The Department of Veterans Affairs (VA) is set to implement the most significant reorganization of its health care management system in over 30 years. This overhaul aims to streamline operations by reducing the number of Veterans Integrated Service Networks (VISNs) from 18 to five and realigning policy offices to enhance consistency. The changes will take effect starting in early 2026.
As part of this reorganization, the VA will require the new VISNs to report directly to the VA Under Secretary for Health. Additionally, the role of the VHA Chief Operating Officer will be eliminated, with Central Office staff realigned under the leadership of the Under Secretary or deputies. VA officials stated that this initiative aims to reduce the “complex bureaucracy” currently hindering decision-making processes and to improve communication and policy consistency.
VA Secretary Doug Collins emphasized that the existing leadership structure is fraught with redundancies that complicate decision-making. “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,” Collins said.
The VA has indicated that these changes are not intended to lead to staff reductions. VA briefing documents suggest that the reorganization has been necessary for nearly a decade, aimed at minimizing duplication, increasing accountability, and enhancing patient service. Officials drew from national health care models to design the new structure.
Political Reactions and Legislative Proposals
In conjunction with the reorganization, Rep. Mike Bost, Chairman of the House Veterans Affairs Committee, introduced legislative measures that also propose reducing the number of VISNs but to eight, three more than the VA’s plan. Bost expressed support for the restructuring initiative, stating that veterans and their families have made it clear that the status quo is inadequate.
Conversely, Rep. Mark Takano, the committee’s ranking Democrat, has called for hearings regarding the proposal. He criticized the VA for not consulting Congress and veterans service organizations during the planning phase. Takano noted, “Redesigning the organizational structure of the nation’s largest integrated health care system should not be a secretive, partisan, closed-door process.”
In response to these political developments, the VA also announced upcoming changes to its community care program, seeking proposals from companies to provide medical treatment for veterans outside the VA system. These contracts could be valued at up to $1 trillion over a decade, with the number of community care regions decreasing from five to two.
Concerns from Veteran Advocacy Groups
Reactions from veteran advocacy groups to the proposed changes have been measured, as they assess the sweeping implications. Following a briefing with VA officials, Carl Blake, CEO of Paralyzed Veterans of America, expressed cautious optimism regarding the VHA changes, noting the expansion of bureaucracy has hindered effective health care decisions in the past.
Similarly, Coleman Nee, National Commander of Disabled American Veterans, voiced support for efforts to improve health care for veterans with service-connected conditions. “We remain committed to working closely with VA, Congress, and other veteran stakeholders to strengthen the high-quality health care our nation’s disabled veterans have earned,” Nee stated.
A blue-ribbon panel established in 2016 recommended that the VA redesign its central office to ensure proper oversight of the VISNs. Their final report highlighted the ambiguity surrounding the roles of the VISNs and the need for clearer responsibilities among medical center directors.
Despite these recommendations, the VA’s own inspector general reported earlier this year that the VISN organizational structure lacked clearly defined roles and responsibilities. This has raised concerns about accountability within the system.
The VA further announced plans to eliminate 25,000 vacant positions within the Veterans Health Administration, which some critics argue may exacerbate existing workforce challenges. VA Press Secretary Peter Kasperowicz stated that these positions largely consist of roles deemed unnecessary post-COVID and have been vacant for over a year. He assured that no current employees would be removed and that the changes would not negatively impact veteran care.
As the reorganization progresses, the VA maintains that it does not anticipate significant changes in overall staffing levels. This initiative is positioned as a means to enhance operational efficiency while maintaining a strong focus on patient care within VA medical centers and clinics.
