Major leadership shakeup, new budget battles coming to VA in 2025

The year ahead will be a period of major changes for the Department of Veterans Affairs, with new leadership, new priorities and likely its biggest budget in history. But how much all of that will impact veterans benefits and health care is less clear.

The department, which now boasts a $350 billion budget and more than 400,000 employees, will start 2025 with VA Secretary Denis McDonough and his administration wrapping up four years of expansion and outreach efforts.

President-elect Donald Trump’s inauguration in January will mean at the least a clearing out of that Democratic leadership, replacing political appointees with his own picks.

During his last administration, VA issues were a major focal point of Trump’s White House. On the campaign trail last summer, he hinted at a repeat during his return to office, with plans to further expand medical care options for veterans and continue reforms in federal hiring (and firing) practices.

The following are some of the top Veterans Affairs stories to follow in 2025.

A new VA secretary

In November, Trump nominated former Georgia congressman Doug Collins as his pick to be the next Veterans Affairs secretary. The choice was a mild surprise among veterans advocates, given that Collins did not sit on the Veterans Affairs committee or champion many veterans bills during his eight years in Congress.

But Collins, 58, has already been endorsed by several veterans groups and is not expected to face the same level of opposition as some of Trump’s other cabinet picks.

Collins served in the active-duty Navy for two years as a chaplain and re-enlisted in the Air Force Reserve following the Sept. 11, 2001 terrorist attacks. He deployed to Iraq in 2008 as a member of the 94th Airlift Wing, and still serves in the reserves.

His confirmation hearing before the Senate Veterans’ Affairs Committee, expected in January, will offer a preview of policy priorities for the upcoming administration. Shortly after his nomination, Collins released a statement promising to “streamline and cut regulations in the VA, root out corruption, and ensure every veteran receives the benefits they’ve earned.”

While he does not have any problematic veterans policy stances on his resume, Democratic lawmakers may question his efforts to help Trump overturn the results of the 2020 election, and his public stances undermining the validity of those results.

But Republicans in the Senate have already signaled strong support for Collins’ nomination, and he could be approved by the chamber in time to take office just after the inauguration.

Department budget battles

One of the first issues Collins will have to deal with as VA secretary will be the department’s budget, both for the current fiscal year and fiscal 2026.

For several months, lawmakers and VA planners have sparred over department budget estimates, with members of Congress promising increased scrutiny before any new funds are approved.

In November, VA officials announced they expect to need at least $6.6 billion in extra funding for the current fiscal year to cover increased costs to higher usage of VA medical facilities over the last year.

That number was revised down from a $12 billion estimate over the summer. Republican House lawmakers have bristled at the numbers, accusing planners of playing politics with their estimates and improperly guessing what the future need will be.

Lawmakers in the next session of Congress will need to approve a full-year budget for VA and most other federal agencies as one of their first priorities. VA operations are largely funded a year in advance, mostly shielding them from shutdown fights.

But officials have said without the extra $6.6 billion in emergency funding early in 2025, some services and operations could be impacted. One of Collins’ first jobs will be to decide if that is accurate, and whether to convince lawmakers to write another check.

Community care concerns

Expanding “choice” in veterans’ medical benefits — particularly in regard to having VA pay for veterans’ appointments outside the department’s health care system — was a major focus of President-elect Donald Trump’s first term in office. Republican lawmakers have already started up that debate again.

In early December, House Veterans’ Affairs Committee Chairman Mike Bost, R-Ill., introduced the “Complete the Mission” Act, which would further expand veterans’ ability to access private-sector medical care options using taxpayer funds. Bost has promised to make the legislation a key priority in 2025.

The bill would expand community care options for patients of the Veterans Health Administration to include nearly all extended care services, such as mental health residential rehabilitation, and block VA from offering telehealth appointments with department physicians in lieu of outside care options.

It would also mandate new reimbursement rules for outside medical offices and mandate better sharing of private-sector options by VA leaders to patients.

At the urging of Trump, Congress in 2018 approved the VA MISSION Act, which overhauled eligibility rules for veterans’ outside care options. Community care options have risen significantly since then, from roughly 27% of VA total scheduled medical visits in 2017 to about 39% in fiscal 2023.

But Republican lawmakers have accused VA of keeping too many patients in the department’s health care system, even when outside care options could be more beneficial.

Democratic lawmakers have countered with concerns that GOP leaders are working to privatize the department, forcing taxpayer money into private-sector businesses and undermining the security of the VA health care system.

Trump’s pick for the VA under secretary of health will be a major voice in that debate, but the president-elect still has not announced names under consideration for that post.