Kristina Keenan, director of the national legislative service for the Veterans of Foreign Wars, testifies Tuesday, July 15, 2025, during a meeting of the House Veterans’ Affairs Committee. (Eric Kayne/Stars and Stripes)

WASHINGTON — Professional caregivers and veterans groups argued over the merits of private medical care versus care at the Department of Veterans Affairs during an emotional House Veterans’ Affairs Committee hearing that examined how demand for community-based health services is shifting billions of dollars from the VA.

Representatives from some nonprofit groups on Tuesday presented instances of the VA denying referrals for private-sector care to qualifying veterans as evidence the federal agency is trying to curtail the use of private medical treatment.

The oversight hearing was titled “Right time, right place, right treatment with VA community care,” but lawmakers, veterans advocates and nonprofit health care providers had sharp disagreements over the role of private-sector care in veterans health coverage.

Mandatory spending by the VA for community-based private care for veterans was $6.74 billion in fiscal 2024 and is budgeted for $9.77 billion in fiscal 2025 — as more veterans seek health care close to home, according to lawmakers.

Private-sector care represents up to 40% of health care for veterans, according to the VA.

Amanda Newman, chief executive officer of Western Illinois Home Care, said her home-health agency is seeing a growing number of elderly patients denied referrals from the VA for home health services and redirected to a VA clinic or hospital.

Newman described the case of 79-year-old client with diabetes who now must drive more than 50 miles each way to a VA clinic for twice weekly medical appointments after being turned down for home health care.

She said some of the patients her home-health agency serves are being denied coverage after receiving it for several years.

But Kyleanne Hunter, chief executive officer of Iraq and Afghanistan Veterans of America, warned lawmakers that large spending increases on non-VA health care could lead to cutbacks and a “downward spiral” of care at the VA.

“Evidence indicates that community care often incurs higher costs due to limited VA oversight and varied local market rates,” she said. “Reports highlight that this dramatic increase in community care expenses threatens direct care funding” for the VA health system.

Hunter said her organization is concerned private, non-VA doctors cannot meet all of the complex medical needs of many post-9/11 veterans.

VA Secretary Doug Collins said earlier this month that the agency will be shedding 30,000 full-time positions by Sept. 30, though he pledged no front-line jobs will be cut. The VA is the second-largest federal agency after the Defense Department.

Army combat veteran Meaghan Mobbs suggested mismanagement at the VA has contributed to “wait lists, distance barriers, specialty gaps and overwhelmed facilities.”

“This is not a funding problem, it’s a function problem,’’ said Mobbs, director of the Independent Women’s Forum’s Center for American Safety and Security, a non-for-profit organization.

“When a VA system goes two years without a full-time gynecologist, as was documented in a 2020 inspector general report, that’s not a scheduling issue. It’s a failure of access and management,” she said.

Rep. Maxine Dexter, D-Ore., said she struggles with having to consider funding veterans health services as a “binary choice” between care in the community and at the VA.

“I know nobody here is advocating necessarily for one versus the other, but I think that is how it feels in this committee at times,” she said. “This is a fixed pie. When we take money out of the VA direct care services and get it out to the community, it is a loss from being able to build up the VA care to the quality that we know.”

Dexter, a pulmonary and critical care physician, said lawmakers need to see more data on outcomes for the delivery of various health care treatments to better understand what works best.

Newman warned community care should not be seen as a replacement of VA health services but as an extension of it.

For many veterans, especially those living in rural or remote areas, private health care is a “vital lifeline,” she said.

Veterans who are elderly and infirmed often face long travel times or limited specialty services at their local VA facilities making nursing care and other health assistance in the home “a necessary option,” Newman said.

“A veteran should not wait for treatment when community providers are already available to meet a need,” said Rep. Mariannette Miller-Meeks, R-Iowa, a former Army doctor and the chairwoman of the House VA Committee’s subpanel on health. “To best serve veterans, VA should pursue whatever gets quality care to veterans when they need it.”

Miller-Meeks also pointed to a national shortage of doctors and nurses that is projected to grow as affecting hiring at the VA and in the private sector.

Hunter acknowledged some highly specialized types of medical care might not be “cost-efficient” for the VA to retain, such as oral and maxillofacial plastic surgery, ocular oncology and vascular surgery.

Passage of the Mission Act in 2018 enabled eligible veterans to receive coverage for their health care services from doctors in private practice within their communities, Miller-Meeks said.

Congress closed a gap that was “crippling” health-care delivery by the VA when it passed the Mission Act, she said.

Funds previously allocated solely to VA facilities could now be used to pay for care provided by private medical facilities. Veterans are no longer “stuck in line” waiting months for a doctor’s appointment, especially for care from some specialists not immediately available from the VA.

“By virtue of being in the community, [doctors in private practice] are closer to veterans and their homes than a brick-and-mortar VA facility,” Miller-Meeks said.

But some Democratic lawmakers said VA cutbacks are causing veterans to look to the private sector for their care.

“VA has become a toxic, unpredictable, hostile place to work,” said Rep. Julia Brownley of California, the top Democrat on the subcommittee.

Brownley said while the VA secretary has said there will be no loss of essential workers, there is turnover among custodians and food service workers as well as doctors and nurses. She asked Hunter of the IAVA about why she believes VA doctors are “uniquely positioned” to care for post-911 veterans with complex medical needs.

VA doctors have extensive training in diagnosing and treating veterans who’ve been exposed to toxins and injured in combat from “blast” injuries, Hunter said, referring to trauma veterans can suffer from direct or indirect exposure to explosions.

“This is a diverse population with unique health care needs, which includes illnesses and injuries that are a result of cumulative and compound exposures, latent impacts of blast-related injuries and the interaction of several physical and mental health care issues,” she said. “Community care is a vital part of overall veterans’ health care. But especially as we consider rising costs, we need to be clear that the evidence does not bear out that community care is a meaningful replacement for all direct VA care.”