The Illusion of Choice

Republicans say that VA patients can get equivalent private-sector care anywhere in the U.S. Here’s a 50-state reality check.

by Suzanne Gordon August 4, 2025

At his confirmation hearing in January of 2025, Secretary of Veterans Affairs Doug Collins, a former congressman from Georgia, assured the Senate Veterans’ Affairs Committee of his commitment to provide specialized, high-quality medical care for the roughly nine million veterans enrolled in the nation’s largest and only truly integrated public health care system, the Veterans Health Administration (VHA).

But Collins, a chaplain in the Air Force Reserve, also explained that his mandate from President Trump is to make it “easier for veterans to get their health care when and where it’s most convenient for them,” by giving them greater choice between in-house and outsourced care. To do this, he planned to lean on the network of 1.7 million private-sector providers who are part of the Veterans Community Care Program (VCCP), created by the VA MISSION Act of 2018. Annual reimbursement of these non-VHA doctors, therapists, hospitals, and clinics now costs the federal government more than $30 billion per year, nearly one-third of the VA’s entire direct care budget.

Collins’s proposed budget for fiscal year 2026 calls for a 50 percent increase in discretionary VHA spending on private care and a 17 percent reduction in discretionary direct care funding. (The overall proposed budget for VA medical services increases, but only because of a large boost in the mandatory Toxic Exposures Fund, which provides health services for veterans exposed to burn pits and environmental exposures. All other diagnoses not in the TEF authorizing legislation would fall under the reduced discretionary budget, and even adding mandatory spending, private care is poised to increase at nearly twice the rate of VA direct care.) And Collins has taken other steps consistent with the goal of downsizing direct service provision and boosting the VHA’s reliance on outside vendors.

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To test the accuracy of these claims, the Veterans Healthcare Policy Institute (VHPI) partnered with the Prospect on a survey of the U.S. health care landscape in all 50 states. State by state, we looked at the data on the current available supply of primary care providers, mental health professionals, and hospitals, particularly in the rural (and remote rural) areas where about one-quarter of all veterans, or about 4.7 million, reside, with 2.8 million of them enrolled in the VHA.
https://prospect.org/health/2025-08-04-illusion-of-choice-va-health-care/