On March 4, 1865—to an America torn by Civil War—Abraham Lincoln delivered a vision of national healing which remains inscribed at Veterans Affairs (VA) hospitals across the country:

“With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and all nations.”

For 160 years, this vision has inspired VA healthcare workers to honor Lincoln’s promise by serving those who served.

We are those healthcare workers: active and retired VA clinicians writing on personal time without use of government resources; faculty at VA affiliated medical schools; care providers across the nation who trained at VA and remain committed to its mission. We have offered our veterans lifesaving therapies and groundbreaking research; removed their cancers and repaired their hearts; seen them through crises and comforted them as they lay dying.

We are also veterans who receive care at the VA, caregivers who support them, and public servants whose work complements the other services VA provides to the nation: health education, research, and public health emergency response.

We write to raise urgent concerns about proposed policies which, in addition to ones already enacted, will undermine VA’s healthcare system, overwhelm VA’s budget, and negatively affect the lives of all veterans. We have witnessed these ongoing harms and can provide evidence and testimony of their impacts.

The rest of this letter presents three core concerns and seven evidence-based truths about veterans' healthcare. It offers three overarching policy recommendations to carry VA forward for the next 160 years. This healthy future requires growth and change. But as America’s largest health professions educator and leading health services researcher, VA has a deep, rich culture of continuous improvement and innovation. This culture has made VA a respected model for cost-effective, integrated, patient-centered medicine and the system that the vast majority of veterans trust and prefer for their care.

We dedicate this letter those veterans, whose service we honor with our own, and to our future patients: the active-duty troops risking their lives and health to protect our nation and its constitution.

Three Growing Risks to VA’s Mission and Veterans’ Healthcare

1. Workforce reductions without published objectives or impact assessments on veterans’ healthcare access
2. Expansion of administrative authority into clinical decisions that are best made by veterans and their clinicians, and best guided by evidence, medical ethics, and the scientific method
3. Rapid growth of purchased (community) care that threatens to divert resources from VHA’s high-value direct care and, over time, veterans’ earned benefits.*

* We support Community Care, which plays a valuable role in many veterans’ treatment. At best, it reflects a mission-driven, public-private partnership—like those in VA’s Academic Affiliations program—that are central to VA’s past and future success. Our concern is ensuring that policy and spending decisions are driven by veterans’ needs, not vendor incentives or market pressures.

Seven Evidence-Based Truths About VA History and Veterans Healthcare

• Over decades, the Veterans’ Health Administration (VHA) has delivered equivalent or higher quality veterans’ healthcare with lower cost and greater patient satisfaction when compared with non-VHA healthcare providers¹
• Over the last 10 years, VA has outsourced a growing share of veterans’ care—and health data systems—to external vendors who do not share VA’s mission
• The main rationale for this shift—concern about excessive wait times causing delays in veterans’ care—is inconsistent with available evidence on timely care and access in VHA and non-VHA healthcare settings²
• The result of this shift has been a rapid increase in VA spending on purchased healthcare services of uncertain quality and value and well-documented waste and abuse³
• The rising cost of Community Care (CC) is eroding VHA’s high value, integrated internal systems and, with passage of the 2026 budget, will further erode VHA's resources⁴
• If this trend continues, VHA facilities may be forced to close, and veterans may be forced into costlier, often overburdened community health systems ill-equipped to meet their specialized needs; as healthcare costs increase, veterans’ benefits will be jeopardized⁵
• Service is the common thread uniting VHA’s 4 missions: to provide veterans’ healthcare, education, research, and emergency services for the common good. This thread not only “binds up the nation’s wounds;” it binds America’s medical, scientific, and military communities in a common patriotic enterprise. If VHA quality degrades, the damage to our cultural fabric may be difficult to repair.

Please see the appendix for evidence supporting these points.

Policy Recommendations

1. Contain Community Care (CC) Spending and Regulate Quality
   • Hold CC funding at 2025 levels, pending investigation and reform
     • Investigate overbilling, overtreatment, waste, and abuse by examining CC spending trends on a per-provider, per-patient, and per-claim basis
     • Reform Third Party Administrator (TPA) contracts
       • Decrease Administrative Fees to <15% (consistent with medical-loss-ratio standards)
       • Investigate Potential Conflicts of Interest in CC Network (CCN) 1-3
         • Examine referral patterns for disproportionate self-referrals from CCN 1-3’s UnitedHealth-owned TPA (Optum Serve) to UnitedHealth-owned practice sites
         • Require that oral prescriptions from CCN providers be issued through VHA’s cost-effective Centralized Mail Order Pharmacy—NOT through OptumRx or private pharmacy benefits managers—and that injectables be given at VA infusion centers if drive-time allows
   • Refine Community Care eligibility standards
     • Hold CCN providers to the same wait time standard as VHA. If a CCN provider is unable to provide care sooner than VHA, that appointment should not be considered wait-time eligible
     • Include VHA telehealth appointments toward wait-time goals when clinically appropriate and preferred by the veteran
   • Amend the following bills which advance VHA privatization
     • The Complete the Mission Act – Extending wait/drive time eligibility to Mental Health Residential Rehabilitation Programs is unwise. These services’ high costs, variable quality, and high fraud rate require close oversight from VHA clinicians.
     • The Veterans ACCESS Act – A pilot in this bill would allow unlimited mental health access—without VA authorization, referral or quality review—thereby draining VA funds and degrading care quality.
2. Fully Staff and Fund VHA’s Direct Care Services
   • Staffing
     • Promptly backfill the positions of the 30,000 staff—including 827 doctors, 2,300 nurses, 618 social workers, and 895 medical support assistants—whose jobs were vacated in 2025
     • To facilitate hiring, reverse the 2017 HR modernization program, which decreased hiring capabilities of large VAMCs whose complex staff needs cannot be nimbly met with centralized HR services alone
     • Freeze further “reorganizations”—e.g., elimination of VISNs or program offices—without Congressional approval
   • Funding
     • Do not cut VHA’s discretionary Medical Service budget
       • The proposed FY26 budget cuts some $12B from VHA’s medical budget and diverts it toward Community Care
       • To support holistic veterans’ healthcare, these funds must be restored to VHA’s direct care budget as discretionary funds, not earmarked for conditions related to military toxic exposures
3. Defer Healthcare Decisions to Clinicians, Patients, and Subject Matter Experts
   • Confirm a healthcare leader as Undersecretary of Health
     • VHA is the largest and most complex health system in the US
     • To retain staff confidence, the USH is statutorily mandated to have frontline medical experience and/or expertise running a large, well-regarded healthcare system
   • Restore medical staff self-governance
     • Medical staff bylaws are a core mechanism by which medical professionals safeguard the standards of the profession
     • Longstanding guidelines from the American Medical Association and Joint Commission on Hospital Accreditation state that staff bylaws changes must be voted on by all medical staff
     • Recent, unilateral changes to VA Medical staff bylaws must be reversed or put to a vote by VA Medical Center staff
   • Ensure VHA clinical protocols follow evidence-based guidelines
     • VHA has long developed clinical practice guidelines derived from objective evidence synthesis by internal and external experts
     • Recent, controversial CDC vaccination guidance raises concern that VA protocols—on vaccination, contraception, and other sensitive areas—may become politicized in a way that jeopardizes veteran-centered care
     • Clinical practice guidelines in these areas—including medication formularies, patient education materials, electronic health record tools—must be crafted by VHA subject matter experts guided by respected, independent medical and health professional societies
   • Restore scientific independence
     • VHA’s research mission depends upon open inquiry and peer review
     • Recent communications requiring administrative review of presentation slides and publication manuscripts undermines this mission and disrupts discoveries that benefit all Americans
     • VHA’s commitment to scientific independence, consistent with VHA Handbook 0005, must be clearly restated