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“Opportunities with VHA Reorganization”

House Veterans Affairs Committee Hearing

February 11, 2026 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

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

• The Honorable John Bartrum: Under Secretary for Health, U.S. Department of Veterans Affairs

• Mr. Mark Englebaum: Assistant Secretary for Human Resources and Administration, U.S. Department of Veterans Affairs

• Mr. Gregory Goins: Acting Chief Operating Officer, Veterans Health Administration, U.S. Department of Veterans Affairs

TOP-LINES TO SHOW YOU ARE IN THE KNOW

1. The proposed VHA reorganization would fundamentally reshape oversight and regional structure at the same time the VA is accelerating its Electronic Health Record Modernization rollout, and members questioned whether the system can absorb both changes at once.

2. Lawmakers pressed the Secretary on workforce strain, citing staffing shortages in mental health and clinical roles, while the VA argued the problem is imbalance, not overall headcount.

3. Women veterans’ care emerged as a flashpoint, with concerns about how the Deborah Sampson Act’s women’s health requirements will be preserved under the new structure.

4. The next generation of community care contracts is moving forward, and the VA says it is building in stronger accountability after a decade of third-party administrator failures.

5. Throughout the hearing, members tied morale and retention, especially in the wake of recent events affecting VA staff, to whether this reorganization can succeed in practice, not just on paper.

PARTY LINE PERSPECTIVES

OPENING STATEMENTS FROM THE COMMITTEE

• Chairman Mike Bost stated that the purpose of the hearing was to examine the significant reorganization of the Veterans Health Administration (VHA) and acknowledged that members had serious questions about its implementation and impact on veterans and the workforce. He requested a commitment from Secretary Doug Collins to continue appearing before the Committee as developments occurred and encouraged a respectful and productive discussion.

• Ranking Member Mark Takano began by honoring VA nurse Alex Pretti, expressing outrage over his death and requesting a moment of silence. He criticized Secretary Collins’ leadership in response to the tragedy and argued that VA employees were experiencing hostility rather than support. He contended that the proposed VHA reorganization lacked sufficient planning and transparency, contrasting it with the detailed 1995 restructuring process that involved broad stakeholder input. The Ranking Member asserted that the administration’s actions had reduced staffing, destabilized VA operations, and risked harming veterans’ access to care.

SUMMARY OF KEY POINTS

• Sec. Doug Collins expressed sympathy for the family and colleagues of Alex Pretti and said the matter was under investigation. He defended the proposed VHA reorganization, rejecting claims that it was rushed, performative, or intended to reduce care, and argued that it was the result of months of analysis and longstanding bipartisan concerns about inefficiencies. He maintained that VA staffing had increased significantly in recent years without proportional growth in veteran encounters and that the restructuring aimed to eliminate redundancies and improve care delivery. Sec. Collins underlined his commitment to putting veterans first, improving efficiency, addressing workforce challenges, and modernizing what he described as an outdated governance structure.

• Chairman Bost asked whether the VA would provide the Office of General Counsel legal opinion about how Title 38, Section 510 applied to the reorganization. Sec. Collins said he could provide what the VA had set up and stated that the VA would follow all statutory requirements when the applicable “targets” were met. He emphasized that he followed the law.

• Chairman Bost then asked whether VHA’s structure needed to evolve as healthcare delivery changed, and Sec. Collins agreed while arguing that the current system was overly top-down and inefficient. Mr. Gregory Goins then explained how oversight redundancies drained resources from frontline care. He stated that multiple layers of duplicative compliance oversight existed at the facility, regional, and central levels and argued that a streamlined model would reduce resource-intensive duplication without harming quality.

• The Chairman inquired about Sec. Collins’ support for Congress modernizing the VA’s statutory structure, including construction, procurement, and research authorities. Sec. Collins strongly supported congressional modernization and argued that construction processes were overly slow and costly under current structures. He cited long build timelines for medical centers and criticized reliance on the Army Corps of Engineers and VA-specific building standards as drivers of delays and inflated costs. He believed that the VA needed statutory reforms so projects could be delivered faster and at lower cost, and he offered to work with the Committee on legislative fixes.

• Ranking Member Takano asked whether Sec. Collins had created the widespread belief that the VA was conducting massive employee cuts and shared prior statements and a memo outlining plans to cut 83,000 employees. Sec. Collins responded by referencing prior discussions about government-wide reductions and said the target had been 83,000, but the outcome had been about 30,000. The exchange became a disputed back-and-forth over whether the question had been answered yes or no.

• The Ranking Member then asked why the VA was not offering signing bonuses comparable to those offered by Immigration and Customs Enforcement (ICE) and pressed the Secretary on whether he was seeking additional hiring authorities or funding. Sec. Collins responded that the VA already had certain incentives and argued that statutory salary caps limited his ability to compete for clinicians.

• Ranking Member Takano also pressed about defending the reputation of Alex Pretti after public attacks, and Sec. Collins refused to engage beyond expressing condolences and restating that the matter was under investigation. The Ranking Member then asked who among the panel was the accountable official for the reorganization, and the discussion turned contentious without a clear, direct designation before time expired.

• Rep. Derrick Van Orden argued that shorter documents could still represent quality and progress and contrasted the existing VHA organizational chart with the proposed simplified structure. He asked whether the goal was clearer accountability and improved performance. Sec. Collins agreed and linked the reorganization to better responsibility lines and better workforce management. He elaborated that the VA had previously lacked a reliable staffing “manning” document and had improved its ability to understand where staff were assigned and how hiring should be targeted. He also said the VA had lacked monthly financial reconciliation until recently and framed this as evidence of systemic management weakness that the reorganization aimed to correct.

• Rep. Van Orden raised concerns about the Army Corps of Engineers’ role in VA construction, and Sec. Collins replied that statutory thresholds drew the Corps into the process. He argued that VA-developed building standards and Corps involvement contributed to delays.

• Rep. Morgan McGarvey supported change but opposed making changes “in the dark,” and he criticized the limited materials provided to Congress for a reorganization of that scale. He asked whether Sec. Collins had provided Republicans with additional reorganization documents not shared with Democrats, and Sec. Collins said he had not and that both sides had been briefed multiple times.

• Rep. McGarvey then asked whether the VA had a continuity-of-care plan during the transition and demanded a yes-or-no answer. Mr. Goins stated that continuity would be preserved because frontline facilities would not be touched, but the exchange became confused and tense as Rep. McGarvey insisted the Committee had not received any such plan. He concluded that the lack of a provided continuity plan underscored the transparency concerns before his time expired.

• Rep. Kimberlyn King-Hinds shared that accountability had been unclear in prior VA oversight and supported efforts to clarify responsibility through reorganization. She raised concerns that the VISN map did not appear to represent U.S. territories and reported that veterans in places like the Northern Mariana Islands already struggled to access basic care. Sec. Collins and Mr. Goins replied that the territories remained aligned as they were in the current structure and that the map had focused on the largest changes within the continental United States, with oversight for certain territories remaining with existing VISNs.

• Rep. King-Hinds asked what data-informed consolidating from 18 VISNs into five would mean and whether it would worsen access challenges. Mr. Goins said the design reflected market research and argued the new structure separated care-delivery focus from bureaucratic national business functions by creating Health Service Areas (HSAs) whose sole scope was care delivery coordination.

• Rep. Julia Brownley raised concerns that the proposed reorganization chart did not clearly reflect the Department of Women’s Health as required under the Deborah Sampson Act and questioned how equity for women veterans would be monitored. Sec. Collins responded that women’s health remained a priority and highlighted expanded women’s health clinics and the removal of a prior requirement that women veterans obtain primary care referrals before seeing OB-GYN providers. Under Sec. John Bartrum added that women’s health programs were included under national programs on the enterprise side of the reorganization.

• Rep. Brownley also criticized the VA’s abortion policy and restrictions on physician counseling, arguing that women veterans had fewer reproductive health options at the VA than while on active duty. Sec. Collins held that the VA was following current law and Department of Justice guidance.

• Rep. Tom Barrett asked whether the new HSAs would focus more directly on managing veteran health outcomes rather than bureaucratic requirements. Mr. Goins confirmed that the reorganization aimed to separate care delivery responsibilities from national-level administrative functions so that VISN leadership could focus more on patient care.

• Rep. Barrett expressed support for clearer accountability and then asked whether the Electronic Health Record Modernization (EHRM) rollout would be disrupted by the VISN restructuring. Sec. Collins said the EHR rollout remained on track and aligned with the new structure, and Mr. Goins added that the Deputy Secretary’s office had ensured the rollout schedule would not be impeded by the reorganization.

• Rep. Chris Pappas inquired about the status of a feasibility study and action plan regarding a full-service VA hospital in Manchester, New Hampshire. Sec. Collins said the plan had been delivered to the White House and was awaiting final review, and he declined to characterize its contents while the process was ongoing.

• Rep. Pappas then raised concerns about a prior gap in Chapter 35 education benefits payments and criticized delayed communication with veterans during a government shutdown. Sec. Collins acknowledged the problem, stated that it stemmed from a manual processing issue that had since been corrected, and admitted that communication could have been better. Rep. Pappas also asked about the implementation of the partial claims program under VASP, and Sec. Collins responded that integration work was underway and an update would be provided soon.

• Rep. Nancy Mace discussed the denial of a floodplain waiver for a replacement research facility associated with the Ralph H. Johnson VA Medical Center and asked why the waiver had been rejected. Sec. Collins replied that long-term flood risk and infrastructure concerns drove the decision and stated he would not reevaluate it at that time.

• Rep. Mace expressed concern that care could be disrupted without the waiver, and Sec. Collins said disruptions could occur for various reasons, but maintained the long-term risk assessment justified the denial. Rep. Mace then asked what accounted for Charleston’s strong performance. Sec. Collins and Mr. Goins attributed it to strong, consistent leadership and longevity of the facility’s director, which allowed for sustained execution of strategy and accountability.

• Rep. Sheila Cherfilus-McCormick referenced a recent veteran suicide in her district and expressed concern about how consolidating Florida into a larger regional structure would affect access and wait times. Sec. Collins responded that the reorganization would not alter frontline facility operations and would instead provide greater consistency and support, including reforms to suicide prevention outreach. Mr. Goins added that the restructuring sought to standardize policy implementation so that care would be consistent across facilities.

• Rep. Cherfilus-McCormick asked whether Government Accountability Office (GAO) recommendations on reorganizations had been incorporated. Mr. Goins said that GAO and OIG findings, as well as frontline leader input, were being integrated into the developing implementation plan.

• Rep. Jen Kiggans supported restructuring efforts aimed at reducing administrative burden and increasing frontline staffing. She asked about the timeline for filling the vacant director position at the Hampton VA Medical Center. Under Sec. Bartrum said a vacancy announcement would be posted imminently, and Mr. Goins added that interim leadership would be maintained or extended to ensure continuity until a permanent director was selected.

• Rep. Kiggans also asked about staffing levels at the new North Battlefield clinic in Chesapeake. Sec. Collins reported that 534 positions were allocated, 335 were filled, and most remaining vacancies were actively being recruited, while confirming the clinic was currently providing all intended services and would scale up as hiring progressed.

• Rep. Delia Ramirez accused the VA of undermining labor rights, harming retention, and prioritizing the administration’s agenda over veteran care, and she repeatedly referenced the killing of VA employee Alex Pretti. She asked whether Sec. Collins had spoken with Homeland Security Secretary Kristi Noem, the President, or others in the administration about Pretti, and Sec. Collins said he had not.

• Rep. Ramirez then asked whether Sec. Collins would call for Secretary Noem’s resignation and pressed about the VA’s involvement in deportations of non-citizen veterans, and whether deported veterans still received benefits. Sec. Collins rejected the premise of one question and did not give a clear yes-or-no answer, and he stated that benefits eligibility depended on legal status and other factors. Rep. Ramirez criticized the VA’s workforce policies and alleged the VA’s “time to hire” metric had been changed to measure tentative job offers rather than start dates, and her time ended mid-remarks.

• Rep. Abe Hamadeh praised the VHA reorganization as necessary and long overdue and cited reports describing excessive layers and bureaucracy. He referenced data showing VHA workforce growth outpacing growth in patient encounters and asked Sec. Collins what the data suggested about staffing. Sec. Collins claimed the issue reflected an imbalance rather than a simple staffing shortage and argued that adding money and people did not automatically improve outcomes, noting that some areas had increased staffing while patient encounters declined. Mr. Goins added that VHA needed a demand-based enterprise evaluation to shift resources to locations with growing veteran populations and to address local physician shortages without overstaffing elsewhere.

• Rep. Hamadeh asked about the upcoming request for proposals for the Veterans Community Care Network (VCCN) contracts and whether the next generation of third-party administrator contracts would include stronger accountability for network integrity. Sec. Collins said prior programs had suffered from inadequate accountability and weak VA enforcement, and he argued that the new request for proposals (RFP) incorporated lessons learned from roughly a decade of failures. He expected better participation and improved accountability in the next contracting cycle.

• Rep. Tim Kennedy claimed Congress was being asked to accept a reorganization that would move thousands of employees while the workforce was strained and asserted that his office had not received the requested workforce impact data for Western New York. He asked whether Sec. Collins would commit to providing detailed staffing change information, including job titles, grades, facilities, reasons for departure, and whether employees had retired, resigned, or been terminated. Sec. Collins and Mr. Mark Englebaum said they would provide the information and argued that the VA had previously lacked adequate tracking and clarity about what roles employees were actually performing, including situations where clinical staff were assigned to non-clinical duties.

• Rep. Kennedy then asked about deferred resignation program costs and whether funds had been diverted from other accounts, and Sec. Collins said standard personnel accounts had been used and denied diversion. He also cited an example from the Western New York facility, stating that staffing had increased over five years while patient encounters had declined.

• Rep. Mariannette Miller-Meeks asked whether Sec. Collins would avoid promoting VA employees with poor performance histories or documented oversight failures into senior roles under the new structure. Sec. Collins said the reorganization aimed to strengthen leadership, mentoring, and accountability and that personnel decisions would consider performance records.

• Rep. Miller-Meeks pressed whether past Office of Inspector General (OIG) findings would be reviewed when selecting candidates for new leadership roles, and Sec. Collins confirmed the VA would consider all available information to place the best people in key positions. Rep. Miller-Meeks then praised recent progress in reducing hiring timelines and argued that faster hiring had been necessary to avoid losing qualified clinicians.

• Rep. Nikki Budzinski criticized VA workforce reductions and labor policy changes and expressed concern that the reorganization could jeopardize the accelerated EHRM rollout. She cited an email indicating that a standing meeting with the GAO had been canceled because leadership and resources were strained, and she asked whether that was true. Sec. Collins replied that the VA continued to meet with and respond to GAO and OIG, and he argued that many GAO reports concerned an earlier EHR approach he described as a failed rollout.

• Rep. Budzinski urged renewed engagement with GAO and asked what Sec. Collins would say to employees facing continued change. Sec. Collins said issues were being addressed on-site and that the EHRM effort had to succeed. Rep. Budzinski then asked how many IT support specialists had been lost since January 2025, but her time expired before a direct answer was given.

• Rep. Keith Self raised concern about unintended consequences, arguing that reducing VISNs to five while creating 15 Health Service Areas could allow new layers to grow into “super-VISNs” over time. Sec. Collins responded that VISNs and HSAs would have distinct functions and boundaries. Under Sec. Bartrum stated that the reorganization sought consistency by establishing a medical operations center to standardize policy implementation from central offices down through VISNs and HSAs to facilities. Mr. Goins added that roles, responsibilities, and boundaries were being clearly defined to prevent unchecked growth.

• Rep. Self asked whether HSAs would be prevented from independently interpreting VA guidance. Sec. Collins agreed and offered an example of inconsistent care practices between facilities as a motivating problem.

• Rep. Herb Conaway repeatedly asked whether the VA employed domestic terrorists and pressed Sec. Collins to state whether Alex Pretti was a domestic terrorist or assassin, referencing public statements by other administration officials. Sec. Collins refused to answer, said he had already addressed the matter with condolences, and objected to being spoken to disrespectfully.

• Rep. Conaway then shifted to the reorganization and questioned whether it added bureaucracy by reducing VISNs while creating administrative sub-areas. He argued that the reorganization was occurring amid staffing losses and long appointment wait times. He cited local examples of delayed primary care and mental health access and described a case where the lack of OR nurses and technicians impeded treatment, but his time expired before the exchange fully developed.

• Rep. Jack Bergman used a metaphor comparing bureaucratic overgrowth to a camel designed by committee and said the VA’s structure had drifted from its intended purpose. He yielded most of his time to Sec. Collins to explain the rationale behind the reorganization. Sec. Collins said the 30,000 departures referenced earlier were voluntary early retirements rather than firings and argued that the new HSAs and VISNs would have distinct, complementary roles rather than duplicative ones. He said the reorganization aimed to empower local medical center directors to make decisions rather than forcing ideas to move upward through paralyzing layers of bureaucracy. The Secretary added that the process was iterative, that transparency would continue, and that he would not accept maintaining the status quo.

• Rep. Maxine Dexter criticized the VA’s response to the killing of Alex Pretti and said the workforce felt harmed and unsupported. She expressed concern that undertaking a major reorganization while the VA was overstressed and understaffed could fail without strong cultural leadership and support for employees. She then asked why her September 2025 letter regarding wait time and drive time data for community care had not received a response. Sec. Collins agreed that members were entitled to timely responses and agreed to review the letter and ensure an answer was provided.

• Rep. Dexter questioned whether the VA could successfully execute a sweeping reorganization within the limited timeframe of the current administration. Sec. Collins replied that frontline leaders were supportive of the changes and that staffing fluctuations were common across healthcare systems.

• Rep. Kelly Morrison said that Sec. Collins had previously pledged not to fire frontline care providers and raised concerns about canceled promotions and reported workforce reductions. She asked whether he would commit to addressing severe staffing shortages identified by the VA OIG in Minneapolis. Sec. Collins responded that staffing levels had increased there since 2019 and disputed the characterization of a simple staffing crisis.

• Rep. Morrison then criticized Sec. Collins’ handling of statements about Alex Pretti and asked whether he disputed ICE’s description of local cooperation in Minnesota. Sec. Collins reiterated that immigration operations were not within his department’s jurisdiction and declined to revisit his prior statements. Rep. Morrison concluded by saying VA employees deserved leadership that defended them, and she yielded back.

• Rep. Bobby Scott asked about staffing at the North Battlefield outpatient clinic, noting prior disagreement about opening staff levels and asking when it would be fully staffed. Sec. Collins reported that staffing had increased from approximately 150 to 355 employees and that 166 positions were in active recruitment, with services already being delivered as planned.

• Rep. Scott also asked about psychiatric inpatient bed availability at the Hampton VA, and Sec. Collins said he would need to follow up with details but noted broader national trends toward outpatient mental health care. Rep. Scott further asked whether administration personnel decisions had harmed recruitment. Sec. Collins replied that the VA faced the same recruitment challenges as other healthcare systems, particularly in offering competitive wages.

• Rep. Debbie Wasserman Schultz questioned the cost estimates associated with the VHA reorganization, referencing a preliminary estimate of roughly $521 million in upfront costs and a projected net cost of about $312 million over five years. She asked whether those costs would be funded in the current fiscal year and whether a reprogramming request would be submitted. Sec. Collins said implementation would occur within current appropriations authorities and that he did not anticipate a reprogramming request at that time.

• Rep. Wasserman Schultz asked whether updated cost estimates and detailed justifications would appear in the FY 2027 budget request. Sec. Collins confirmed that additional information would be provided.

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