The Department of Veterans Affairs (VA) is set to implement a comprehensive reorganization of its health care management system, marking the largest overhaul since 1995. This initiative aims to streamline operations by reducing the number of Veterans Integrated Service Networks (VISNs) from 18 to five, with these networks reporting directly to the VA under secretary for health.
The plan involves significant structural changes, including the elimination of the VHA chief operating officer position and a realignment of policy offices. VA officials assert that this reorganization will cut through the “complex bureaucracy” that has slowed decision-making and caused confusion within the system. According to VA Secretary Doug Collins, the current leadership structure contains numerous redundancies that hinder effective governance.
In his statement, Collins emphasized the need for a clearer delineation of responsibilities: “Under a reorganized VHA, policymakers will set policy, regional leaders will focus on implementing those policies, and clinical leaders will focus on what they do best: taking great care of veterans.”
The VA has asserted that the reorganization is not intended to reduce staff numbers. According to internal documents, the changes have been under consideration for nearly a decade, with a focus on improving accountability and patient services. VA officials have studied national health care models to inform their approach.
Legislative Support and Concerns
The announcement comes as House Veterans Affairs Committee Chairman Rep. Mike Bost, R-Ill., introduced several legislative proposals aimed at reforming the VA’s organizational structure. Notably, one of these proposals also seeks to reduce the number of VISNs, but suggests a larger reduction to eight networks. Bost expressed support for Collins’ restructuring efforts, noting that veterans have demanded improvements in the face of bureaucratic inefficiencies.
Conversely, Rep. Mark Takano of California, the committee’s ranking Democrat, criticized the VA for lacking transparency during the planning process. He highlighted that most congressional members and veteran service organizations were not consulted, stating: “Redesigning the organizational structure of the nation’s largest integrated health care system should not be a secretive, partisan, closed-door process.”
Expansion of Community Care Programs
In conjunction with the reorganization, the VA announced plans to modify its community care program, seeking proposals for contracts from external companies to provide medical treatment for veterans outside the VA system. This initiative could potentially reach a value of up to $1 trillion over ten years. Under the new plan, the number of community care regions will decrease from five to two, although these regions may still be supported by various health care networks.
Reaction from veteran advocacy groups has been measured as they assess the implications of these sweeping changes. Following a briefing, Carl Blake, CEO of Paralyzed Veterans of America, expressed cautious optimism, stating that the proposed changes sound “promising” if they facilitate more efficient health care decision-making.
The VA also plans to eliminate approximately 25,000 vacant positions within the Veterans Health Administration. While some critics fear this could exacerbate existing staffing shortages, VA press secretary Peter Kasperowicz argued that most positions targeted for elimination are outdated roles no longer necessary post-pandemic. He reiterated that no current employees would be dismissed as a result of these changes.
The reorganization is expected to unfold over the next two years, with implementation beginning in early 2026. As the VA moves forward with its plans, it remains committed to improving veteran care while addressing the ongoing challenges within its operational framework.
