The Department of Veterans Affairs (VA) is set to implement the largest reorganization of its health care management system in nearly three decades. This significant overhaul aims to streamline operations, cutting the number of Veterans Integrated Service Networks (VISNs) from 18 to five while enhancing policy consistency across the agency. The changes are scheduled to take effect in March 2026 and reflect a response to longstanding inefficiencies within the Veterans Health Administration (VHA).
Under this new structure, the VISNs will report directly to the VA under secretary for health. The plan also includes the elimination of the VHA chief operating officer position and a realignment of VHA Central Office staff under senior leadership. VA officials assert that these modifications will reduce bureaucratic complexities, thereby improving communication and policy implementation.
Doug Collins, the Secretary of Veterans Affairs, stated, “The current VHA leadership structure is riddled with redundancies that slow decision making, sow confusion and create competing priorities.” He emphasized that the reorganized structure will clarify roles, allowing policymakers to focus on setting policies while regional leaders implement them effectively.
While the VA maintains that the reorganization is not designed to cut staff, it does plan to eliminate 25,000 vacant positions within the VHA. This decision follows earlier job reductions that resulted in a loss of 30,000 jobs due to early retirements and layoffs under directives from the previous administration. VA press secretary Peter Kasperowicz explained that the targeted vacancies largely consist of roles deemed unnecessary in the post-COVID environment.
The reorganization comes after nearly a decade of calls for improvement in the VA’s operational efficiency. According to internal documents, the changes are intended to enhance accountability and patient care services. VA officials have studied national health care models and the structures of leading health systems to inform their approach.
Political Responses and Legislative Action
The proposed changes have drawn a mixed response from lawmakers. Rep. Mike Bost, Chairman of the House Veterans Affairs Committee, introduced legislation aimed at restructuring the VA’s organizational framework, advocating for a reduction in VISNs to eight. Bost expressed his support for Collins’ reorganization efforts, noting the necessity for change to meet veterans’ needs.
Conversely, Rep. Mark Takano, the committee’s ranking Democrat, criticized the lack of transparency during the planning process. He pointed out that most congressional members, alongside major veterans service organizations, were not consulted prior to the announcement. “Redesigning the organizational structure of the nation’s largest integrated health care system should not be a secretive, partisan, closed-door process,” Takano asserted.
Community Care Program Changes
In addition to the reorganization, the VA announced forthcoming changes to its community care program. The department is seeking proposals from private companies to provide medical treatment for veterans outside the VA system, potentially amounting to contracts worth up to $1 trillion over the next decade. This initiative will reduce the number of community care regions from five to two, although multiple health care networks may still be involved.
Veteran advocacy groups have reacted cautiously to these sweeping proposals. Following a VA briefing, Carl Blake, CEO of the Paralyzed Veterans of America, expressed cautious optimism that the restructuring could alleviate bureaucratic hurdles that have obstructed health care decision-making. He stated, “If it works the way it is intended, it gives us hope that many of these administrative barriers will be knocked down.”
The organization Disabled American Veterans also voiced support for improving VA health care. National Commander Coleman Nee expressed eagerness to learn more about the details of the reorganization plan, emphasizing the need for ongoing collaboration with the VA and Congress.
As the VA embarks on this ambitious restructuring, it remains to be seen how these changes will impact veterans and the efficiency of care delivery. Continued scrutiny from Congress and veteran advocacy groups will likely shape the outcomes of this significant overhaul in the coming years.
