Veterans Affairs Secretary Doug Collins faced questioning Tuesday from lawmakers over the proposed overhaul of the Veterans Health Administration, as they raised concerns about staffing cuts, accountability, and whether the reorganization risks disrupting veterans’ care.
The plan, known as RISE, short for “restructure for impact and sustainability,” would reshape how the VA manages and oversees healthcare nationwide, consolidating its 18 Veterans Integrated Service Networks, or VISNs, into five and creating new “health service areas” to handle day-to-day engagement with hospitals and clinics.
Collins describes the proposal as the most significant reorganization of the VA’s health system since the 1990s, arguing it is designed to reduce bureaucracy, standardize operations, and push resources closer to the front lines.
“This is not a reduction in force,” Collins told the Senate Veterans’ Affairs Committee. “This is not an effort to diminish direct care for veterans. This is about eliminating administrative overhead and empowering local leaders to do what they’re supposed to do, which is take care of veterans.”
Committee Chairman Jerry Moran (R-KS) said the overhaul responds to years of warnings from the Government Accountability Office and the VA Office of Inspector General, which have repeatedly flagged unclear lines of authority, weak accountability, and inconsistent oversight across the system.
“These are important goals,” Moran said. But he cautioned that reorganization “carries risks,” and said lawmakers would closely examine how the VA plans to mitigate those risks, measure success, and protect continuity of care during the transition.
Republicans press VA on execution and unintended consequences
While several Republicans welcomed Collins’ focus on reducing bureaucracy, they repeatedly pressed VA officials on whether the restructuring could deliver results without repeating past failures or leaving veterans behind.
Sen. Kevin Cramer (R-ND) questioned whether the department’s touted efficiency gains translate into better patient outcomes, warning against management-driven reforms that overlook the lived experience.
“If I’m really critically ill, waiting 125 days to see a doctor is not enhancement and quality of care,” Cramer said. He pressed Collins on how the VA defines success, saying veterans measure performance in access and outcomes, not organizational charts.
Sen. Dan Sullivan (R-AK), who has long criticized prior VISN realignments, warned that Alaska’s unique geography makes it especially vulnerable to disruption. A previous restructuring, he said, “collapsed the system” in his state and left thousands of veterans without adequate care.
“We cannot repeat what happened last time,” Sullivan said, urging VA leaders to ensure Alaska is not grouped into a structure that fails to account for its challenges.
Sen. John Boozman (R-AR) asked what safeguards are in place to ensure continuity of care during the transition, while Sen. Tommy Tuberville (R-AL) defended the department’s efforts to rebalance staffing levels, arguing that workforce growth in recent years has outpaced increases in patient demand.
Collins said the new structure would tighten lines of authority and ensure policy changes are consistently implemented across facilities, rather than filtered through layers of bureaucracy that often leave hospitals guessing.
“You just described exactly why we’re doing this,” Collins told Moran, responding to the chairman’s account of policy fixes that never made it to the facility level.
Workforce cuts cast long shadow over reorganization
Concerns about staffing dominated much of the hearing, with Democrats warning that the VA is attempting to restructure its health system amid deep workforce losses that could undermine care and morale.
Ranking member Richard Blumenthal (D-CT) said Congress provided an additional $6 billion in fiscal 2025 to address higher-than-expected demand for VA healthcare, including hiring providers and expanding community care, but questioned whether that funding instead went toward covering workforce reductions.
“My understanding is that almost all of that $6 billion was used to cover the cost of staff reductions,” Blumenthal said, citing deferred resignations, early retirements, and payouts for employees paid to stay home. He pressed Collins to provide a full accounting of how the money was spent.
“It appears that money intended to sustain VA medical operations was used to push out essential healthcare providers,” Blumenthal said. “We have repeatedly asked for this information and have not received it.”
Blumenthal said roughly 30,000 VA employees have left the department over the past year and warned that lawmakers still lack a clear breakdown of which positions were cut and how those losses affect patient care.
“We shouldn’t have to ask for this in a public hearing,” he said.
Collins disputed claims that the cuts targeted frontline workers, saying many of the eliminated positions were vacant or administrative roles and that the department has not conducted layoffs. He pledged to provide detailed staffing data to the committee.
“There was nothing done to push anyone out,” Collins said. “This was not about diminishing care.”
Sen. Maggie Hassan (D-NH) said the assurances rang hollow, given reports that the VA is planning to permanently eliminate up to 35,000 additional positions, including some clinical roles, on top of last year’s losses.
“Doctors and nurses aren’t overhead,” Hassan said. “They are not bureaucracy.”
Hassan warned that uncertainty surrounding layoffs, canceled contracts, and proposed staffing caps has made recruitment more difficult and strained trust between the department and Congress.
“When there’s chaos and a lack of transparency, it doesn’t make people eager to come work at the VA,” she said. “You are operating from a trust deficit right now.”
She also raised concerns that caps on hiring at the VISN level could prevent new or expanded facilities from staffing up adequately, including a long-planned full-service VA hospital in New Hampshire, and warned against what she described as “arbitrary caps from the top down.”
VA officials responded that the department is building a long-overdue workforce planning model to align staffing with patient demand rather than relying on years of unstructured growth.
Greg Goins, acting VHA Chief Operating Officer, said staffing increases during COVID-19 and after the passage of the PACT Act outpaced actual workload growth, leaving the system unsustainable.
“We’ve never had a strategic approach to enterprise resource allocation,” Goins said. He said the department plans to rebalance staffing gradually through attrition, not layoffs, and will allow exceptions for critical clinical needs.
“We will not execute anything that puts veterans at risk,” Goins said.
Electronic health records overhaul resurfaces as test case
Lawmakers also returned to the VA’s long-troubled electronic health record modernization effort, which Collins described as an “absolute unmitigated disaster” spanning multiple administrations.
Early failures stemmed from allowing individual facilities to customize systems to the point they could not communicate with one another, Collins said. Under the revised approach, the VA is standardizing around roughly 90% of the vendor’s core product, with limited customization.
Michigan is scheduled to go live on April 1, followed by sites in Ohio, Alaska, and Indiana.
Sen. Elissa Slotkin (D-MI) said lawmakers in her state remain uneasy, citing staffing vacancies and concerns that inspector general recommendations have not been fully implemented. She asked Collins to commit to direct briefings for Michigan’s delegation.
“Set the date,” Collins replied.
Pretti’s death reverberates through VA
Much of the hearing kept returning to the killing of Alex Pretti, a 37-year-old ICU nurse at the Minneapolis VA Medical Center, who was shot by Border Patrol agents during an altercation Saturday as he recorded a federal immigration operation.
Blumenthal opened his remarks by honoring Pretti, calling him “one of the most dedicated staff [members] who served our nation’s heroes.” He said Pretti was known for his compassion and commitment to veterans.
“He loved his job. He loved his family. He loved his country,” Blumenthal said.
Sen. Patty Murray (D-WA) sharply criticized the administration’s response, accusing officials of spreading misinformation about Pretti in the immediate aftermath and failing to acknowledge his service.
“Words cannot describe how outraged I am,” Murray said, calling for an independent investigation and accountability. She pressed Collins on whether Minneapolis VA employees were being given time and support to grieve amid staffing shortages.
Hassan and Sen. Ruben Gallego (D-AZ) also raised the case, warning that Pretti’s killing has shaken morale across the VA workforce and raised broader concerns about the safety of federal employees.
Collins expressed condolences to Pretti’s family and colleagues but declined to address specific characterizations made by other administration officials, citing the ongoing investigation and noting that the VA is not conducting it.
Goins said the department supported staff efforts to honor Pretti, confirming that hundreds of employees attended a memorial service and that counseling and employee assistance resources were made available.
