What’s Going on at the VA

It is hard to overstate the importance of the Veterans Health Administration (VHA), the branch of the U.S. Department of Veterans Affairs (VA) that manages health care services for veterans. It is the nation's largest integrated health system, providing care to 9.1 million veterans through medical centers and outpatient clinics. Its services range from primary care and mental health to highly specialized treatments, rehabilitation, and assistance with health-related needs such as food and housing. It is at the forefront of efforts to prevent veteran suicide.

There is a lazy and inaccurate narrative about the VA. We hear about extended wait times, bloated budgets, and low-quality care. But the reality is different. Research and patient experience surveys indicate that the VA performs as well as, and often better than, the private sector. Is there fat to trim? Absolutely. But the VA has also been shown to be more efficient than the private health system.

Nearly 3 months into the new federal administration, how is the VA faring?

Here is a look at what's going on:

Mass layoffs: The VA plans to fire 80,000 employees. The VA Secretary assures us that it won't harm health care or benefits in any way. If you believe that, I also have a bridge to sell you.

How will claims be resolved and wait times shortened when there are fewer staff available to do the work? And one-quarter of VA employees are themselves veterans who might find themselves unemployed.

Decline of telehealth: A rare silver lining of the COVID pandemic was the rise of telehealth, which can be highly effective when used correctly. The VA invested in telehealth, especially to bring mental health services into rural areas. Now that all VA staff must work in the office, there is a lack of privacy and space that raises ethical issues. Would you like a veteran struggling with PTSD to be "treated" in an open call center?

If you truly want to improve telehealth for veterans, here are many smart ideas.

Undermining suicide prevention: The first Trump administration placed much-needed emphasis on veteran suicide. It established, via executive order, the President's Roadmap to Empower Veterans and End a National Tragedy of Suicide (PREVENTS), a national plan to raise awareness about mental health, connect veterans to resources, and conduct research into suicide.

The Veterans Crisis Hotline, operated jointly by the VA and HHS, reported nearly 3 million calls between 2009 and 2017, which led to 82,000 emergency dispatches to prevent veterans from harming themselves. The VA steadily increased crisis-line staffing to address concerns that veterans were not receiving timely help, given the high volume of calls.

But that is being reversed. Ending remote work options for the 800 to 900 out of 1,130 crisis-line workers who work remotely will further undermine staffing.

Loss of research: The VA's investment in medical research, nearly $916 million per year, benefits all of us. For example, VA research established the causal link between smoking and cancer. And the VA leads the world in researching and treating veteran-specific issues like traumatic brain injuries and toxic exposures.

Medical breakthroughs don't just happen; they require a lot of brainpower. But it is estimated that 350 VA researchers will lose their jobs.

Key positions unfilled: Leadership matters. The VA has just launched searches for undersecretaries for health and benefits. The undersecretary for health manages 1,300 medical facilities, oversees guidelines for training clinicians, and develops plans for health emergencies, such as pandemics. The first Trump administration failed to fill this health role permanently and cycled through temporary leaders for the entire four-year term.

For the past few months, the VA has ignored the issues that matter most to veterans. It has instead focused on shrinking the agency, ending gender dysphoria treatment for transgender veterans, ending remote work policies, and ending diversity and inclusion programs.

We know what veterans really need and care about because we've asked them directly. An NYHealth survey of New York's newest veterans found:

• One-quarter had probable depression or probable PTSD;
• 1 in 10 thought about suicide last year;
• Twenty percent of younger veterans rate their health as fair or poor;
• More than 60% report being fully or partially disabled.

It is still very early in the new administration. By listening to veterans, the VA can get its priorities straight.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on April 17, 2025