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Will Veterans be forced to compete with civilians for healthcare?

VHPI LogoThe Department of Veterans Affairs’ Veterans Health Administration (VHA) serves 9 million patients annually. VHA provides everything from basic primary care to complex rehabilitation programs and helps Veterans find housing, employment, and even legal services.

More importantly, Veterans have what many Americans do not – equitable access to healthcare over a lifetime. To cite only one example of how this produces better outcomes, the publication Cancer found “African American men did not have more advanced disease at the time of diagnosis or die earlier than white men [in the VHA], unlike trends seen in the greater U.S. population of patients with prostate cancer.”

Unfortunately, the VHA may soon look the same as America’s broken private healthcare system. President Donald Trump dramatically expanded the pool of for-profit providers who are contracted to care for Veteran patients when he signed the 2018 VA Mission Act into law. The Trump administration’s 2021 budget submission increases VHA medical care to $90 billion. It’s unclear how much of that money will pass through the VHA and into the pockets of private, for-profit providers. Between 2014 and 2017, the budget for private sector care increased by 49 percent while the VHA’s direct budget increased by only nine percent.

The VHA has a worker shortage of 49,000 vacancies, many positions that, if filled, would provide or support direct care to Veterans. The resulting delays, wait times, or unavailable VHA providers are then used by Trump administration officials to justify additional outsourced care.

Veterans may increasingly find themselves forced to compete with civilians for health care. The Department of Defense announced that it’s closing the doors on retired military members and their families at 38 separate military hospitals. The DoD is downsizing its military medical corps and moving more active-duty members into the private sector. Another 18.1 million retired military and 20 million family members may flood a private sector healthcare system that is already straining to take care of civilian sector patients.

Veterans will confront many problematic practices that are typical in a healthcare system that is driven by profit. Surprise bills are commonplace in private care, but unknown at the VHA. The cost of care, while consistent throughout the VA health care system, can vary wildly in the private sector even within the same community. If more veterans are cared for in the private sector, they likely will be burdened with bills the VA will not be able to cover.

And what will happen to Veterans who have many expensive, complex conditions, when private sector providers discover Veterans aren’t as profitable as they had imagined?

The Veterans Healthcare Policy Institute is a 501(c)3 nonprofit. Learn more at

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