VA secretary nominee promises expanded care options amid worries of ballooning costs

Former Georgia Rep. Doug Collins, President Trump’s pick to lead the Department of Veterans Affairs, on Tuesday hinted at an expanded health care delivery system after years of pressure to bring down costs and lower wait times for care for former service members.

“At the end of the day, the veteran is getting taken care of. VA care is going to happen. . . [but] there’s different expressions of how we make it better. We don’t do the same things 40 years ago that we still do today,” Collins said at the top of the Senate Veterans Affairs Committee hearing. “Our newer veterans deserve every access to finding care where they can.”

Collins faced questions from panel members for nearly three hours, fielding queries ranging from appointment backlogs and outdated record-keeping systems to whether he would require VA employees to report back to work in person or if he would uphold former President Biden’s abortion policy at the department. 

But a majority of the time was devoted to how Collins might improve how the VA provides health care and other services to former members of the military, particularly through a program introduced by Trump in his first term known as the Mission Act.

The act, passed by Congress in 2018, allows veterans to seek health services with private systems outside the department’s purview if they have to wait too long to receive a service from the Veterans Health Administration or must drive at least 30 minutes to a VA facility. 

“We’re going to be following the Mission Act. . . . nothing’s going to hold that up,” Collins said.

Though expansions under the Mission Act sought to strengthen VA’s direct care service and what’s known as community care - particularly for rural veterans - the department experienced ballooning costs. In 2023, community care cost the VA $28.5 billion, up from about $15 billion in 2018. 

Today, roughly nine million veterans are enrolled in the VA health care system but about 40 percent of all their health care appointments are through the community care system.

Democrats now fear that more veterans seeking medical care outside the VA could pull funding away from department medical centers, which already struggle with appointment backlogs and staffing.

Republicans contend that the Biden administration sought to prevent some veterans from finding care outside VA centers using excessive bureaucracy. 

Former VA Secretary Denis McDonough, in his final news conference earlier this month, denied that the department was trying to thwart veterans' access to community care, calling it “patently, fundamentally, overwhelmingly inaccurate.”

Collins, who faced the panel after a delay in his FBI background check forced lawmakers to move his nomination hearing from last week, told senators he supports veterans choosing where they receive medical care, including mental health help. 

He asserted that “delivering timely access to care and benefits for every eligible veteran is job No. 1 at VA.”

Among his other goals, Collins said he will encourage VA employees to “come back to work” after Trump signed an executive order Monday directing federal workers to return to office.

“We’re going to encourage them to come back to work, we’re going to follow the president’s directive on that, and we’re going to make sure that we get people in there because at the end of the day, it’s about veterans,” Collins said.

He noted, however, that there are “certain issues” surrounding the VA’s roughly 470,000-person workforce - about 80 percent of which are unionized and on contracts.

Many federal employees have been able to work remotely since the COVID-19 pandemic began in 2020, but Trump and his allies have signaled that requiring them to return to in-person work could be a way to thin out what they see as a bureaucrat-heavy workforce.

But Collins, a Navy veteran, Air Force Reserve chaplain and former pastor, did not commit to upholding a Biden administration rule enacted two years ago that allows the department to provide abortions to veterans for a pregnancy resulting from rape or incest, or when the life of a pregnant woman is at risk - even in states where it has been largely outlawed. 

The question was raised by both Sens. Maziei Hirono (D-Hawaii) and Patty Murray (D-Wash.).

“It is something that has been looked at here as what the law actually says, and the original law from 1992 says the VA does not do abortions. Two years ago, that was a decision that was looked at and decided. I will tell you this, we will be looking at that issue when I get in there to confirm that the VA is actually following the law,” Collins said.

As VA secretary, Collins is expected to help roll back abortion access for veterans in states that enforce abortion bans following the Supreme Court’s Dobbs decision.

Collins did promise that the VA would not assist with migrant healthcare if he is confirmed, a topic that was brought up by  Sen. Tommy Tuberville (R-Ala.).

The Veterans Affairs Financial Services Center contracts with the U.S. Immigrations and Customs Enforcement (ICE) detention healthcare facility to process medical claims reimbursements for migrants detained at the southern border, according to a DHS report released in July 2023. 

Collins said he would immediately investigate the situation.

“I do not believe any money taken outside of the VA to help the veteran is a worthy cause for the money that has been appropriated for the veteran,” Collins said.

The hearing was not expected to make waves, and Collins is expected to have bipartisan support in the panel's confirmation vote, expected on Thursday. Following that, he would advance to the full Senate, where a confirmation vote could come as early as next week.