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“A Review of the President’s Fiscal Year 2026 Budget Request for the Department of Veterans Affairs”

Senate Appropriations Committee, Military Construction, Veterans Affairs, and Related Agencies Subcommittee Hearing

June 24, 2025 (recording here)

HEARING INFORMATION

Witness & Written Testimony (linked):

• The Honorable Douglas A. Collins: Secretary, Department of Veterans Affairs

Keywords mentioned:

• Workforce, staffing, Electronic Health Record (EHR) program, access to care, rural veterans, tribal veterans, Toxic Exposure Fund (TEF), oversight, accountability

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairman John Boozman discussed the hearing’s focus on the administration’s FY 2026 budget request for the VA. He expressed concern over the VA’s delay in submitting detailed budget justification materials, which he claimed are essential for congressional oversight. He then highlighted the increased investment in VA systems, particularly a $3.5 billion request for the electronic health record (EHR) program, and looked forward to hearing how the VA would execute accelerated deployments. The Chairman also expressed interest in hearing about the VA’s plans regarding mental health services, suicide prevention, women's and rural veterans' care, and workforce reviews.

• Ranking Member Jon Ossoff underscored that VA benefits are earned through service and described the hearing’s purpose as assessing the $441 billion FY 2026 budget request. He raised concerns over the absence of detailed supplemental budget materials and criticized the VA’s unilateral actions and lack of transparency, despite prior commitments to congressional oversight. The Ranking Member hoped for improved responsiveness and accountability, specifically regarding staffing, Georgia facilities, and the reallocation of $18 billion from medical care to the Toxic Exposure Fund (TEF).

SUMMARY OF KEY POINTS

• Secretary Doug Collins reflected on his first few months in office, during which he visited over 60 VA facilities in 16 to 17 states and observed both successes and ongoing challenges. He stressed the importance of prioritizing veterans over bureaucracy and acknowledged persistent systemic issues dating back to his time in Congress. He also mentioned improvements in disability claims processing, including a reduction of more than 70,000 backlogged claims since his arrival. Sec. Collins affirmed his commitment to modernizing health records, reducing wait times through expanded community care, and ensuring transparency and collaboration with Congress moving forward.

• Chairman Boozman asked how much financial risk the VA was assuming with its FY 2026 budget, noting past issues including a $12 billion medical care shortfall and unused emergency funds. Sec. Collins responded that he had taken steps to ensure fiscal responsibility and was confident in the accuracy of the current budget’s assumptions, which he reviews regularly.

• The Chairman then asked about the VA’s efforts to reduce veteran suicide. Sec. Collins called suicide prevention his top personal concern, criticized the lack of progress despite $588 million in spending, and called for a new approach. He highlighted the importance of initiatives like the Fox Grant Program, which engage veterans not enrolled in VA care, and said that the VA must rethink its methods entirely.

• Ranking Member Ossoff pressed Sec. Collins for specific staffing numbers under the FY 2026 medical services budget, including physicians, dentists, and nurses. Sec. Collins provided some figures but was unable to specify physician or nurse totals, promising to deliver that information later.

• Ranking Member Ossoff expressed frustration, pointing out that such data is typically submitted before a budget hearing and that a proposed $17–$18 billion cut to the medical services account raised serious concerns. He demanded to know who would be laid off to account for the reduction. Sec. Collins maintained that it was not a cut to total VA funding, framing the shift as part of an overall reallocation to support community care.

• Sen. Deb Fischer asked about the future of the External Provider Scheduling (EPS) system, citing past delays and uncertainty. Sec. Collins confirmed that the EPS rollout would continue and reported success in scheduling efficiency, provider onboarding, and reducing wait times. When asked whether EPS should be a separate line item in the budget, Sec. Collins said that the VA would not oppose that change if Congress wished to make it.

• Sen. Fischer then raised concerns about aging VA infrastructure, including a 75-year-old facility in Omaha. Sec. Collins agreed that the VA’s construction model needed reform and advocated for front-loading funding to avoid the delays and rising costs seen in projects like Louisville and St. Louis. He supported more strategic use of resources, such as building larger CBOCs in lieu of full hospital replacements when feasible.

• Sen. John Hoeven praised Sec. Collins for his leadership and specifically thanked him for advancing the Fargo National Veterans Cemetery project through collaboration with state and local partners. He urged the Senate to confirm more of Sec. Collins’s senior appointees, including the Assistant Secretary for Cemeteries and the VA CFO, arguing that leadership gaps hinder the agency’s effectiveness. Sec. Collins agreed and underlined that having only one Senate-confirmed appointee at the VA was an ongoing challenge.

• Sen. Hoeven also raised concerns about regulatory barriers that prevent nursing homes from accepting VA reimbursements. Sec. Collins acknowledged that duplicative federal reviews were a problem and said he was working to streamline processes across VA programs, especially as the aging veteran population increases demand for both institutional and home-based long-term care.

• Sen. Cindy Hyde-Smith thanked the Secretary for visiting Mississippi’s Gulf Coast State Veterans Home and expressed concern about the VA’s limited construction funding given its large backlog of priority projects. Sec. Collins responded that the FY 2026 request prioritized safety and critical upgrades but reiterated that systemic change was needed to reform the VA’s long-term construction processes, which are currently slow and overly complex. He said that the department was exploring alternatives, like scaling up clinics to relieve pressure on aging hospitals.

• Sen. Hyde-Smith then asked how the VA was ensuring that increased funding translated into more timely and efficient care. Sec. Collins claimed that the VA was reassessing its use of community care and applying the “best medical interest” standard to ensure veterans receive timely care either within or outside VA facilities, depending on individual needs and local capacity.

• Sen. Patty Murray sharply criticized Sec. Collins for recent VA actions she said had “scared veterans,” including mass staff terminations, canceled contracts, research censorship, and changes to anti-discrimination language. She asked why language protecting veterans against discrimination based on age, politics, and marital status had been removed. Sec. Collins denied any policy change that allowed discrimination, blamed the controversy on misleading media coverage, and insisted that existing federal laws already protected veterans.

• Sen. Murray then asked whether the VA would adhere to statutory guardrails on the use of TEF dollars. Sec. Collins confirmed that he would follow the law and honor agreements with the committee. When pressed on how an $18 billion shift from general medical care to the TEF would not reduce care for non-PACT Act veterans, Sec. Collins replied that the VA would still meet veterans’ needs through proper budget execution. Sen. Murray also raised concerns about reports of research censorship within the VA. Sec. Collins denied restricting researchers but admitted he was unfamiliar with the policy referenced and promised he would follow up.

• Full Committee Chairwoman Susan Collins highlighted the lack of transportation options for rural veterans in Maine and mentioned the restrictive eligibility requirements of the Highly Rural Transportation Grant Program. She asked whether Sec. Collins would support bipartisan legislation to expand access to these grants. Sec. Collins responded that he supported the bill and looked forward to working with her on potential improvements, acknowledging the transportation challenges rural veterans face.

• Chairwoman Collins then raised concerns about inadequate per diem rates for State Veterans Homes, noting the disparity between VA and private sector rates. Sec. Collins said that he had met with representatives from State Veterans Homes and agreed they were essential partners in long-term care. He expressed willingness to revisit financial and regulatory barriers that limit their operations, underscoring a renewed focus on state and local partnerships.

• The Chairwoman also asked about implementing the pilot program authorized in the Elizabeth Dole Act to explore VA-funded assisted living. Sec. Collins replied that many of the law’s provisions were underway, with some fully implemented, some delayed, and others facing funding issues. He committed to working with Congress to secure the resources needed and said the pilot programs were viewed positively within the VA.

• Sen. Kirsten Gillibrand questioned Sec. Collins about the impact of the administration’s return-to-office policy, especially on mental health providers who now had to conduct telehealth appointments in shared office spaces. She asked whether he agreed veterans deserve confidential care. Sec. Collins said that such arrangements violated VA policy and should not be occurring, urging Sen. Gillibrand to share specific cases so the VA could investigate and correct them.

• Sen. Gillibrand followed up by asking whether Sec. Collins had heard about the harms to care caused by space limitations. Sec. Collins claimed that he had not received such reports, noted exemptions were being granted as needed, and reiterated that policies prioritize confidentiality and clinical needs. Sen. Gillibrand urged the VA to conduct a review of space and staffing allocations for mental health care, and Sec. Collins agreed to provide a letter with information from major facilities and to have his team follow up with her office.

• Sen. Gillibrand concluded by asking for more details on how the VA planned to use the $52.7 billion requested for the TEF. Sec. Collins pledged that more detailed information would be provided to the committee soon.

• Sen. Lisa Murkowski described the unique rural healthcare challenges in Alaska, including the need for air travel, limited broadband, and provider shortages. She asked whether Sec. Collins would support mobile outreach strategies to reach off-road veterans and inform them of their benefits. Sec. Collins agreed and mentioned the need to break from traditional clinic-based models, citing mobile clinic concepts already being explored, including in urban areas like Los Angeles after recent disruptions.

• Sen. Murkowski suggested using mobile mammography models as an example of creative outreach and asked about the future of the Office of Tribal Government Relations and the VA Advisory Committee on Tribal and Indian Affairs. Sec. Collins confirmed that both would continue their work and said that the VA was strengthening intergovernmental coordination with states and tribes. He added that he planned to visit Alaska in October, potentially to coincide with the Alaska Federation of Natives conference. Sen. Murkowski submitted additional questions for the record, including concerns about the Palmer Pioneer Home and the upcoming rollout of the EHR system in Alaska in 2026.

• Sen. Tammy Baldwin asked whether Sec. Collins agreed that veterans deserve safe and comprehensive pain management and that it remains a core part of the VA’s mission. Sec. Collins agreed and stated the VA's ongoing commitment to implementing Jason's Law, which he confirmed was named in the budget.

• Sen. Baldwin raised concerns about the ability to sustain pain management efforts amid proposed staffing cuts, especially in administrative roles. Sec. Collins responded that the reported 83,000 cuts had been mischaracterized, claiming that reductions would not impact clinical staff and that hiring remained possible, although the VA faces internal inefficiencies and salary competitiveness challenges.

• Sen. Gary Peters expressed concern about the ambitious EHR deployment schedule, especially with four Michigan facilities included and ongoing workforce reductions. Sec. Collins described steps he took to relaunch and reform the EHR program upon arrival, including confronting communication gaps between VA and Oracle and streamlining internal governance. He said that the system must be modernized to support both internal and community care coordination.

• Sen. Peters also pressed Sec. Collins on the VA's response to OIG recommendations and the proposed 10% budget cut to the IG's office. Sec. Collins pledged to continue implementing recommendations and said he met regularly with the IG.

• Sen. Bill Hagerty praised Sec. Collins for acknowledging inefficiencies and seeking reform. He asked what the Secretary encountered on his first day at VA. Sec. Collins recounted serious organizational dysfunction, including the inability to immediately produce a headcount or reconcile payroll.

• Sen. Hagerty also raised disparities in quality of care within Tennessee VA facilities. Sec. Collins spoke on his push for standardizing practices, encouraging innovation from local leadership, and creating a cohesive VA identity across sites.

• Chairman Boozman noted that the VA requested $3.5 billion for the EHR program while the House marked up only $2.5 billion, and he asked what would happen if that lower number prevailed. Sec. Collins warned that underfunding could delay implementation, worsen cost overruns, and perpetuate inefficiencies in the legacy system.

• Ranking Member Ossoff asked for updates on the sterilization failures at the Dublin VA and whether the OIG’s March recommendations had been fully implemented. Sec. Collins reported that they had been resolved to the best of his understanding and promised to follow up with confirmation. Ranking Member Ossoff asked if hiring for Dublin leadership had been exempted from the freeze. Sec. Collins confirmed that it was as of May 15.

• The Ranking Member then questioned Sec. Collins about ongoing vacancies at the Atlanta VA and repeatedly asked for a target date to reach full staffing. After a lengthy and somewhat heated exchange, Sec. Collins said that he would work with local leadership to provide a staffing plan and potential timeline.

• Ranking Member Ossoff then asked about reports of a toxic workplace at the Augusta VA. Sec. Collins confirmed that he had removed prior leadership and installed an acting director, and he committed to finding a permanent leader.

• Ranking Member Ossoff pressed Collins about a February letter regarding Department of Government Efficiency (DOGE) engagement with VA facilities, asking which DOGE personnel had accessed medical records. Sec. Collins said that three VA employees affiliated with DOGE had access as part of their roles, but the Ranking Member expressed frustration at the lack of detailed responses.

• Chairman Boozman, an optometrist by trade, raised concerns about physician salary caps, stating that pay limitations are a major factor in VA recruitment issues. He asked Sec. Collins to work with committee staff on a proposal to raise caps. Sec. Collins agreed and said bipartisan collaboration on this issue could significantly improve hiring outcomes.

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