As Trump names VA pick, firing and privatization come back into the spotlight

President-elect Trump has tapped former Rep. Doug Collins, R-Ga., to head up the Veterans Affairs Department, who has military experience but was not otherwise discussed as a candidate. 

The surprising selection demonstrated Trump’s proclivity for choosing loyalists, as Collins—while lacking in experience on veterans issues—steadfastly defended Trump throughout his first term and campaigned with him this year. He did not serve on the House Veterans Affairs Committee while in office. 

“None of us really know much about him,” Joe Chenelly, executive director of AMVETS, said of his and other veteran service organizations. He added his group was pleased by the selection of a veteran—Collins served as a chaplain in the Navy and later joined the Air Force Reserve—to the post. 

Trump’s approach at VA in his first term was met with some controversy as his administration sought to make it easier to fire department employees and for veterans to receive private sector care on the government’s dime. Congress eventually passed the 2018 MISSION Act on a bipartisan basis as a follow up to a 2014 law with similar goals, but lawmakers disagreed over its implementation and conservatives have accused President Biden of seeking to rein in the use of “Community Care.” 

Trump has frequently boasted of his expansion of choice as one of his signature accomplishments in his first term, and Collins appears poised to continue those efforts. 

The secretary-designate said on X he would “fight tirelessly to streamline and cut regulations in the VA,” perhaps an allusion to reducing the barriers to private sector care. Collins recently told Fox News that if veterans “want to go back to their own doctors, then so be it.”

The Biden administration under Secretary Denis McDonough has continued to implement the MISSION Act and spending on Community Care has grown each year. Still, VA has faced some criticism for not expanding its use further. 

Chenelly said AMVETS had feared Trump would tap someone “more extreme” on the issue of privatized care. Among the names considered by the transition team, according to briefings provided to veterans groups, were former Rep. Tulsi Gabbard, D-Hawaii, who Trump instead selected to lead the Office of the Director of National Intelligence, Robert Wilkie, who previously led VA under Trump, Darin Selnick, a former Trump policy advisor on veterans issues and Jeff DiLullo, a vice president at Phillips North America. Collins does not appear to have much experience with veterans policy, Chenelly said, but he hopes to meet with him before Trump’s inauguration to present AMVETS’ ideas. 

John Byrnes, strategic director at Concerned Veterans for America, a right-leaning veterans group with deep connections inside Republican circles, said Biden and McDonough have undermined the spirit of the MISSION Act and veterans deserve "full health care choice." 

“Doug Collins has been vocal about fixing the broken VA health care system and ensuring veterans’ access to choice,” Byrnes said. “We look forward to working with the Trump administration’s next Secretary of Veterans Affairs to hold the VA accountable to meet the needs of our nation’s heroes so that no veteran is left behind waiting for care.”

After his firing, Trump’s first VA secretary, David Shulkin, suggested he was pushed aside for political reasons surrounding his reluctance to further privatize parts of the department. VA at the time rejected the assertion and said it was a myth that it had any interest in privatizing the department. 

Collins has also discussed the longstanding conservative goal of firing more VA employees. Following his selection, he vowed to “root out corruption” from the department. Collins has also criticized VA under McDonough for following a ruling that demanded the department rehire employees it improperly fired. 

McDonough last year ended the implementation of disciplinary provisions included in the Trump-signed 2017 VA Accountability and Whistleblower Protection Act, citing its repeated defeats in court, labor panels and elsewhere. The decision marked the second time in the last decade that Congress tried and failed to speed up firing at VA. In 2016, the department announced it would no longer use a 2014 law aimed at making it easier to fire career senior executives after it similarly suffered a series of legal setbacks.

The Trump White House and VA would likely be much friendlier to a measure House Republicans passed through the House Veterans' Affairs Committee last year in a party-line vote. The Restore VA Accountability Act would reinstate and strengthen many of the provisions of the 2017 firing law. The measure would again remove the requirement for a performance improvement plan and lawmakers made clear in the new bill that its reforms would supersede any agreement VA had negotiated with a union. Sen. Jerry Moran, R-Kan., who is in line to take over the chairmanship of the Senate Veterans Affairs Committee, has introduced companion legislation. 

The Biden administration forcefully pushed back on the renewed efforts, saying the legislative proposal was unnecessary and a retread of failed ideas. 

Another effort Collins could revive with congressional help is the process of identifying VA facilities for consolidation or closure. The MISSION Act created a commission for that purpose and the Biden administration identified hundreds of facilities for closure—and additional areas for building new clinics and medical centers—but a bipartisan group in the Senate spiked the initiative.