. The gentleman's time has expired.
Mr. Takano. I just want to know who we should hold
accountable----
The Chairman. The gentleman's time has expired.
Mr. Takano [continuing]. if this reorganization fails to
meet----
The Chairman. We are going to hold to the 5-minute.
Representative Van Orden, you are recognized for 5 minutes.
Mr. Van Orden. Thank you, Mr. Chairman.
The ranking member made a point to hold up a book as
opposed to the slide deck that you have. I would just like to
point something out. The Magna Carta was one page. The
Declaration of Independence was one page. The Constitution,
four pages. The Bill of Rights, one page. What I have noticed
in the 3 years I have been in Congress is that we often confuse
quantity with quality. We often confuse motion for progress.
I would like to show people what we are talking about
because it has been referred to. This is the current structure.
Right? What is great about this chart is you can look at it
upside down and it still does not make any sense at all. It
just does not matter. Right? If you look at this, this is what
you are striving to get to. Right? Okay. I would just like to--
Mr. Chairman, I ask unanimous consent to enter this into the
record.
The Chairman. Without objection.
Mr. Van Orden. Okay. We are trying to go from here to
there. This is the I got six bosses, Bob, program. This is the
I actually know who I work for and I can be held accountable
program. Is that what you are striving for, sir?
Secretary Collins. That is correct, Mr. Van Orden. You hold
that other one up right there for a second.
Mr. Van Orden. The first one----
Secretary Collins. Yes.
Mr. Van Orden.--or the second one?
Secretary Collins. No, the first one you showed up.
Mr. Van Orden. Yes. This is the one that looks like----
Secretary Collins. Yes. This is what has been----
Mr. Van Orden.--the aftermath of Burning Man.
Secretary Collins. Yes, this is what is been defended for
almost 30 years by everybody. You know, they are saying, well,
we just do not need to work on it. We will work on it. We will
patch it. We will patch it. We will patch it. That is what you
get when you patch it.
Mr. Van Orden. Correct.
Secretary Collins. It is time for us to go to something
that actually works.
Mr. Van Orden. Right. What we are trying to do here, and,
you know, please correct me if I am wrong, you know, I have
been here, as I said, for 3 years, and I chair the Subcommittee
on Equal Opportunity--excuse me, Economic Opportunity. I have
yet to see anyone at the VA being held accountable for the
billions and billions and billions of dollars wasted for lack
of planning and just throwing money at a problem. I think that
if we can actually hold people accountable, that their job
performance will improve. That is my experience as a Navy SEAL.
Is that what you are trying to accomplish, sir?
Secretary Collins. Yes. Would you let--and I appreciate the
question, and it goes to the heart of what I was trying to get
at here. If you allow me for just a second.
Last year when I came in, I told the chairman and ranking
member, I told everybody on this committee that we did not have
a manning document. Some of you have rightfully so been
concerned about what was reported in the press wrongly about
empty positions. Mark Engelbaum will be happy to describe what
we did to get our manning document right. For those of us who
are not sure what a manning document is, we did not know where
our people were or where they are supposed to work. We now have
a manning document that allows us to actually hire in ways that
we get more doctors and nurses where we are at instead of
trying to move them between different places.
Then I got another one for you, and I shared this one just
this week. Up until we were able to consolidate our Chief
Financial Officer (CFO) and get a CFO in and actually working
through this, we had no monthly reconciliation. I do not care
what side of the aisle you are on here. How do you run a
business without having monthly reconciliation of what you are
spending? We just got to the end of the year and said, wow, we
got enough money, we are good. This is the kind of stuff that
we are trying to deal with to get it to where we can actually
put the people in the places that need to be instead of just
putting people.
Here is your question. You said a minute ago there is all
this idea that the more is better.
Mr. Van Orden. Right.
Secretary Collins. Well, when I got here, we had 480,000
employees. We had 260,000-plus in a backlog. We had wait times
that were going up. By the way, for those who are concerned,
the vacancy rate for doctors and nurses over the past 4 years
has stayed consistently between 19 and 14 percent. By the way,
the 19 percent was in 2022 under Biden. We are at 14. We stay
consistent.
Mr. Van Orden. Mr. Secretary, I have a minute left.
Secretary Collins. No worries.
Mr. Van Orden. I do want to talk about the salary cap
issue.
Secretary Collins. Yes, sir.
Mr. Van Orden. I know that is statutory. That is something
we can work on. Then you said something is actually deeply
disturbing, that the Army Corps of Engineer is--Army Corps of
Engineers are responsible for building our VA facilities?
Secretary Collins. They are because of a certain amount. It
is a threshold amount that they have to be involved in, and
that gets them involved actually in Community-Based Outpatient
Clinic (CBOC) as well.
Mr. Van Orden. Okay. Well, I----
Secretary Collins. They do not need to be there.
Mr. Van Orden. I have----
Secretary Collins. Good folks, but they do not need to be
there.
Mr. Van Orden. I have a great relationship with the Army
Corps of Engineers, but they do think they are the fourth
branch of government. If we can work together, Mr. Chairman,
and with the ranking member to see if we can move that around,
that would be great because, again, the Veterans Affairs
Administration, and you have stressed this in your leadership,
it is about the veteran. It is not about the Veterans Affairs
Administration.
Secretary Collins. Exactly.
Mr. Van Orden. I greatly appreciate your efforts.
Secretary Collins. Can I answer that real quick or you got
another question?
Mr. Van Orden. No, I just have 14 seconds, so I do not want
to cut you off.
Secretary Collins. No, let me finish it real quickly. The
reason the Corps is problematic, and there is something I did
not mention a minute ago, VA developed its own building
standards. We do not use national building standards. We
developed our own standards because we had nothing better to
do, I think. Then we take it to the Corps of Engineers who have
their own standards terrible.
The Chairman. The gentleman's time has expired.
Mr. Van Orden. Thank you, Mr. Secretary. Thank you, Mr.
Chairman. I yield back.
The Chairman. Representative McGarvey, you are recognized
for 5 minutes.
Mr. McGarvey. Thank you, Mr. Chairman. Thank you, Mr.
Secretary, for being with us today.
As you know, this committee's job is to make sure the VA is
working for veterans, not that it is working for political
appointees, not that it is working for career employees, not
that it is working for a small group of insiders who are making
decisions behind closed doors. What you all are proposing, it
is very likely the biggest shakeup of the VA in 30 years. I
think our veterans deserve to know what the VA is planning.
Now, I want to tell you I am not opposed to change. I am
opposed to making that change in the dark. I am not opposed to
change, but I do want to make sure that that change actually
improves the care our veterans receive. One thing we do well on
this committee is we actually understand the mission: to take
care of our veterans. We do it in a bipartisan way. For the
nearly 40,000 veterans in my district, we are here to take care
of them. For the veterans in Mr. Luttrell's district, in every
representative district on this dais, we are here to take care
of them, to make sure that we honor the promise we made to them
for their service. We might not always agree on the path, but
we all want the exact same outcome, which is a stronger VA that
delivers the highest quality of care for our veterans.
The experts who helped design the Veterans Integrated
Service Network, or the VISNs as we are calling them, they have
warned for 30 years that you do not fix policy failures or
culture failures by redrawing an organizational chart. They
have said that large reorganizations are disruptive, expensive,
and almost never solve the real problems, which are unclear
rules, inconsistent oversight, and a lack of accountability.
Both GAO and GIO have been saying that same thing for more than
a decade, as you alluded to earlier.
Again, I want to point out I am not opposed to change. Here
is the problem you are hearing and the frustration you are
getting from this committee. We do not know what those changes
are.
Mr. Secretary, the Federal law requires a report to
Congress on any proposed VHA reorganization. What you have
provided to us is a half-page letter and a 10-page slide deck,
a PowerPoint. It is not much. Given how this committee
operates, I hate that I am even asking this question, but I do
want the honest answer. Have you provided my Republican
colleagues on the other side of this dais with any additional
materials, documents, memos, reports, data about this
reorganization that you have not shared with the people on our
side of the dais?
Secretary Collins. Well, first off, Congressman, I will
never--I will not ever intentionally or any otherwise give you
dishonest information, so an honest answer is all you are going
to get from me. I have given nothing. We have briefed both
sides of the dais on this multiple times and had multiple phone
calls with us.
Mr. McGarvey. That is then the problem. I mean, the problem
is, no matter how you answer that question, it was not going to
be a great answer because what we have is very little
information on what is going on here. Again, it is not that we
are supposed to change. We want the VHA to work. We know that
it can work better for our veterans. We need to know what those
changes are. When you are proposing a reorganization of this
size and this scale, and our veterans do not know what is
coming, that concerns me because our veterans, as you know,
some of them, are worried about these changes.
Right now in Louisville, Kentucky, we are undergoing a
change in our VA. Robley Rex serves about 45,000 veterans
across the Commonwealth. We are moving to a new building. They
are in the middle of this full facility move. What worries me
is that this reorganization adds yet another layer of
disruption for the people who have risked everything to serve
our country.
When talking about how we are ensuring that veterans
continue to get the care, that it does not slip through the
cracks during the transition which you propose, and we do not
know enough about, do you all have a continuity of care plan?
Yes or no.
Secretary Collins. We always have it. I want you to hear
from Greg Goins, who is actually from your area, who actually
was the VISN in that. He can describe exactly what we are
talking about for you right now. This is why we are doing this
hearing, by the way.
Mr. McGarvey. Yes, only because I only have a minute and 9
seconds left. Do you guys have a continuity of care plan? I
need it to be yes or no.
Mr. Goins. Yes. The plan--we do.
Mr. McGarvey. Okay. Perfect. So----
Mr. Goins. The continuity of care plan is the fact that we
are not touching frontline facilities whatsoever.
Secretary Collins. That is an innovation.
Mr. Goins. The other thing I want to say about Louisville
and the hospital, the biggest issue that is running into
challenge----
Mr. McGarvey. I got to cut you off because I got 51
seconds.
Mr. Goins [continuing]. is the Federal and State level
officials have not----
Mr. McGarvey. I got to reclaim my time, Mr. Chairman.
Mr. Goins [continuing]. addressed the traffic issues.
Mr. McGarvey. Okay. I got, sorry, we got really little
time. If you have a continuity of care plan, one of you said
yes, one of you said no. What I need----
Secretary Collins. No, no, no, no. Mr. Chairman----
Mr. McGarvey. Guys, I reclaimed my time, Mr. Chairman.
Secretary Collins. Mr. Chairman, stop the clock. Stop the
clock and give him time.
Mr. McGarvey. I reclaimed my time, Mr. Chairman.
Secretary Collins. I need to make this clear. Stop the
clock and give him his time. I said no to yes----
Mr. McGarvey. Mr. Chairman, I reclaimed my time.
Secretary Collins. I said yes-no. I did not say no to the
answer that he gave. I said no to yes-no questions.
Mr. McGarvey. Mr. Chairman, I got to reclaim my time here.
The Chairman. You have reclaimed your time.
Mr. McGarvey. Maybe even get a little extra time. This is--
we are trying not to be combative, Mr. Secretary. I heard--
okay, okay, perfect. If you have a continuity of care plan, we
have not received it. This goes to the lack of transparency
that we are talking about.
This is a massive reorganization. It is going to impact our
veterans, and we on this committee do not know how. What we
care about is the veterans. We care about doing right by the
veterans. What doing the right thing is having this out in the
open.
The Chairman. The gentleman's time has expired.
Mr. McGarvey. I yield back.
The Chairman. Representative King-Hinds, you are
represented--yes, you are, you are recognized for 5 minutes,
too.
Mr. King-Hinds. Thank you, Mr. Chairman.
Thank you, Secretary Collins, for making time to be with us
today to talk about this reorganization.
I think you took 10 minutes to describe how getting or
seeing change in DC is like watching molasses roll down a hill
on a cold winter's day. Since my time here, right, that is kind
of how it feels. One of the things that I have noticed, really,
when it comes to change is that, you know, everybody wants
change, but for the most part, they want change when it does
not affect them or they want change in their pocket. Right?
That seems to be a common theme around this town.
We have been having multiple hearings over different
programs to include the Digital G.I. Bill (DIGB) rollout, for
example, modernization rollout, for example. One thing, you
know, has been very apparent is that it is very difficult to
get folks from the VA to be able to say who is accountable, who
is responsible. You know, I think Representative Van Orden said
it best the other day that like some of these hearings feels
like Groundhogs Day. I think that the reorganization chart,
right, or I am sorry, the old organizational chart, speaks to
that is, you know, the line of business is very--it is not
clear. I am very glad that something is being done about that
so that we can actually hold somebody responsible and
accountable for some of these mishaps. Right, because right now
it is not clear who is in charge based on the organizational
chart.
The one thing that I do want to raise to your attention,
because I was looking at the slides that you shared, and I am
concerned that in the map of the V-I-C-Ns, right--or the VISNs,
that there is no representation of any of the territories. I am
going to tell you this. You know, it had me in my feelings a
little bit because that is all that I talk about with regards
to just trying to get basic care. Can you speak to that,
please?
Secretary Collins. I will speak to the one who is over it
and been working it to get the area that you are talking about
done and John can address that for you.
Mr. Bartrum. With--are you referring to the Compacts of
Free Association (COFA)? Just so I--or you talking territories
in general?
Mr. King-Hinds. There is COFA, right?
Mr. Bartrum. Right.
Mr. King-Hinds. They are not U.S. citizens. There are
people who live in the territories, like the people of the
Northern Mariana Islands, who have the highest--one of the
highest per capita enlistment rates in any territory or any
State, who get no care. Right? We do not have a CBOC. Now we
are going from a map that used to actually identify the
Marianas as part of this VISN, but now we are just focused on
the continental United States. That kind of upsets me, right,
because it feels like we are going backward.
Secretary Collins. We are not. We do. It is still there.
Greg?
Mr. Goins. All the American territories are aligned exactly
how they are in current states. That map is reflective of what
is going to be the biggest change, which is the overall VISN
boundaries within the continental United States. The care for
those veterans that you are talking about is remaining
unchanged and associated oversight is still with Southern
California as it is current day.
Mr. King-Hinds. Okay.
Mr. Goins. The Atlantic--sorry, the Caribbean is still with
what is current day VISN 8, State of Florida.
Mr. King-Hinds. I want to, I guess, want to ask that in
terms of the reorganization. What data was analyzed when making
the determination to consolidate from 18 VISNs into 5? I mean,
I ask this question because we are having challenges with
access to basic care. Right? I want to make sure that when we
do this reorganization that they are not further shortchanged.
Mr. Goins. Yes, I completely agree. This is a fundamental
shift in the way which we currently do things in the VA at the
VISN level. The VISN directors and the VISN teams currently
have to participate in national level business functions, you
know, I am going to use a loose term here, the bureaucracy
aspect of what is necessary in addition to those oversight and
coordinating functions for care delivery. When you look at the
big picture, if you just went from 18 to 5 and had the same
scope, that would be a big problem.
In the new structure that was completely based on market
research for all kinds of entities to include public and
private, for-profit, not-for-profit. It was very clear that we
needed to have an entity within each one of our VISN structures
that focused directly on the care delivery and those
coordinated needs at the care level without competing
priorities against some of that bureaucratic stuff. Each VISN
in the current five structure has three Health Service Areas
(HSA). Their only focus of scope is care delivery.
Mr. King-Hinds. All right, thank you. I am out of time.
The Chairman. The gentlewoman's time has expired.
The gentlewoman, Representative Brownley, is recognized for
5 minutes.
Ms. Brownley. Thank you, Mr. Chair. Thank you, Mr.
Secretary, for being here.
I wanted to focus on women veterans for a moment. Women
veterans are the fastest growing group of veterans treated at
the VA. When I looked at the organizational chart from, you
know, the current organizational chart to the reorganized
chart, the Department of Women's Health is not included
anywhere. In the Deborah Sampson bill that was signed into law
in 2021, codified and required that there be a Department of
Women's Health, I think reporting to the undersecretary, which
is, in the new reorganization, is not there. That is a concern
for me. I am not sure how one is going to monitor the
improvements that the Deborah Sampson Act demanded in making
sure that we are working toward equity for our women veterans
compared to men veterans in terms of access to their
healthcare.
Secretary Collins. Yes, thank you for that. I am going to
address that. I want to address something up front because I
agree with you. Also, by the way, sorry to see you go. We came
in together and seeing you go, you have been a great voice in
this committee. I do appreciate that.
Ms. Brownley. Thank you, Mr. Secretary.
Secretary Collins. Look, women's health has been very--
something I put on the forefront and we are going to take care
of it in the structure. I will talk about that in a second. I
wanted to highlight a couple of things. We have actually are
opening more of our women's healthcare clinics where they have
better access.
Ms. Brownley. No, I understand. That was required in
Deborah Sampson.
Secretary Collins. Well, the other thing is, too--is,
though, is I had this year--I made the change last year in
which we were making our women veterans, if you was not aware
of this, go through their primary care doctor to get to their
OB/GYN.
Ms. Brownley. I am aware.
Secretary Collins. They were delayed. We did away with
that. They can now go straight to it. With that, I just wanted
you to know that and let----
Ms. Brownley. Okay.
Secretary Collins [continuing]. John say where this at in
the structure.
Mr. Bartrum. Ma'am----
Ms. Brownley. Quickly. I want to take advantage of my time
here.
Mr. Bartrum. Yes. Women's Health is there and the Women's
Health Programs, under our national programs, and it is on our
enterprise side of the reorganization and that report.
Ms. Brownley. Okay, Okay. I want to--I am having a hard
time, reproductive health, obviously, is part of women's
healthcare within the VA. I am having a hard time reconciling
when women now make up 20 percent of the Active Duty military
and reserves. If you are in the military, woman is in military,
in uniform, she has access to abortion in the cases of rape,
incest, or the health of the mother. When she leaves the
military, takes off her uniform, comes to the VA, now she does
not have access to abortion in the cases of rape and incest and
I must say, a very confusing definition of her life being in
danger. Talking to women veterans across the country, this is
what women veterans want, yet it is being taken away. They
serve the military, they have the benefit, they come to the VA,
the VA is taken away. I am having a hard time reconciling that.
If you could comment.
Secretary Collins. Yes, I am not having a hard time at all,
Congresswoman, and I appreciate it. This is something that is
been talked about in this committee. The VA, up until 3 years
ago, did not do abortions, period, anyway.
Ms. Brownley. I understand.
Secretary Collins. It is the same happened under both
presidents, Republicans and Democrats. It is not in our----
Ms. Brownley. We finally did the right thing.
Secretary Collins. I would disagree because----
Ms. Brownley [continuing]. by changing the regulation.
Secretary Collins. Again, that is a political difference
that we will have in that regard, but it is also a legal
difference in the sense that the Department of Justice found
that what was done does not follow current law on what VA can
do, and that is what we are following.
Ms. Brownley. Okay. I would like to have this argument with
you off the dais----
Secretary Collins. It would probably be a great one.
Ms. Brownley [continuing]. because it is a longer argument.
The other thing I would just want to point out, too, with
regards to the physician's ability to counsel women around
abortion. Just to have a complete prohibition and gag order
that a physician, even if they are talking to a woman patient
who is seriously ill and perhaps the option of an abortion
might save her life or make sure that she has a higher quality
of life later on in her life, yet there is a gag order. A
physician cannot do that. It is against their, you know, their
Health Insurance Portability and Accountability Act (HIPAA)
obligations.
I just, again, I do not understand why you would do that.
Even giving the woman the opportunity, if she needs an
abortion, to go outside of the VA, if the VA is not going to
provide it, but not to be able to have the physician advise her
just seems, you know, outrageous to me.
The Chairman. The gentlewoman's time----
Ms. Brownley. Cruel.
The Chairman. The gentlewoman's time has expired.
Representative Barrett, you are recognized for 5 minutes.
Mr. Barrett. Thank you, Mr. Chairman. Appreciate it. Mr.
Secretary and gentlemen, thank you for being here for, for
testimony in front of the committee.
Mr. Goins, I wanted to allow you, you had mentioned in one
of the earlier questions about some of the changes in how these
VISNs typically operate today, where they have a lot more of a
focus perhaps on the organizational apparatus as it relates to
expectations coming out of Washington, the management of the
organization that way, and less about the actual care delivery
for veterans. As I look at the new organization chart, I think
the health service areas are going to be the ones that are
directly engaged with the management of health outcomes for
veterans. Is that true in that sense?
Mr. Goins. Yes, that is exactly true. The current state of
affairs, a VISN director and their team would be responsible
for that. Plus, as you said, the organizational apparatus
requirements that I referred to as bureaucracy.
Mr. Barrett. Yes, the bureaucracy.
Mr. Goins. Yes.
Mr. Barrett. Yes, the things that fatigue people to death.
Mr. Goins. Yes. The challenge is it pulls you physically
away from the space as well.
Mr. Barrett. Right.
Mr. Goins. It is an important need, organization of this
size, largest integrated health system in the country. We need
those functions, no different than----
Mr. Barrett. Right.
Mr. Goins [continuing]. a Procter & Gamble or any other
organization of this complexity and size. At the end of the
day, it also requires you to come to DC to be part of some of
these larger group decisions through governance, et cetera, and
for every day or minute you are involved with those kind of
things, it is less time you can be engaged with VSOs, local
community hospital partners.
Mr. Barrett. Tell me, I come to DC every week.
Mr. Goins. Yes.
Mr. Barrett. You know. I feel it, man. I completely get
that. Allowing people to be basically assigned to the health
delivery outcomes and managing the staff in that sense and the
hospitals that are within that, I think is a great way of
elevating that role to the most important piece that they have,
which is ultimately the health outcomes of these veterans. I
mean, we hear from a lot of folks about, oh, you know, we want
to make changes, but we do not want to make changes in a
fashion that we did not come up with ourselves or something
like that. Or perhaps we have a pride of ownership of who came
up with these ideas or how the structure is going.
A chronic frustration I have here in Congress is that we
never seem to be ready to make changes. It is always not the
right time to do it or we are going to wait and do it a
different time. These have been things that have been talked
about, as you pointed out, for decades to bring about real and
systemic change to veterans for their health outcome.
I can tell you candidly, I have been a veteran for 23 years
now, since I was 21 years old. If you had asked me when I was
25 what a VISN was, I would have had no idea because I did not
need to know. It was not relevant to my actual interfacing with
the VA. It is relevant to the management of the organization,
but our veterans deserve to be able to walk into a VA, get the
care that they need without being fatigued by which VISN they
are in and which, you know, process is being followed. To have
somebody that is assigned to their health outcomes in a much
more focused and exclusive manner should bring about better
outcomes for them, and I certainly hope that it does.
I did want to touch on, though, Secretary, or either of
your panelists joining you, I got to bring up the Electronic
Health Record Modernization (EHRM) rollout and how that will
interface with this realignment of VISNs, and what type of
expectation we have there, and if we can be satisfied that that
will go on unencumbered with this change that you are talking
about as.
Secretary Collins. That is one of our most important pieces
as we go forward, not only for direct care, but also community
care in the future is getting EHRM, which, again, will go live
April 1st in the four areas.
Mr. Barrett. April 11th.
Secretary Collins. Yes, in Michigan. It is on track and I
think it aligns with--we have aligned it with the VISN
structure as we change. The rollout, hopefully, is we are
successful as it looks like we are going to be in these 13 this
year, will actually help with momentum getting into the other
areas as well, possibly quicker.
Mr. Barrett. Okay.
Mr. Goins. Can I just add to that, just so we are perfectly
clear. We have worked with the deputy secretary's office as the
one designated as the owner for EHRM rollout.
Mr. Barrett. Secretary Lawrence?
Mr. Goins. Yes. On the operations side, we have made an
agreement through the Undersecretary Bartrum that we will make
sure that the schedule that is already been published is
completely considered and unencumbered as we do the
reorganization. Again, this is an iterative phased approach and
we are not in a hurry to just blow things up.
Mr. Barrett. Even though we are doing EHRM by the current
VISN structure rollout, it will not be impeded or affected by
the change that you are proposing.
Mr. Goins. Correct. In addition to the continuity of care
priority, that is our second highest priority through the
reorg.
Mr. Barrett. Okay, thank you. I am almost out of time, but
I wanted to share briefly with you the reason why this is so
important. My father-in-law came to visit from Oklahoma to
Michigan over Christmas. He gets his healthcare through the VA.
He had a diabetic sensor on his arm. That battery died or
something. I think you all helped us with that. They could not
coordinate between the two VA hospitals to get him that very
easily.
The Chairman. The gentlemen's time is expired.
Mr. Barrett. Looking forward to that rollout. Thank you so
much.
The Chairman. The gentleman from--sorry, Mr. Pappas, you
are recognized.
Mr. Pappas. Thank you very much, Mr. Chairman. Mr.
Secretary, it is good to see you. I appreciate the recent visit
to New Hampshire. I know that veterans appreciated the fact
that you were on the ground and getting familiar with some of
the unique circumstances that we face at our medical facility
in Manchester. It is obviously an old facility. It has
infrastructure that has failed on many occasions that have put
whole areas of that facility out of commission.
During your visit we talked about the ongoing action plan
and feasibility study to talk about delivering a full-service
VA hospital for the veterans of New Hampshire. We are the only
State in the lower 48 without a full-service hospital, a
designation that we lost over 20 years ago. It was due to the
President on November 5th of last year, and I am really
interested to know if that plan was delivered to the President
and where things stand. Veterans in New Hampshire are really
interested in getting a read on that.
Secretary Collins. It is good. It was good to be with you.
Also, I think one of the things that--and I am just going to
make this as a blanket statement, if--and I just say this with
just a heart, if you have not visited a VAMC or a facility and
you are on the committee, please do so. Okay? I am not--I am
just--I am saying it to Republicans and Democrats because you
get a better understanding of what is going on. I have done
over 30 states and almost 75 of our facilities, various from
VAMCs to vet centers. By the way, go to vet centers, they need
me.
VAMCs in yours is a unique situation that goes to an
earlier comment about our construction issues and how--why it
is taking so long. That has been delivered to the White House.
It is at the White House now for the final processing and we
hopefully have an answer out of that in the very near future.
Mr. Pappas. Can you characterize it at all and let veterans
in New Hampshire know, is this a menu of options? Is it one
recommendation? Is the President the decision-maker on this or
is it the Department?
Secretary Collins. Well, we are going to let the process,
the White House process, go through it. I would rather do that
than have to come back and then be accused of saying something
that, you know, was not true or there was not as a plan that
came out. It is with them and we will get that out.
Mr. Pappas. They have been waiting a long time and I
appreciate----
Secretary Collins. I understand, believe me.
Mr. Pappas. understanding what is going on here at the
earliest moment that you can provide that to me and----
Secretary Collins. The gentleman I work for actually made
the promise----
Mr. Pappas [continuing]. to the people in New Hampshire.
Secretary Collins [continuing]. so it is coming.
Mr. Pappas. Great. I want to move on to another issue that
we have been dealing with on our Economic Opportunity
Subcommittee. It is the issue with Chapter 35 education
benefits and a gap that occurred last fall that was very
severe. We were hearing from veterans in our office, people who
had trouble paying their rent and paying their prescription
costs because their tuition bill was not paid. I am just
wondering if you can provide some more insight into the
breakdown there.
It was a month and a half where veterans were in the dark.
Congress was also left in the dark. We had letters that went
unanswered. I appreciate we received a letter yesterday that we
sent over to you on December 15, I believe, initially asking
for some further detail. It is inexcusable for veterans not to
have this basic information about where these payments stood.
Again, you know, you talk about the shutdown, that is the
excuse that we received. The Anti-Deficiency Act is pretty
clear that in situations that involve the protection of
property and life and making sure that veterans get access to
benefits that they should have been receiving an answer on
this. I would like you to address that.
Secretary Collins. Happy to on that. Yes, that was a
problem, frankly, that was--that we received. We dealt with it.
It came from a manual issue from basically going back to 2024
that rolled into 2025. We stopped that.
Mr. Pappas. I understand that.
Secretary Collins. At this point that has been transferred
over and most are getting there almost same day on GI benefits
they are getting. The GI Bill is working.
Mr. Pappas. It is really the communication that I think----
Secretary Collins. Well, the communication----
Mr. Pappas [continuing]. is inexcusable, the lack of it.
Secretary Collins. Look, I do not disagree that all these
communication on any level from both sides could be better,
okay, on anything. I face this every day in this job that I
take because I have to get the same information. I have to ask
sometimes multiple times to get it. The issue that we have
here, though, is--and I know that it was a concern and I
understand your issue with the shutdown, but it did hamper us.
We were getting benefits out. When you are down to one or two
people when you are normally having a lot more people to do it,
it does slow the process down. We were doing what we were
supposed to under law, but we had to do it under also the
burden of a shutdown that lasted longer than any in history.
Mr. Pappas. Well, you eventually, during the shutdown, did
communicate with veterans in late October, but, again, this was
a month and a half after the problem was discovered and
veterans were left in the dark here, coming to us for answers
that we could not get out of the Department. I just know that
there are going to be other instances in the future where there
are systems that are migrated, where there are gaps and
disruptions to benefits. Veterans deserve answers at the very
least.
I want to move on to one final issue and this is an issue
that I raised with you in your last appearance before this
committee around Veterans Affairs Servicing Purchase Program
(VASP) and the partial claims program. You said at that time, I
think the first step is that Congress needs to act upon this.
We took your advice, we passed a bipartisan bill. It has been 6
months since the partial claims program was signed into law,
has not been stood up yet. I have got veterans that are asking
when they can get relief. Can you give us an answer on when we
are going to be able to see that program put into place?
Secretary Collins. Yes, that is being done now. We have got
the--it is be done and it should be done shortly. We did have
to integrate it in with the current system that we had. You
will be getting an answer on that very shortly.
Mr. Pappas. Thank you. I yield back.
The Chairman. The gentleman's time has expired.
Representative Mace, you are recognized for 5 minutes.
Ms. Mace. Thank you, Mr. Chairman. I want to thank the
Secretary for being here this afternoon as well.
The Ralph Johnson VA Medical Center in partnership with the
Medical University of South Carolina continues to play a
crucial role in improving the lives of veterans throughout the
Lowcountry. I kid you not, I had a call this morning from a
veteran praising the Ralph H. Johnson VA facility in
Charleston, South Carolina, as being a model facility, that
they get about 70 percent of their care there, and they are a
cancer survivor and they are just truly grateful for the
example that the Ralph Johnson VA Center in Charleston is for
other veterans' facilities and medical treatment around the
country.
The location of the Ralph Johnson Medical Center has been
critical to improving outcomes for veterans and conducting
high-quality medical research. After a 60-year track record in
downtown Charleston, I was deeply disappointed in the VA's
decision in 2024 to deny a floodplain waiver for the lease of a
replacement research facility. We get a lot of flooding in
Charleston. If it sprinkles, it is flooding. We want to make
sure that veterans have access to the care that they need.
Last year, Secretary Collins, I wrote to you asking you to
reconsider this denial and you declined to do so. May I ask you
today what led you to make that decision to deny this waiver?
Secretary Collins. Congresswoman, I think the biggest thing
is we--one of the things you brought up, one of our best, is
not just in the top few percentage, it is probably in the top
two or three of the whole system, Charleston is. The same
things that denied the first time are the same things that we
go back on as the issues that we have to deal with when you
look at long term and where we have to build and how we have to
build in a floodplain or not build in a floodplain. This is--
there is other options that are available and we are looking at
those other options then going back into this area.
Ms. Mace. You will not reevaluate this decision?
Secretary Collins. Not at this point, no.
Ms. Mace. Okay. Can you assure that care for our veterans
will not be affected?
Secretary Collins. I mean, that is the first and foremost
thing we do.
Ms. Mace. Or be interrupted?
Secretary Collins. First and foremost thing we do.
Ms. Mace. Without this waiver, I mean, care potentially
could be interrupted for veterans.
Secretary Collins. I would disagree with that
characterization. It could be disrupted for many reasons, not
this one in particular.
Ms. Mace. You do not think this is just a simple tweak we
can do right now, temporarily, even----
Secretary Collins. In the--Congresswoman, I understand the
situation here, but here I am just going to play out.
Ms. Mace. Are you going to move the Ralph Johnson VA
facility or--I mean----
Secretary Collins. No, that is not necessarily--let is deal
with the point. Here is the issue. Let me just take it out a
step further. We issue a waiver and then 5 years from now it
floods. Okay. I have to look at the long-term process is how we
do this.
Ms. Mace. Five years from now what? I missed that. Five
years from now.
Secretary Collins. Five years it could flood in the
floodplain where we put it.
Ms. Mace. It could flood tomorrow.
Secretary Collins. It could. That is why we do not put it
there.
Ms. Mace. If we are talking about like ingress and egress
of a facility, you know, that to me seems like a--not a major,
you know, infrastructure issue. That it is not--you know, my
biggest concern is getting quality care for our veterans in
South Carolina.
Secretary Collins, the Ralph Johnson Medical Center has not
experienced the staffing shortages per se, as other facilities
have. To what do you attribute the success of the Ralph
Johnson?
Secretary Collins. I think it is just--it is leadership and
that is what we are looking, striving for across the board. One
of the things that has happened and is the standards have been
set on our leadership, we have allowed our--many times our VA
medical centers, which oversee also our clinics, have been
paralyzed into being non-senior leaders. Okay. The fortunate
part at Charleston is they have acted like senior leaders. They
have made decisions and they put those first. We have not seen
that across the board.
Greg Goins, who was a VISN director, saw this firsthand. He
has been--had a lot of input across with Secretary Bartrum as
well. We just--again, we are now putting it back into the place
where we have leadership. That one of the things we have right
now is a dashboard that allows every hospital to see how they
rank with every other hospital. If they are down in something,
they can go to a Charleston and say, hey, how do you do this?
How can we get better?
Ms. Mace. I love that.
Mr. Goins. Can I add to that? I can tell you definitively
based on my experience the secret in Charleston is the leader.
Scott Isaacks has been in place for a long time. We have a lot
of really good leaders in the VA, frankly, but we do not have a
lot of really good leaders with longevity. The issue that has
been so prevalent in Charleston is because of the longevity of
Scott and a vision he has been able to set and execute.
Ms. Mace. Scott Isaacks, he has been wonderful, actually.
He was the one that told me that the VA does outpatient care
with our geriatric patients. He actually put my father and one
of my family members in a program and outfitted the bars in the
hallway and the scooter and the walker and all those things
that I did not know veterans could get as they are aging. I
have been amplifying and spreading that to every aging veteran
that I know to get that high-quality care throughout South
Carolina.
I want to thank you, Secretary Collins, for being here
today answering my questions. Thank you so much.
The Chairman. The gentlewoman's time has expired.
Representative Cherfilus-McCormick, you are recognized for
5 minutes.
Ms. Cherfilus-McCormick. Thank you, Mr. Chairman, and thank
you, Secretary Collins, for being here.
Before we talk about innovation and administrative
restructuring, I really want to point out what is at stake.
Recently, last week in my district at our VA, we actually had a
veteran suicide. One of the workers went outside and shot
himself in the parking lot. For every veteran who is watching,
for every veteran who came to my office yesterday crying and
scared about what is going on and our responsibility to protect
our veterans, it increases my responsibility to scrutinize this
restructuring. I think we all understand that.
Right now in Florida, when we look at the VISN, it actually
adds Florida with five more states. There is a lot of concern
there that are our veterans going to be able to get the help
that they need? Right now, the wait time is 31 days. There is a
lot of concern about this grouping.
I have heard your explanation already of how this is
supposed to work. For our veterans who are watching right now,
who are very scared, could we say it in layman's term, of how
this is going to get better as we are grouping a complex State
like Florida with five extra states?
Secretary Collins. One, I am going to answer it from the
top level and let Greg or John, whichever one wants to answer
this. The top level aspect is with the HSA structure, they are
actually going to get more care. Also the biggest part about
this reorg, I think that is missing sometimes when we talk
about this, and I appreciate your discussion, is that we are
missing that this is not affecting how the hospitals and the
VISNs--the hospitals and clinics operate. We are giving them
more freedom, more latitude.
You all have some of the best programs for food down there.
I am championing that all over the country with the food. If
you have never seen this, I encourage you to talk to her. They
have Amazon boxes basically where they get food.
In suicide, I mean, because you brought it up, let me--
right, I get those reports. There is nothing that bothers me
more than those reports. That is why we have redone the entire
suicide prevention program. That is why we are now looking--we
are actually doing outreach to those who are not being cared
for in the other. John.
Mr. Bartrum. I will pass over to Greg in a minute. Ma'am,
you are absolutely right that we have to do this reorganization
to make sure that it is consistency across the facilities.
Right now, when you saw the org chart that my friend from the
Navy had put up, the Congressman, that showed all the
disjointedness. If you are running a facility right now, you do
not get consistent information. We have all heard the adage, if
you have seen one VA, you have seen one VA. We need to have the
adage that when you go to one VA, it is like all the VAs,
because we have to have consistency of policy and consistency
of application.
Ms. Cherfilus-McCormick. This kind of brings me to my
concern. My time is running out. Every VA has been unique. When
we see the uniqueness, we have not seen any streamlining
actually going on before this reorganization. We talk
consistently about making sure that we have standardization,
and we have not seen any real standardization being
incorporated or being successfully incorporated. Lumping all
five is concerning.
Before we go to that, also, when we look at the VA, the VA
is a unique structure. Part of that is learning from the
lessons, the past lessons, as we go forward. Such a big
reorganization is disruptive, and we all know that. If it could
work, if we actually had real steps in place that we can
scrutinize, feel comfortable with, I think more people, but
that is actually lacking. As we shift the conversation and you
talk about it, I do want to see if you have actually
incorporated some of the nine steps that the GAO recommended
when actually restructuring and to make sure we are learning
from our past mistakes.
Mr. Goins. Let me say first that I agree completely with
everything you have said as far as the criticality of this, as
far as how we do this and how we go about it. One of the
biggest pieces in order to make this successful has to be
frontline voice. Not just from veterans, but, more importantly,
from the frontline employees that are actually caring for
veterans and the frontline leaders. We have done that twice. We
had over 300 leaders, every single hospital director in one
room at a time. The sole purpose of that is to create a plan
that has exactly the details that you are looking for.
Ms. Cherfilus-McCormick. And so as my----
Mr. Goins. We are continuing to develop that.
Ms. Cherfilus-McCormick. As my time is running out, I just
want to know specifically about this GAO document that
highlights of the GAO reform. It talks about the mergers. It
has nine actually policies and steps in here. Have you seen
this document and have you incorporated anything from it?
Mr. Goins. As we develop the plan that I just mentioned a
second ago, all aspects of those types of reports, GAO, OIG, et
cetera, in addition to the original documents when the VISNs
were created, are going to be part of the action planning that
is associated with our future State and how we get there.
Ms. Cherfilus-McCormick. I am assuming that you are going
to fully incorporate it, so when we get a plan that is more
detailed that we will see everything in to have more confidence
in it. As of right now, because we do not have that kind of
information, I think it creates an anxiety not just amongst us
as legislators, but also with our veterans. We would love to
have a real plan so we can actually meet the needs of all of
our veterans. Thank you so much.
Mr. Goins. An outcome of the work that is been going on to
incorporate frontline feedback to--in addition, we have met
with VSOs, we started to work with Congress the way that you
have heard the Secretary talk, all of that will be incorporated
in it. In addition to that, there should be references and
there will be in that plan to the things in which we are
referring to to include the report that you have got in front
of you.
The Chairman. The gentlewoman's time has expired.
Representative Kiggans, you are recognized for 5 minutes.
Ms. Kiggans. Thank you Mr. Chair. Thank you so much to our
panelists and Mr. Secretary for taking time to be here and for
what you are doing to support our veterans.
I represent Virginia's Second District, so home to a large
Navy population, large veteran population. It is so nice to
have my neighbor and colleague, Congressman Scott, here. Our VA
Medical Center actually sits in his district. So very, very
nice to welcome him. You know, I wanted to thank you also for
the work you are doing with mental health. That is certainly a
priority of mine.
I do not know how many of us who sit on this committee have
had the privilege of actually working at a VA facility as a
nurse practitioner. I spent 3 months working in the Hampton VA
when I was a new nurse practitioner. One of the reasons I left
was because I did not touch patients. I did a lot of
administrative work. I was losing my clinical skills, so--and I
would walk around on my lunch break and see buildings full of
people, and I did not know what those buildings were doing,
what those people were doing. I spent some time and would find
the one geriatrician who we had on staff and shadow her for--
over my lunch breaks just to keep up my clinical skills. She
was overwhelmed. The physicians there were overwhelmed. The
nurses there were overwhelmed. They were doing the bulk of the
work of actually touching patients, talking to patients, caring
for patients. Those are the people we needed more of. I did not
know what was happening in all the other buildings. I still do
not even want to go back there.
I applaud your efforts with this restructuring. I know
change is hard. I know you have to be brave and it takes
courage and you are going to take some heat for that, but thank
you. The picture I saw, and again, I was just a lowly nurse
practitioner, but there was so much room for improvement. I
think the time is now to do that.
I wanted to bring my questions a little bit closer to home
and ask about the Hampton VA. I know we had a lot of leadership
changes there over the past couple years. We still do not have
a director position that is filled. It would be great to put
new leadership in place. I know we did a lot of work just to
change, you know, the current leadership that we felt was kind
of a root part of the problem. What are you doing and can you
tell me the timeline for that leadership replacement?
Mr. Bartrum. Thank you for that question, ma'am. You are
absolutely right. We are in the process of putting out a
advertisement. I am anticipating from our HR team that the
advertisement will go out this week, at the latest next week.
Then we will start the process for advertising for a new leader
at Hampton and a number of other sites as well.
Mr. Goins. To that end, just so I can try to help quelch
some of the fear that I can detect in your voice, we do that
nationally, so that is what the undersecretary is talking
about. However, there is a process to get it done. In the
meantime, if there is an issue with Taquisa Simmons' detail
needing to expire or needing to be extended, we are committed
to make sure that we have long term leadership longevity prior
to that selection. She will either be extended or we will go
through a process to find a qualified leader in that place.
Ms. Kiggans. It would be great to put permanent leadership
in place. I think if we are looking for culture shift or
looking for just, you know, a direct new direction to solve
some of the problems we have there. It is a great facility, but
I just want to make sure that permanent change is made.
Secretary Collins. Yes. Congresswoman, I also want to say,
and this is to everybody on the committee, we are--one of the
things that was disheartening to me when I first came in was
how many interims we had sitting around executive leadership
teams across the country. I have made a very concerted effort
to change that at all of our facilities, where you are getting
at least the director, the executive director, the chief of
staffs, those are permanent, so they can make real changes.
What we are having to do right now, though, is, frankly,
because we have not done a good pipeline, we are having to move
some people in to fill gaps while we develop that pipeline.
That is my top goal, is to get those permanent.
Ms. Kiggans. Okay, thank you. I appreciate prioritizing
that.
Then my other question is about our great new facility, our
North Battlefield Clinic in Chesapeake. I know, Mr. Secretary,
you were there at our ribbon-cutting. Thank you for coming down
for that. I understand why we did not open our doors and have
of all the providers and all the places and that we were
working on building up that patient base and it made sense to
me. I know that our goal was January to have it at, you know,
max capacity for staffing, and that we are now in February and
we are not quite there. I know, you know, we have addressed it.
I think my colleague, you know, Congressman Scott has addressed
it as well.
Can you tell us what the timeline is for adequate staffing
or full staffing, I guess I should say, at that facility? It is
a beautiful new building. I know that our veterans are using
it. I know there is a provider shortage on the nurses and
physician side, but what are we doing to make sure that
facility is fully staffed?
Secretary Collins. Everything we possibly can. I think that
is the issue that I appreciate what you said there at the very
end because that makes it very determinant. We will hire as we
need. There is 534 allocated positions built. We have built
those positions out. There is 335 that are encumbered, 199 that
are vacant. Out of those 199, 166 are in active recruitment
right now, 27 are pending, 5 are pending, just getting back to
us. Let me also state that that facility is now doing every
service it was provided to do. They are doing the service, and
we will ramp up the amount of service as we are able to hire
and get away from other, you know, facilities to hire these
people. It is doing what it is supposed to be doing. This is
where we are at.
Ms. Kiggans. Great. Thank you for prioritizing that as
well.
I yield back.
The Chairman. The gentlelady yields back.
For the--advising the committee members, Representative
Ramirez, you are going to get 5 minutes. Everybody else, we are
going to cut it down to three. Everybody will have the
opportunity to at least ask questions before they are going to
call votes. We have got that hard out. I have talked with the
ranking member, and he is in agreement with that, and so we are
going to do it that way.
You are recognized for 5 minutes.
Ms. Ramirez. All right. Thank you, Chairman and Ranking
Member. I will keep it tight. Mr. Secretary, it is good to see
you again.
I want to get straight into some of what we have seen in
this past year. We know that VA workers have been stripped of
nearly all their labor rights. The Department is struggling to
staff and deliver services to veterans. Proven programs have
been gutted while promising new, more effective solutions. The
U.S. Department of Homeland Security (DHS) is kidnapping and
deporting veterans and executing VA employees in broad
daylight, and yet folks seem unbothered. I have come to believe
that is because employee retention and satisfaction, quality
service delivery, consistent outcomes, and veteran protections
are not actually the goals of the VA. The truth is that it does
not seem like you care about those things. Your mission, I will
be frank, from what I am seeing is you care about pleasing this
President and advancing his privatization to profit agenda.
Look, I want to take your words after Alex Pretti was
executed by DHS. You used your statement to blame Minnesota
State and local officials for a murder perpetrated at the hands
of Federal agents. At a time when accountability, integrity,
honesty, and courage were needed, Secretary, you peddled some
of the same trash that DHS was peddling, even though your
responsibility is to lead the VA, not to do the job of DHS.
I want to ask you a couple questions. Secretary, did you
talk to Secretary Noem or the President or anyone in the
administration about Alex Pretti, yes or no?
Secretary Collins. No. I have not talked to anyone about
that in the administration.
Ms. Ramirez. Okay. Well, let me ask you if you would have,
would you have talked to them about how he cared about the
Nation's veterans as he took care of them in hospitals?
Secretary Collins. I am not going to engage in hypothetical
conversations.
Ms. Ramirez. Okay. Well, let us--so you have not talked to
them and you are not going to talk about hypothetical standing
up for Alex. Mr. Secretary, let us see if there is some care
now. Would you call for Secretary Noem to resign given her
execution of a VA employee?
Secretary Collins. I have said all on this issue that I am
going to say and that would be my answer.
Ms. Ramirez. Okay, you have nothing else to talk about it.
Secretary Collins. Asked and answered. Asked and answered.
Ms. Ramirez. Okay, got it. I want to then pivot and talk to
you about deported veterans. Let us take your words on VA's
role in targeting noncitizen veterans. In a letter dated
January 13th, at the same time that you recognize that your
mission is to serve all veterans, you also admitted that you
are sharing noncitizen data consistent with interagency
agreements. Has your agency assisted in the deportation of
noncitizen veterans, Mr. Secretary, yes or no?
Secretary Collins. That comes from a report that has
nothing to do with sharing the legal status of veterans. It
actually helps us----
Ms. Ramirez. Secretary, has your agency helped----
Secretary Collins. I am not going to----
Ms. Ramirez [continuing]. deport veterans?
Secretary Collins. I am not answering any----
Ms. Ramirez. Oh, you are not going to answer.
Secretary Collins. You want an answer or not?
Ms. Ramirez. I do, but you do not seem to----
Secretary Collins. You want an answer or not? Then yes-no
is not an answer. You have been here long to figure that out.
Ms. Ramirez. Then it tells me that you are trying to cover
up the fact you are assisting.
Secretary Collins. No, it says that you have your own
opinion.
Ms. Ramirez. I am moving on and I am reclaiming my time.
Secretary Collins. Well, I can sit here and talk unless you
want an answer.
Ms. Ramirez. Let us continue. Mr. Secretary----
The Chairman. The gentlewoman is reclaiming her time.
Ms. Ramirez. Let me ask you another question. Are you
ensuring that deported veterans are still receiving their
benefits? Are deported veterans still receiving their benefits?
That is a pretty simple yes or no. Yes? No?
Secretary Collins. On that question, I will be frank with
you, on that question depending on their legal status and
everything, how they would actually get veterans benefits, we
will have to see what that actually says.
Ms. Ramirez. We do not know.
Secretary Collins. I am not going to----
Ms. Ramirez. Okay, then let me move on. I only have----
Secretary Collins. Unlike you, I am actually answering
honestly.
Ms. Ramirez. I have a minute and 26 seconds. Actually, I am
being very honest. It was a yes or no. You do not know if they
are getting their benefits or not.
I want to talk about VA workers now. Secretary Collins, let
us take your words on VA workers. At the same time that you
said VA employees need to be singularly focused on veteran care
and services, you dragged VA employees as too often fighting
against the best interests of veterans. In your crusade against
VA labor you have illegally terminated collective bargaining
rights, ended unpaid parental leave, and terminated the use of
Family and Medical Leave Act (FMLA) for in-law care. Yet people
seem to be running to work at your VA.
I almost applauded you for reducing the time to hire a VHA
employee from 109 days in 2024 to 47 days as of last month.
Look, I took a closer look at it and I realized that it is
smoke and mirrors. Unlike your predecessor, who measured the
time to hire as the number of days it takes for a new hire to
start the job, you are measuring the number of days it takes
for an applicant to receive a tentative job offer. That is why
we cannot trust anything that is coming out of your office.
It is clear, Secretary Collins, that you do not care about
Alex Pretti. You certainly cannot even respond a yes or no
basic question about deported veterans or the workforce. You
have no commitment to accountability, to integrity, or to
honesty. You cannot be trusted to do the reorg of the VA
because just like that time to hire board, you peddle lies,
half truths, and misinformation. Look, this is what I am going
to say to you. I only have 2 seconds.
The Chairman. The gentlewoman's time has expired.
Ms. Ramirez. You will be held accountable.
The Chairman. The gentlewoman's time has expired.
Representative Hamadeh, you are recognized for--we are
going to go to--I am sorry, I need to tell the timer this.
Staff's conversation we are going to go back to 5 minutes.
Staff had agreed back and forth, so we are going 5 minutes. We
will go as far as we can go. You are re-recognized.
Mr. Hamadeh. Thank you, Mr. Chairman. Secretary Collins,
thank you for being here today.
First of all, I would like to say something that you are
not hearing enough of. Thank you for your service to our
veterans. I hear the great work and the improvements that are
happening in my district and what you are doing to reorganize
the Veteran Health Administration is not--you know, it is
necessary, it is responsible, and it is long overdue.
Now, for years now, the committee has been handed report
after report by the GAO and the IG from the Commission on Care,
all saying the same thing, that the VHA's management structure
is broken. Too many layers, too many redundant bureaucracy.
What should be decisions that take a day becomes one that takes
even months. Now you and the administration are finally doing
something about it. Certain members of this committee want to
pretend like the sky is falling. Well, Mr. Secretary, let us
get some facts on the record.
Now, this chart behind me compares two lines over the same
time period. The VHA's workforce increased by about 14 percent
between the Fiscal Year 2019 and Fiscal Year 2024. The patient
encounters, it grew by just 6 percent. Workforce expanding at
more than twice the demand for care. That is not a staffing
crisis. That is an imbalance.
Mr. Secretary, this chart speaks for itself, but I want to
give you the chance to speak to it directly. Can you walk
through this committee about what this data tells us about VHA
staffing?
Secretary Collins. I can, and I am going to also get you
some more color on that. Also I want to say for this committee,
first and foremost, and it is been said many times, the only
thing that I have on my agenda is the veteran, period. That is
what started the change to good at the VA last year when I said
the only thing that is going to come first is veterans first.
Our workers now have a purpose and our workers know what they
are doing and they have actually improved. I am proud of that.
I am not going to take nameless names and programs that have
been gutted, supposedly, that have not been given a chance to
answer to.
This is an issue, though, that we have that is the heart
problem of where we are. In this town, it is throw money and
people and everything gets better. That is just not the way it
is. Fourteen percent over 6, it actually is worse in some
areas. I could go list by list by everybody. You had some that
increased 30 percent in FTE counts, but yet they actually went
negative in actual touches of people. This is something we
faced in the field. Greg has had to deal with this, and he is
one of the reasons that we came forward on how we deal with
this going forward and why this restructuring is needed.
Mr. Goins. Thank you, Mr. Secretary. One of the things that
is very objectively clear, and this goes back to Ranking Member
Takano's question earlier about does the VA have enough
employees or enough staff? The short answer is at a totality
level, probably pretty close. What is not true, though, is that
there is an absolute imbalance. There are places where we do
need more physicians and there are places where we have plenty
of staff. The short answer is if we do not go through with an
evaluation from a demand basis. We do not have an ability at a
national level to address resource needs where there are
growing veteran populations. That has never been able to be
done in the past at an enterprise level.
Mr. Hamadeh. In other words, making sure the tax dollars
are not tied up in excessive administration overhead, but
instead redirected to frontline service, modern equipment, and
facilities that actually serve the veteran.
Now, you are undertaking a new Request for Proposals (RFP)
for entire Veterans Community Care Network, VCCNs. Correct?
Secretary Collins. We are in the process. It is in RFP now,
so I can speak to what we had as you had the hearing on last
week. I will speak to that, right.
Mr. Hamadeh. What confidence can you provide to this
committee that the next generation of Third Party Administrator
(TPA) contracts that the administrators will be held
accountable for basic network integrity?
Secretary Collins. I cannot tell you how long I have been
waiting for that question to come from this committee. I very
much--because many of us have done this for years and I was a
part of this committee and there is only about four of us on
this committee that can say this actually voted for choice and
actually voted for mission, which set this up. What we did not
know at that time was because we were trying to get help from a
bad situation of wait times and issues, we set it up as quickly
as possible. Frankly, I can just say from a bigger perspective,
we had very little takers on helping us.
We ended up with the Veterans Access, Choice, and
Accountability (Choice) Act was a disaster. The John S. McCain
III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining
Internal Systems and Strengthening Integrated Outside Network
(Mission) Act has put us into two vendors, third party access.
There was nothing in the contracts that were holding
accountable. Well, let me rephrase that. There was, but VA just
did not hold them accountable.
One of the reasons that I am confident in this RFP that is
out right now and when it goes through is that we have
basically 10 years of failure to learn from. We have 10 years
of why this does not work, that we incorporated those problems
into this so we can hold them accountable, do better
management, and make sure that we are doing not only what is
best for the veteran, but what is best for the VA as well. I
have full confidence when this comes out that we are going to
have much more participation. We are also going to have 10
years.
I will go back to where we ranking member and I agree on,
history does teach us things. This one is a big one where
history has taught us things that we need to add on to it.
Mr. Hamadeh. Thank you, Mr. Secretary.
The Chairman. The gentleman's time has expired.
Representative Kennedy, you are recognized for 5 minutes.
Mr. Kennedy. Thank you, Chairman. Good morning.
Mr. Secretary, you are asking Congress to accept a VHA
reorganization that had moved 4-to 5,000 employees while the
workforce is already strained by the deferred resignation
program, attrition, and hiring disruptions. The VA has the data
of the workforce. I requested back in August a detailed
description of the employment changes and impact in western New
York for the Buffalo VA in the healthcare system for VAs. I
received a response from you in October that was vague and did
not answer any of the questions outlined regarding staffing
levels. Will you commit to me today to provide the data that I
asked for back in August to my office?
Secretary Collins. We are working that right now and can
discuss that as far as staffing levels go.
Mr. Kennedy. Is that a yes? You will----
Secretary Collins. I just that we will get it to you, yes.
Mr. Kennedy. You will give me--you will provide me----
Secretary Collins. That whole thing, yes.
Mr. Kennedy. The detailed description I asked for was
occupation, job title, grade level, facility, reason for
departure, whether the employee was retirement eligible,
participated in that deferred resignation program, or whether
the employee was terminated. The idea that it has been about 6
months, Mr. Secretary, that I have not gotten a response and
you are asking us to buy into this reorganization is
unacceptable. Please.
Mr. Engelbaum. Yes, Representative, we can commit to
getting the data and the information. One of the things I
wanted to highlight and just highlight really the issues that
we have been facing collectively and I think Representative
Kiggans really kind of mentioned it. There she was a trained
nurse that was doing administrative work. When you talk about
what somebody does and what positions we have, we do not even
know what they are doing. The ability from a bottom-up delivery
of medical centers, actually restructuring and reorganizing and
identifying their requirements and outlining their personnel we
will be able to look and identify.
Up to this point, we have not had the ability to do that.
We were not tracking people hired, people all over the place,
people were nurses not doing nurse jobs. This is exactly what
we are tackling. We will get you that information.
Mr. Kennedy. Thank you. I would like to enter both of these
letters into the record, Mr. Chairman.
The Chairman. Without objection.
Mr. Kennedy. I do want to focus on the workforce impacts
already hitting the Veterans Health Administration. The
reorganization, again, comes at a time where tens of thousands
of employees have been lost in the last year, doctors, nurses,
mental health professionals, police officers, forcing
facilities to close hundreds of beds because of the lack of
staff. The VA has eliminated vacant positions, pushed full
steam ahead with changes that risk driving even more
experienced staff out the door, and failing to provide Congress
up to this point, and we will take you at your word here today,
that you will provide clear, detailed workforce data.
I would like all of the data, quite frankly, obviously for
my own purposes in Buffalo, at the VA in western New York. I
think it is important that every member of this committee at
least has information regarding their own VA to the same effect
that my letter outlines.
Secretary Collins, for each of the VA's three
administrations, the VA, the VHA, National Cemetery
Administration (NCA), what is the total amount of paid salary,
benefits, and terminal leave under the deferred resignation
program? What accounts were used to cover those costs?
Mr. Engelbaum. I would just say, Representative, the
standard personnel accounts were utilized for those folks. We
budget--when you look at the, you know, FTEs that are budgeted
for personnel throughout the year, that was the resources that
were used. Those people remained on VA rolls through the end of
the year or through the termination, whenever they left the
service. Their traditional salary was utilized as far as our
standard personnel budgets.
Mr. Kennedy. Was there money that was diverted from other
accounts without informing this committee?
Mr. Engelbaum. I think I just answered that it was the
standard personnel accounts that would have been used to pay
them in any regard. Yes, the answer is no. There was no
diversion. It was their standard personnel accounts that were
already programmed for.
Mr. Kennedy. Okay. Well, we do not have that information
because you never provided it. Again, that information is vital
for us to not only make these determinations, but to be
supportive of this restructuring.
Secretary Collins. Congressman, can I answer one part of
your question? Your western--you mentioned your western New
York facility.
Mr. Kennedy. Yes, sir.
Secretary Collins. Right. It had, over the past 5 years, it
is had a 7 percent increase in FTE and a negative 6 encounters.
It is actually went backward. That is just one of the----
The Chairman. The gentleman's time is expired.
Dr. Miller-Meeks, you are recognized for 5 minutes.
Ms. Miller-Meeks. Thank you very much, Mr. Chair. I thank
Secretary Collins for being here as well.
Mr. Secretary, this reorganization is supposed to correct
decades of weak oversight and inconsistent leadership across
VHA regions. As we saw, one of the purposes and the momentum
for the Mission Act was because of VA deaths and waiting lists
that occurred, some up to 9 months for diagnosis and treatment
of cancer. That led to reorganization, if you will, or the
Mission Act, implementation of the Mission Act, but yet there
was no accountability. Can you give this committee your word
that you will avoid promoting any VA employee with a poor
performance history or documented oversight failures into
senior roles under the new structure?
Secretary Collins. That is one of the things, and I
appreciate the discussion here because you are getting--I know
that everybody believes that we are taking this in a big
picture, but I am traveling--this is the multiheaded snake, so
to speak. I am having to address the facility needs. I am
having to address leadership needs. Yes, we are putting into
place now to where I actually have a structure that can
actually do that, that can actually get us to a position where
we can have, you know, strong leadership and mentoring as we go
forward. That is our intent and purpose of this.
Ms. Miller-Meeks. The reason I asked that question is under
the previous administration, under the Biden administration,
very early in my time in Congress, we had a hearing in this
room in February 2024 after a young female whistleblower had
contacted the minority party, had not had any action, contacted
Chairman Bost. Chairman Bost then requested information from
the Secretary. After 45 days and a personal phone call, had no
information. We had to subpoena to get the information.
Now, the whistleblower was reporting on sexual harassment
by her senior leadership. This was senior leadership of the
Office of Resolution, Management, Diversity, and Inclusion
(ORMDI), which has a zero tolerance policy for sexual
harassment. No investigation was taken. Through emails and
texts that came out after being subpoenaed, we found that the
Secretary had, in fact, arranged for a soft landing for the
assistant secretary responsible for ORMID, and, in fact, that
person was effectively promoted into another job. Was the
senior leadership of ODMI, one of them, and then another
retired.
In testimony, Secretary McDonough said, there is no
question that I failed in this instance. None of those
individuals were held accountable, and this poor woman was made
to suffer and was disbelieved in her allegations of sexual
harassment.
Mr. Secretary, if this reorganization is truly about
accountability, will you commit today that no individual with a
substantiated record of mismanagement in prior OIG, GAO, or
internal VA reviews will be appointed to lead any offices that
have decision-making powers and, therefore, institute
accountability at the VA?
Secretary Collins. Yes, my goal is to, Congresswoman, is to
do exactly that, take into account the entire record and going
forward as we go forward.
Ms. Miller-Meeks. Thank you, sir. Mr. Secretary, in your
testimony, you specifically cited OIG reports as a foundation
for this reorganization plan. Are you applying the same
standard to personnel decisions and reviewing past OIG findings
when selecting candidates to lead the new VISNs, HSA, and
operations?
Secretary Collins. We are taking into account everything
that we can to find the best possible people in that regard as
we go, you know, forward in this. I think that is going to be,
you know, our guiding light. Are we actually getting the right
people in the right places?
Ms. Miller-Meeks. Thank you for that. Prior to what I heard
earlier with one of our colleagues on the other side of the
aisle, I have worked in the VA, both as a nurse and a
physician. I have applied for jobs at the VA, so both nurse,
physician, and military veteran. Let me just say it took 9
months for that application at the VA, by which point in time I
had dozens of offers elsewhere. Let me just say that 47 days is
a monumental achievement and thank you for that. Thank you for
working on hiring at the VA because it is a morass and we are
losing good people at the VA because we can--in the previous
administration, could not process applicants or give them job
offers rapidly enough. I know of two other physicians who had
that same problem.
Secretary Collins. That is something we are----
Ms. Miller-Meeks. Thank you so much.
Secretary Collins. I appreciate it. That is something we
are working on right now. When I was in uniform--just a week
ago, we had a lady who got a year later, got all--said, hey, we
are ready to talk to you now. We are fixing that, 30 days or
less.
The Chairman. The gentlewoman's time is expired.
Quick piece of housekeeping here. In accordance with the
committee rules, I ask unanimous consent that Representative
Wasserman Schultz from Florida be permitted to participate in
today's committee hearing. Without objection, so ordered.
Representative Budzinski, you are recognized for 5 minutes.
Ms. Budzinski. Thank you, Chairman Bost, Ranking Member
Takano, for holding this hearing, and thank you to Secretary
Collins and your team for being here.
You know, I want to just kind of cut to the chase here. I
really think over this last year, what you have done to the VA
is really hollow it out. This is cutting to the bone. It is not
trimming fat. It is really hitting VA employees, union
employees, the hardest. You have stripped their collective
bargaining rights, damaging their morale and dignity, leaving
employees wondering if their jobs will be cut next to. I just
want to point out none of that is done to service our veterans.
This is not happening as work is slowing down, of course,
within the VA. It is happening while VA experiences the largest
expansion of VA healthcare and benefits in decades, thanks to
the passage of the Sergeant First Class Heath Robinson Honoring
our Promise to Address Comprehensive Toxics (PACT) Act. It is
happening as VA is restarting one of the largest and most
complex EHR deployments in modern history in just over 2
months.
I want to point out, I have been asking, when is the VA
going to nominate a Chief Information Officer (CIO), something
that would be a critical leadership position to ensuring
success of this EHRM program. We still do not have that. That
is a really important leadership position.
Now you are proposing this massive reorganization without
consulting Congress first. I have serious concerns with how
this reorganization could impact that already ambitious
rollout. I support efficiency, but it should not be and it
should never jeopardize success and most certainly not at the
expense of our veterans or VA employees.
Mr. Secretary, I am concerned about your plans to initiate
a VHA-wide reorganization at the same time as you have
accelerated the deployment of EHRM. I am looking at an email,
and I can show it to you, from the GAO that says that you have
canceled your standing meeting with GAO, an independent body
who performs critical oversight on the EHRM program, because,
quote, ``your leadership and resources are strained.'' Is that
true?
Secretary Collins. We will take meetings as need be, but
the things that we get, we will meet with GAO and we meet with
those regularly. We are answering every GAO or every OIG report
that we get.
Ms. Budzinski. They have made recommendations on solutions
that will help to make the EHRM deployment successful and you
have decided to just shut down meeting with them.
Secretary Collins. I would disagree with that. Most of the
GAO reports, in fact, almost all of them dealing with the EHRM,
dealt with a system that does not exist anymore. They said what
was wrong with the system that was rolled out in Washington
State, which was, and I will admit to you right here, was an
absolute, utter mitigated disaster.
Here is the issue. If you have a new program coming in in
which you have redone and reshaped how you are doing it, there
are lessons that we learned, like standardization issues,
standard--the problem we had in Washington State was is we
allowed every hospital to decide what they wanted to do. Every
doctor got to decide how they wanted it set up.
Ms. Budzinski. That is great. I only have 2 minutes, Mr.
Secretary.
Secretary Collins. I am trying to explain----
Ms. Budzinski. Out of respect, we just provided you with
the email from the GAO. I am hoping that what this will shed a
light is that it is helpful to reengage the GAO and work with
them on solutions to make sure that the EHRM program is
successful.
Secretary Collins. I look forward when it is rolled out. I
am sure that they will have plenty of----
Ms. Budzinski. They have----
Secretary Collins [continuing]. as it is rolled out because
there is nothing really to report----
Ms. Budzinski. Okay.
Secretary Collins [continuing]. on right now.
Ms. Budzinski. Okay. There is a lot to ask of your
workforce, a workforce that I will note has gone through a lot
of changes over the last 6 years and I do worry. You brought up
some of the cases in Washington State with the EHRM program and
the struggles with that. They were not the only ones to
identify and deal with many of the issues with this new system.
What do you have to say to the hardworking employees who are
now facing even more change with this reorganization,
especially when many of their problems with Oracle have not
been addressed?
Secretary Collins. That is such an open-ended question that
they have been addressed. We have--in fact, my deputy
undersecretary--my deputy secretary is in the facilities this
week again. He is there almost every other week. They are
addressing this as it goes along. Any issues that come up, we
are solving those as we go forward.
We have made a situation now in which it is working, it
will work because it is not a choice not to work. I think that
is the biggest--when you take the lessons of the past, I agree
with you on that. The lessons of the past were
nonstandardization, non-looking-at-it, and now we are looking
at how we do it better.
Ms. Budzinski. I am just concerned that we have not fully
resolved the problems of the past. We are going to be
expediting 13 new Go Live sites with about 164 more Go Live
sites within 2031, and you are decimating your own workforce. I
think that is a real problem and not setting the VA up for
success. Do you know how many Information Technology (IT)
support specialists you have lost since January 2025?
The Chairman. The gentlewoman's time has expired.
Ms. Budzinski. That is unfortunate.
The Chairman. Representative Self, you are recognized for 5
minutes.
Mr. Self. Thank you, Mr. Chairman.
Mr. Secretary, you have told us about the growth of the
VISNs, the unintended growth of the VISNs in terms of
employees. We now have 5 VISNs and 15 new health service areas.
It is not lost on me that equates to the number of VISNs that
we have today. I want to talk about potential unintended
consequences of this because I think this is good. Let me
preface this, but I want you to talk to us about it because
there are people on this committee whose worldview is bigger is
better, bureaucracy is better. Can you--I hope that we do not
have 5 super VISNs and 15 VISNs at the end of the day through
growth.
How are you going to organize this plan so that that does
not happen and it is all in execution so that in the future we
do not have the super VISNs and VISNs? It is an open-ended
question. Please tell us.
Secretary Collins. Yes, here is the top end and I am going
to let the team finish this. Top end is they do different
things, okay? The HSAs and VISNs do not do the same thing at
all. There is a purpose for that and a reason for that as we go
forward. John.
Mr. Bartrum. I really appreciate your question, sir. I
think this is a great question that gets at the heart of what
we are doing here.
This reorganization streamlines how we do our operations.
Right now, if you look at the current operation, every program
office comes up with their own policies and then each VISN
comes up with their own policy on top of that and then each
facility turns that into their own policy. What we are doing in
streamlining this is we are creating not just the HSAs, which
will help with the execution of focusing down in the markets,
but, more importantly, and what we have not talked about are
the operations center. The medical operations center will
ensure consistency across policy. If a policy is determined on
whatever at the senior level of the VACO for a national
program, the medical operations center will then put
consistency guidelines out that will go down to each of the
VISNs, the five VISNs and the HSAs, to the facilities so that
it's consistently applied, so that we don't get one VA is one
VA. We get all of VA being the same VA as we as we move
forward.
Greg, do you want to talk about how that challenges our
facility directors and our ability to serve veterans?
Mr. Goins. Yes, sir. I think there is an element here that
has been missing in our discussion that is really important to
answer the question you asked directly. We have heard from
everyone that has looked at a VISN structure. Does not matter
where you come from or where you sit, that the roles and
responsibilities are not clearly defined. The way in which we
make sure that our organization does not balloon the way that
Congressman Bergman has described bureaucracy as a rose bush,
it is a great metaphor, thank you for that, sir, is by clearly
defining roles, responsibilities, and boundaries. When we do
that, it does not allow those organizational entities, like a
VISN or an HSA or even a program office, as you heard the
undersecretary say, to define their own roles and
responsibilities that then facilitate a massive growth in those
units unchecked. The roles and responsibilities are part of
this reorganization.
Mr. Bartrum. Sir, if I could just add one more thing. This
is a conversation, not a final plan that we presented in
December. We said, this is the structure that we are doing. We
are moving out. This is the transition. As the Secretary
committed to, and we always will do, is follow the law. When we
get to that final plan, we will be submitting that over as a
final plan. It may look somewhat different than what we have
seen because we are getting input and we are continuing to get
input from the field as we continue to evolve. It is an
iterative process.
I would just--there is been some assertions here that we
identified in December what we were doing and we started the
implementation. What we identified in December is the start of
a discussion and a dialog that says, we all recognize this
needs to change. Here is the structure and the framework of how
we are going to change it. We are continuing to have that
dialog today and continuing tomorrow until we send over the
notice. We will continue to talk even after that point. It is a
iterative, ongoing developmental process.
Mr. Self. It looks to me like the vital issue here is that
the HSOs--HSAs cannot have their own interpretation of VA
guidance.
Mr. Bartrum. Correct.
Mr. Self. That looks to me, Secretary, to be key.
Secretary Collins. Yes. This was the biggest issue for me,
is--and I will go back to something I think I even shared last
year. I had a veteran come up to me who had moved from Salt
Lake to Hampton Roads actually, Representative Scott. Moved
over there, was getting treatment, he is an amputee, was
getting treatment at Salt Lake, came to Hampton, and the
Hampton doctor said, the VA does not do that. He said, this is
the VA, correct? He said, yes. He said, but we do not do that.
That, in essence, is the whole genesis of thought behind the
upper level----
The Chairman. The gentleman's time has expired.
Secretary Collins [continuing]. the reason why you do it.
That is why we do it.
The Chairman. The gentleman's time has expired.
Dr. Conaway, you are recognized for 5 minutes.
Mr. Conaway. Thank you, Mr. Chairman. Thank you, Mr.
Secretary, for presenting yourself to this committee today.
You know, I am sorry, I am going to have to start out with
a rather pointed topic here. You may know that 90 percent of
the people in the country have seen the killing of Mr. Pretti.
A number of statements have been made by the administration
about his death that are very concerning, certainly to the
family, whose loved one has been defamed by members of the
administration. I am compelled to ask you, Secretary, does the
VA employ domestic terrorists, yes or no?
Secretary Collins. That is a question that is aimed at an
answer that I have already given. I am not going to indulge----
Mr. Conaway. Reclaiming my time. I am sorry.
Secretary Collins. I am not going to indulge in this.
Mr. Conaway. Reclaiming my time. Your colleagues have
labeled Mr. Pretti, a VA nurse, one of your employees, a hero
to many, as a domestic terrorist. Is he a domestic terrorist?
Secretary Collins. As I have already answered to this
committee, I have answered and made my statements of
condolences to the family. I am not answering and I am not
going to entertain these questions.
Mr. Conaway. The Vice President and Kristi Noem and Stephen
Miller have certainly mishandled this situation by calling a
domestic terrorist. They have called him an assassin. Did they
handle this, his killing, appropriately, in your view?
Secretary Collins. Asked and answered.
Mr. Conaway. Kristi Noem herself has even walked back and
said--walked back this charge that was made. You know, you lead
a large organization with employees that are hurting in the
wake of this killing. While you have reached out to the family
and that is certainly commendable, it would be helpful to show
just some of the courage that our many veterans have shown in
their service by standing up and calling out what is wrong,
particularly with respect to Mr. Pretti and his life's work.
Can you say on the record whether or not Mr. Pretti was a
domestic terrorist or an assassin? Will you stand up for him
and show just a little bit of the courage that our veterans
show every day?
Secretary Collins. Excuse me. I have showed the courage of
a 27-year veteran sitting in front of you and will not be spoke
down to. I have asked and answered the question.
Mr. Conaway. Now, moving on. I think your inability to
answer a question about Mr. Pretti and his life is certainly
disturbing and I think it is unfortunate.
Let us move on to the VA reorganization. Looked at your
plan and had some briefings on this. As I understand it, back
in the 1990's, there was a big reorganization, the last large
reorganization that was done. The VISN system, this integrated
service networks, were created, 18 of them. To deal with the
large, complex nature of the VA----
Mr. Goins. There was originally 23, sir.
Mr. Conaway. Twenty-three. Well, thank you. It was even
more than that. You are reducing that 22 down to 5. As I
understand it, you are breaking up that five into three
administrative areas, is that right, in each of these five
VISNs? Am I describing that the right way?
Mr. Goins. Clinical oversight areas. If I can just tell
you, when the VISNs were first created, the 23 that were
created, it was considered an industry best practice. What ends
up happening over time in the public sector, unlike the private
sector, private sector moves on. They actually started
emulating us. Then over time they also recognized there were
better ways to do business and did not do it.
Mr. Conaway. Thank you. I need to reclaim my time. It seems
to me we are adding in a layer of bureaucracy and the issue
without necessarily doing things better, that could not be done
under the current system, and you are doing so at a time when
30,000 employees have been laid off. In my own county,
Burlington County, it takes over 2 months to get an appointment
for just primary care, longer for mental health services.
Another county, Hamilton, they have a similar issue where it
takes about a month to get a primary care clinic and about a
month and a half to get mental health services. This is in the
wake of a decimation of the employee force. We have 1,000 less
physicians, we have 3,000 less nurses.
Of course, you are focusing as rightly on direct care. How
can you get that direct care to people if we do not have the
nurses and the doctors to do the care? It shows up in these
numbers. These are your numbers as of February 4th about the
wait times there. How do you justify the cuts to services that
are occurring?
I just have to share one story about this issue. I spoke to
my colleagues about--who work in the VA system. There is an
institution out in Colorado, a patient languishing in the
emergency room. They had the doctor, they had the Operating
Room (OR), what they did not have were the OR techs and the
nurses to actually deal with and definitively treat someone----
The Chairman. The gentleman's time has expired.
Mr. Conaway [continuing]. that needed amputation because
they had an infection in their leg, so.
The Chairman. The gentleman's time has expired.
Mr. Conaway. It matters. Employees matter.
The Chairman. General Bergman, you are recognized for 5
minutes.
Mr. Bergman. Thank you, Mr. Chairman.
Anybody here want to offer a definition of what a camel is?
It is a horse designed by a committee. Okay. I have seen
several parts of the camel displayed today. Since, Mr. Goins,
referenced my rose bush comment earlier, I want to make sure
that when you think about the most majestic animal in the
world, it is a horse, strength, compassion, awareness. Our
veterans are those magnificent men and women who serve. Over
time, not through necessarily intent, but maybe just lack of
focus, the Veterans Administration through its organization has
begun to look like a multiple-humped camel.
In my office I have the chart that you gave us of the new
organization, the chart of the current organization that you
are transforming because you are doing it for the right
reasons. Those of us, I think, who ran for Congress, especially
as veterans, we served for the right reasons. We serve now for
the right reasons. I would like to, because I have 3 minutes
and 40 seconds left, yield any or all of that to you, Mr.
Secretary, to make any comments that you would like in the rest
of my time.
Secretary Collins. General, I appreciate that. In the sense
of--because let us just--you know, I think there has been a lot
of discussion today that does miss each other as we go forward.
The interesting issue is we have talked about, one, I want
to go back to one that has been said several times that we have
laid off or got rid of, however you want to look at it. The
30,000 number was all voluntary early retirement or bureau. We
did not fire any of them. They--that is a voluntary issue. Let
us just keep that where that is.
We have discussed the issues of why we are doing this, and
also this duplicative nature of an HSA and a VISN. I cannot
describe this possibly any better than to say the HSAs and the
VISNs are as different as the quarterback and the center. It is
not duplicative to have a quarterback and a center on the field
at the same time. In fact, it is necessary to have the
quarterback and the center on the field at the same time. To
look at this plan and say it is a--it is adding layers has
really not, honestly, I think, looked at the perception of what
we are doing now in the VISN system, which is broken and has
been admitted to by most everybody that looks at it over the
years.
What we are trying to do here is empower center directors,
chiefs of staffs at the local--and executive directors, the
folks at the base level, to make decisions. I spoke to another
general recently and I said, sir, let me ask you a question. I
said, are you tip of the spear when you are back at
headquarters making decisions or is it the units that are in
the field knocking on doors? He looked at me and said, that is
a dumb question. I said, no, it is not. I said, if you just
help me here. He said, of course, they are tip of spear. I
said, so you are not. I said, well, we have that reversed in
the VA because our center directors right now were ones that
would have to end up sending up--I heard this so many times,
and when I would go to--and I go to hospitals, I would say,
well, what happened to that idea? They said, well, we sent it
up and they found your camel committee. It never got back to
them. They never had an answer. They were paralyzed into what
they were doing. Thus you developed over 170 different
hospitals, ambulatory centers that did it differently because
they could not get clear answers.
The VISN was supposed to add that in, but it did not
because after a while they become so bogged down in the
different functions of what they do. When you look at it from
an operating perspective, this is the--sort of the opening up.
I will go back to what I said in my opening statement. Part
of what we are doing here is giving, frankly, more information,
starting it earlier than is even required under our 510(b), you
know, need. We are starting this last month. We are still
working it as we are speaking here today. We are still looking
and making sure that we have the right areas in the right
places, so that we can give a finalized plan, which we are
actually going to give out in pieces probably. We are not going
to--we are going to actually show it as we are making progress,
to give you more transparency into the process.
What I will not tolerate, though, is the status quo. Also
to continue this issue of when you looked at it, like we just
said a few minutes ago, we have facilities that FTE counts are
higher now after 5 years than their actual encounters with
patients. We have to be able to readdress where we are putting
our workforce at the same time as we are working within our
system of both direct care and community care.
Mr. Bergman. I guess I will yield back and just say, sounds
like you are running a Marine Corps type operation, and I am
proud of you for doing that. Thank you.
I yield back.
The Chairman. The gentleman yields back.
Dr. Dexter, you are recognized for 5 minutes.
Ms. Dexter. Thank you, Mr. Chair. Thank you once again,
Secretary Collins, for being here with us.
Off the top I also want to take a moment to acknowledge the
murder of Alex Pretti. Throughout my career as an ICU
physician, including working at the VA, I worked with dedicated
professionals just like Mr. Pretti. We critical care clinicians
are the ones who literally run into rooms when someone is dead
or dying and try to revive them or bring them back. Alex
Pretti, until the last moments of his life, was protecting
people and the principles that this country is built upon.
The VAs across this country are understaffed, overstressed,
and now grieving. Secretary Collins, your failure and the
failure of the agency to honor his memory and the impact on VA
workers is both a disgrace and further undermines trust and
leadership for the public servants who are committed to caring
for our veterans. The employees of your agency feel threatened,
silenced, and now deeply harmed by the lack of acknowledgment
that one of their own was murdered at the hands of the U.S.
Government, the country our patients sacrificed to protect.
I ask you to please reflect on the long-term impacts of how
you address the murder of Alex Pretti for the people working in
it and caring for the VA's across this country. Please hold
yourself accountable to your overstressed workforce and the
veterans who sacrificed to protect this country and the
Constitution.
As you know, and I am sure that whatever you are writing is
very important.
As you know, I am a physician, and I also was the chair of
the board of the largest multispecialty physician group in the
Northwest. I know how hard it is to run a complicated
organization as much as I can. Not as complicated as the VA,
but I know that changing structure in an organization is
challenging, and it requires a culture that is dedicated to
making that change possible and effective. I am worried, deeply
worried, that this labor-intensive and costly endeavor that you
are embarking upon at a time when the VA is already
overstressed and understaffed is destined for failure unless
you can really lean into the culture and supporting the people
who have to make this possible.
I am going to leave that because I am going to run out of
time. I want to go back to about 2 weeks ago, Secretary, your
colleague Mr. Topping was in front of our committee to testify
on the new community care contracts. During that hearing, I
shared that my office is waiting for the VA's response to a
September 22, 2025, letter that was urging the Department to
take action to provide our veterans with better data on wait
time and drive times to care in the community as opposed to
those through the traditional VA system. Mr. Topping promised a
response on where the VA's letter was, and my staff is still
waiting.
Secretary Collins, do you feel it is appropriate for
members of this committee to wait over 4 months for a response
to a simple letter about how we can better serve our veterans?
Secretary Collins. I think that getting you a timely and
proper response is needed by everybody. We are trying--I am
trying my best to do that in all cases. I think the issue here,
you know, is looking at it was a question directed him. I will
have to go back and look at that actual letter, but I do not
have it in front of me. I agree, we need to get you an answer.
Ms. Dexter. I appreciate that. That is similar to the
answer I got from Mr. Topping. I appreciate that my team has
stayed on top of this as well. I just have a challenge that if
we cannot get an answer to a simple letter, that being able to
reorganize the entirety of the VA health system is going to be
a challenge that we cannot rise to.
I also want to believe you that the VHA can undergo a
reorganization. I agree with you that the status quo is not
acceptable for our veterans, but it has to improve the care for
our veterans. While you are losing staff, whether, you know, it
is because of early retirements or not, it is extraordinarily
difficult to get through that. My skepticism is not because I
want your agency to fail. It is because I know that the time
and the capacity and the leadership that is necessary may
extend past the time that we actually have with this
administration. Things continue to pendulum. How are you going
to get that done in that amount of time?
Secretary Collins. Well, I think that one of the things is
actually in my conversations with employees, and especially
getting their input from our directors and center directors,
they are actually excited about this because for the first
time, they are actually having somebody at the top that says
what they have been feeling for years, and that is they are
being over neglected and looked at. I would also just have to
say as a reminder that the VA is a healthcare system just like
the one you used to run as well. I am sure you lost employees
as well, just like we do, and we hire employees as we can. That
is what we are continuing to do and we have never stopped.
Ms. Dexter. The ability to retain employees, and this is
incredibly important, and your commitment to them is going to
drive that. I appreciate that and yield back.
The Chairman. The gentlewoman yields back.
Dr. Morrison, you are recognized for 5 minutes.
Ms. Morrison. Thank you, Mr. Chair.
Secretary Collins, in May, you gave this committee your
word that you would not fire any VA staff responsible for
providing care to veterans. Since the announcement of this
massive reorganization, I have already heard two direct
accounts, the impending reorganization leading to canceled
promotions for critical support staff and the dismissal of
concerns regarding access to care. Under your leadership,
applications to work at the VA have fallen 57 percent. A
spokesperson for the VA confirmed planned cuts to 25,000
unfilled positions, which will strain the workforce caring for
our veterans.
Trust me when I tell you almost every healthcare worker in
America can tell you exactly what it is like to be overworked,
short-staffed, and overwhelmed. In August, the VA inspector
general found that the Minneapolis VA had 130 different
categories of positions facing severe staffing shortages,
including 78 clinical positions.
I sent you a letter in September requesting details about
the employee departures we have seen since last year, which you
still have not responded to. In your testimony, you stated,
quote, ``Staffing and operations at VA medical centers and
clinics will not change as part of this reorganization.'' Given
reports of existing severe staffing shortages and negative
impacts from this reorganization effort, will you commit to
addressing the severe staff shortages that threaten access and
quality of care for our veterans? Just a yes or no, please,
sir.
Secretary Collins. There is no yes or no. Minneapolis is 7
percent more in FTEs since 2019 and two----
Ms. Morrison. Mr. Secretary, I am asking you to commit to
addressing that.
Secretary Collins. No, you made the statement that we are
overstaffed--understaffed, 7 percent more FTEs since 2019----
Ms. Morrison. I will take that as a no, sir.
Secretary Collins [continuing]. and only 2 percent----
Ms. Morrison. I reclaim my time. Mr. Secretary, the crisis
of morale in your agency has reached a fever pitch in
Minneapolis. Minnesota has been overrun by masked, lawless
Federal agents who are terrorizing our communities. It has
resulted in untold human and economic damage, including the
killing of two American citizens. One of the people we lost was
VA nurse Alex Pretti. Alex Pretti was the best of us. Like his
colleagues at the Minneapolis VA, he was a dedicated,
hardworking care provider who honored the sacrifice of the
veterans he cared for by helping deliver on the promise our
country made to our veterans for their service. Alex's parents
described him as a kind-hearted soul, who cared deeply for his
family and friends and also the American veterans whom he cared
for.
Mr. Secretary, you said you have not spoken with ICE. I
have spoken directly with ICE on the ground in Minnesota and
they clarified that State and local officials are cooperating
with ICE regarding violent criminals. This has been the case
long before Operation Metro Surge. In fact, they told me that
the idea that there is no cooperation is completely false.
Do you dispute ICE's account on the ground in Minnesota,
yes or no?
Secretary Collins. I have no idea what you are talking
about because it is not my department.
Ms. Morrison. That is true, Mr. Secretary. You are
responsible for the VA, not immigration operations, not
investigating shootings by Federal agents, the Veterans
Administration. Please help me understand your official
statement. What evidence do you have to blame the violent death
of one of your employees on State and local officials? Do you
have any evidence?
Secretary Collins. I have stated my statement on Alex
Pretti, and I am not going in--I mean, there is nothing else
for me to say.
Ms. Morrison. You retract part of your original statement?
Secretary Collins. Asked and answered.
Ms. Morrison. Senior officials in the Trump administration
have slandered Alex Pretti as a domestic terrorist, an
assassin, that he wanted to do maximum damage, and massacre law
enforcement. No official has retracted those abhorrent and
ridiculous statements.
Mr. Secretary, it would go a long way for the grieving
staff at the Minneapolis VA if you corrected your statement
blaming State and local officials, which, by the way, also
actively undermines the work of local law enforcement and made
a deliberate effort to honor Alex for his service and care of
veterans. Alex Pretti was a beloved nurse, son, brother, and
friend, and will be remembered as an American hero. It is
profoundly disappointing that you refuse to correct the record
and reject the hateful lies spewed by this administration about
Alex and stand up for your employee. Veterans and those that
care for them deserve VA leadership that honors their service
and sacrifice with words and actions. If you cannot stand up
for Alex Pretti, how can any VA employee trust that you will
stand up for them?
Mr. Chair, I yield back.
The Chairman. The gentlewoman yields back.
Mr. Scott, you are recognized for 2-1/2 minutes.
Mr. Scott. Thank you, Mr. Chairman. I appreciate the
opportunity to participate.
Mr. Secretary, when the North Battlefield Outpatient Clinic
opened in my district in April of last year, I expressed
concern that the clinic would be opening with only 150 staff
members. You called me a liar. Then in the same article that
you called me a liar in, you said that it would be opening with
150 employees. I said it was 150 employees. I am lying. I guess
you are lying when you say 150.
You have indicated in a previous answer that the staffing
is still incomplete. Can you give us an idea--you were supposed
to be fully staffed by January. It is now February. When it
will be--when will the facility be fully staffed?
Secretary Collins. Congressman, we started with 150 and we
are up to 355 now. As I said earlier, we have 166 in active
recruitment, and all functions that that facility was supposed
to be doing are currently being done.
Mr. Scott. When do we expect it to be fully staffed?
Secretary Collins. When we get the 166 hired.
Mr. Scott. Okay. The Hampton VA psychiatric ward, I have
been told, has 40 inpatient beds, but only 20 available for
veterans due to lack of staff. Is that true? Is there a
timetable for fully staffing? If you do not know, just get back
to me.
Mr. Goins. Yes, I will have to get back to you, but I do
want to offer context. Inpatient mental health wards across the
whole country, public and private, have been dwindling for
years because most of the care is being delivered on an
outpatient basis now, as much as it can be. I do not know the
details on Hampton.
Mr. Scott. We have the beds there. Let us see.
Mr. Secretary, do you believe the decisions made by the
administration regarding hiring freezes, proposed layoffs in
the tens of thousands, termination of collective bargaining
agreements, and other personnel actions have adversely affected
your ability to recruit personnel?
Secretary Collins. I think the bigger problem of taking
personnel and others into the VA is the same as any other
hospital system that you have in your district. I think we face
the strange struggles as everyone, and that is, you know,
finding the right people, having enough come out, and actually
being able to pay a competitive wage for finding that.
Mr. Scott. Thank you, Mr. Chairman. I appreciate the
opportunity to participate.
The Chairman. Representative Wasserman Schultz----
Secretary Collins. Congressman, can I just say this?
The Chairman. His time has expired.
Secretary Collins. Congressman, it is good to see you. I
have not seen you in a while. It is good to see you.
The Chairman. Representative Wasserman Schultz, you are
recognized for 2 minutes and----
Ms. Wasserman Schultz. Thank you, Mr. Chairman. I really
hope I can get an extra minute or so since this will be my only
appearance here and I am asking a straightforward question.
Mr. Secretary, last week your staff, and forgive me for
dispensing with the niceties, last week your staff, including
Mr. Goins, who is with us here today, briefed our subcommittee
on the major elements of this reorganization. One new piece of
information provided to us was a draft cost estimate. It showed
that there will indeed be a cost where I was previously told
that this would end up being cost neutral.
As the ranking member on the Military Construction,
Veterans Affairs, and Related Agencies (MilCon-VA)
Appropriations Subcommittee, eventually it will be mine and
Judge Carter's responsibility to find the resources to fund
this reorganization if we decide that it is worth funding or to
approve any funding that you plan to transfer internally to pay
for this reorganization. I look forward to the report that you
are statutorily required to submit to the Appropriations
Committee so we can see on paper exactly what your plan
entails, including robust and appropriate justifications.
Now, recognizing that you are in the early stages and that
your cost estimates are preliminary, to better understand your
assumptions, based on your estimates there will be a tremendous
upgrade upfront cost in the first year, around $521 million,
but with some potential savings along the way, a final net cost
of around 312 million over the course of a 5-year period.
Assuming that you are planning on doing this immediately in
this fiscal year, is that correct?
Secretary Collins. We intend to begin part of this with
inside our current--as I have told you before, with inside our
current authorizations on appropriations.
Ms. Wasserman Schultz. In the Fiscal Year 2026 bill, which
has already been signed into law and we did not appropriate any
funding for a reorganization of VHA, where are you proposing
that the $521 million comes from?
Secretary Collins. Yes, as you have had your briefings with
the Office of Management (OM), this is going to come out of our
regular account funds. We are just moving people here. That is
not accounting for this in that situation. We will have more
information as we go forward on this.
Ms. Wasserman Schultz. Do you expect that you will be
sending the committee a reprogramming request for approval?
Secretary Collins. For money?
Ms. Wasserman Schultz. Mm-hmm.
Secretary Collins. Probably. That one is not at this point.
We are living within the guidelines that you gave us and we
appreciate what you gave us.
Ms. Wasserman Schultz. The fencing based on their current
budgets.
Secretary Collins. We do not project that there is a--that
is going to trigger in that.
Ms. Wasserman Schultz. Will we see an updated cost estimate
with detailed justification in the Fiscal Year 2027 budget
request?
Secretary Collins. That is being put together now, yes.
Ms. Wasserman Schultz. Okay. I want to express concern
about the proposed savings of $1.7 billion from personnel
actions resulting from this reorganization. Part of it moves
administrators into clinical roles which will result in pay
cuts for many.
The Chairman. The gentlewoman's time is expired.
Ms. Wasserman Schultz. Mr. Chairman, if you can give me an
extra couple of minutes, I would appreciate it.
The Chairman. I would appreciate--I would like to do that.
At the very beginning of the meeting, I told them we had a hard
stop at 1--or at 12:30. It is exactly that. Votes have been
called and you can submit them for the record. We are even
going to have--we are going to submit our closing statements
for the record.
Mr. Takano. Mr. Chairman, I do want to point out this is
only the second time that he has appeared before our committee,
the Secretary, since he was sworn in.
The Chairman. We have----
Mr. Takano. Secretary Wilkie showed up three times in 2019
alone.
The Chairman. We will have more hearings. We will have more
hearings.
Mr. Takano. I do not know what is more important than this
hearing.
The Chairman. We will have more hearings. I ask unanimous
consent----
Mr. Takano. I heard he has an appointment at the White
House.
The Chairman.--that all members have 5 legislative days in
which to revise and extend their remarks, including extraneous
material.
Mr. Takano. I want to know when we are going to have a
continuation of this hearing.
The Chairman. Hearing none, no objection----
Mr. Takano. Clearly, there are----
The Chairman.--so ordered.
Mr. Takano [continuing]. more things we need to hear from
the Secretary.
The Chairman. We are adjourned.
[Whereupon, at 12:30 p.m., the committee was adjourned.]
=======================================================================
A P P E N D I X
=======================================================================
Prepared Statements of Witnesses
----------
Prepared Statement of Douglas Collins
Chairman Bost, Ranking Member Takano, and distinguished Members of
the Committee, I appreciate the opportunity to present the VA plan to
improve the Veterans Health Administration's (VHA) management structure
in order to strengthen care for Veterans nationwide. Joining me today
are VA Under Secretary for Health John Bartrum, VA Assistant Secretary
for Human Resources and Administration Mark Engelbaum, and VHA Acting
Chief Operating Officer Gregory Goins.
Let me start by addressing some misleading and inaccurate
descriptions we have heard about this effort. This is not a reduction
in force (RIF), and this is not an effort to diminish direct care for
Veterans. This is a reorganization designed to eliminate excessive VA
administrative overhead and redirect more resources directly to the
field.
In other words, this is something that will lead to better results
for the Veterans, families, caregivers, and survivors we serve.
The current VHA leadership structure is burdened with redundancies
that slow decision-making, create confusion, and foster competing
priorities - each of which undermines the quality of care for Veterans.
The current structure also lacks clear accountability, leading to the
frustration we hear from Veterans and staff regarding VA operations.
But you do not have to take my word for it. This is the same
conclusion we have heard for years from VA's Office of Inspector
General (OIG), the Government Accountability Office (GAO), and many in
Congress - all of whom have repeatedly underscored the need to
reorganize VHA.
For instance:
In 2016, GAO identified ``deficiencies in VHA's
organizational structure and recommended significant restructuring,
including eliminating and consolidating program offices and reducing
VHA central office staff.'' \1\
---------------------------------------------------------------------------
\1\ https://www.gao.gov/assets/690/680170.pdf
That same year, the Commission on Care strongly
recommended a new VHA governance model.\2\
---------------------------------------------------------------------------
\2\ https://permanent.fdlp.gov/gpo69908/Commission-on-Care_Final-
Report_063016_FOR-WEB.pdf
In 2019, GAO\3\ noted VHA's lack of a comprehensive
policy to define Veterans Integrated Service Network (VISN) roles and
responsibilities.
---------------------------------------------------------------------------
\3\ https://files.gao.gov/reports/GAO-19 462/index.html
In 2024, OIG said: ``...weaknesses in VA's governance and
oversight have affected many aspects of program performance and
operations.'' \4\
---------------------------------------------------------------------------
\4\ https:// www.vaoig.gov/ sites/ default/ files/ document/ 2024-
03/ sar_90_final_3_14_2024_6.pdf
Chairman Moran said last year that, ``The VA needs reform. If the
status quo were working, we would not have spent 2 weeks hearing from
VSOs on way the VA needs to improve.'' \5\
---------------------------------------------------------------------------
\5\ https://www.veterans.senate.gov/2025/3/chairman-moran-leads-
hearing-with-va-vsos-to-review-pending-legislation
---------------------------------------------------------------------------
And House Committee on Veterans' Affairs Chairman Mike Bost said,
``Simply put, this outdated structure created in the mid-1990's no
longer aligns with the scale, complexity, geographic demands, or
performance management requirements of the modern VHA.'' \6\
---------------------------------------------------------------------------
\6\ https://veterans.house.gov/news/
documentsingle.aspx?DocumentID=7823
---------------------------------------------------------------------------
So there is widespread agreement that VHA needs reorganization and
reform, and that is exactly what we are doing. Here are our goals:
Improve health care quality for Veterans;
Empower local hospital directors;
Eliminate duplicative layers of bureaucracy; and
Ensure consistent application of VA policies across all
medical facilities.
Here is how we will get there: We will establish clear lines of
authority and accountability to ensure that everyone is focused on what
they need to do to improve our services to Veterans.
No more overlapping responsibilities, no more confusion:
The VHA Central Office will have responsibility for
setting policy goals and conducting financial management, oversight,
and compliance.
Our VISNs, along with a new operations center, will take
policy direction from VHA Central Office to develop operational,
quality, and performance standards that will guide VA's nearly 1,300
medical facilities.
These changes will provide clearer guidance and greater
decision-making authority for VA health care systems, which deliver
health care through more than 170 medical centers and nearly 1,200
outpatient sites.
Staffing and operations at VA medical centers and clinics
will not change as part of this reorganization.
You are going to hear all kinds of scary stories saying this is bad
for VA, but I want to emphasize again: we are simply acting on more
than a decade of advice from people and organizations who study this
for a living and have been calling for change.
Those calls went unheeded for years, but those days are over. Under
President Trump's leadership, we have a mandate to make VA work better
for the men and women we are charged with serving, and that is exactly
what we are doing.
The reorganization at VHA will help us build on the historic
achievements VA has already made during the second Trump
Administration. These include the following:
Reducing the backlog of Veterans waiting for VA benefits
by nearly 60 percent since January 20, 2025, after that backlog grew 24
percent under the Biden Administration;
Eliminating the backlog of Veteran families waiting for
VA health care;
Opening 25 new health care facilities, expanding access
for Veterans across the country; and
Permanently housing nearly 52,000 homeless Veterans in
Fiscal Year 2025, the highest total in 7 years.
Our reorganization of the VHA will position us to achieve even more
historic gains for Veterans in 2026 and beyond.
With that, I am happy to take your questions.
Statements for the Record
----------
Prepared Statement of Kenneth Kizer
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Letter to Douglas Collins from Timothy Kennedy
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Douglas Collins Response to Timothy Kennedy
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of the American Podiatric Medical Association
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
Questions for the Record Submitted by Mark Takano, Debbie Wasserman
Schultz and Bobby Scott
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]
[all]