VA Secretary Doug Collins is defending a plan to increase spending for private medical care by $17 billion in fiscal 2028, while keeping funds for medical care at the Department of Veterans Affairs largely unchanged. He is shown here testifying at a hearing in February 2026. (Eric Kayne/Stars and Stripes)
WASHINGTON — Veterans Affairs Secretary Doug Collins is defending a plan to increase spending for private medical care by $17 billion in fiscal 2028, while keeping funds for medical care at the Department of Veterans Affairs largely unchanged.
At a hearing of the Senate Veterans’ Affairs Committee on Wednesday, Collins told lawmakers that dollars spent on medical care at VA hospitals and clinics is double the amount that VA pays to “purchase care” in the private sector for non-VA medical services.
The hearing’s focus was to examine the VA’s $488 billion budget request for fiscal 2027 and to give lawmakers a preview of the spending plan for 2028.
But Sen. Tammy Duckworth, D-Ill., Sen. Angus King, I-Maine, and other lawmakers pressed Collins on a year-over-year trend that shows the VA accelerating spending on private medical services in communities while reducing the VA workforce, including medical personnel.
An estimated 40% of veterans enrolled in VA health care use private-sector medical services, according to the VA.
Collins also fielded questions and concerns about proposed cuts in fiscal 2027 to VA research, the VA Office of Inspector General and the Veterans Home Grant Program.
In an angry exchange, Duckworth, a disabled Iraq War veteran, said that Collins is ignoring requests from veterans service organizations to spend more on VA health care services.
Duckworth accused Collins of carrying out a “privatization blitz” by accelerating spending for non-VA medical services that she claimed “enriches private donors” of President Donald Trump.
Collins denied those statements and emphasized VA’s commitment to providing health care to millions of veterans.
“When you say we’re privatizing you are flat out wrong. We pay double than what we do in the community,” Collins said.
But King asked about trends that show an increasing rate of VA dollars going to non-VA private medical care.
“Yes, spending on direct VA care is twice that of community care, but that is changing rapidly,” Sen. Angus King, I-Maine, said during a Senate Veterans’ Affairs hearing on May 20, 2026,, as a staff member held a chart illustrating the change. “There is a percentage increase, year by year, that shows a move toward community care.” (Screenshot from the hearing.)
“Yes, spending on direct VA care is twice that of community care, but that is changing rapidly,” King said, as a staff member held up a chart illustrating the change. “There is a percentage increase, year by year, that shows a move toward community care.”
“There is no intention to gradually privatize health care, to accelerate it, or to privatize it at all,” Collins responded. “We’re maintaining our quality at VA and our responsibility to community care.”
Collins said that no veteran can “go straight to the community” for their health care. They first must obtain a referral from their VA doctor if a VA medical service and appointment is unavailable in a timely manner.
Richard Topping, the VA chief financial officer, said the agency is in the process of developing a different accounting approach that more accurately shows the costs to provide VA medical care compared to spending on non-VA private medical care.
Topping said the agency has asked for a breakout of costs that is more “apples to apples.”
“Nobody knows right now the expense of direct care over [non-VA] community care,” Topping said. “We don’t track data that way.”
Sen. Richard Blumenthal, of Connecticut, the top Democrat on the committee, expressed concern that funding for VA medical care fails to keep pace with inflation and will not provide the services that veterans need.
“Veterans will be forced into the community care system, a system that may be ill-equipped to deal with their unique needs,” Blumenthal said.
Sen. Jerry Moran, R-Kan., the committee chairman, asked about plans to cut 143 positions at the VA Office of Inspector General.
“I have great respect for the OIG. They have been valuable to me as chairman and a member of this committee by providing audits and investigations that help me help those I serve,” Moran said.
“I hope we can make certain that the inspector general at the VA is adequately funded to provide oversight and investigative work,” Moran said. “Less funding seems to be damaging to that possibility.”
Collins said he has focused on making common-sense changes to staffing, structure, contracts and processes as he pursues a larger plan to reorganize the system and reduce the workforce.
Collins said he also agreed that the VA OIG does “excellent” work and that he consulted with Cheryl Mason, the VA inspector general, when proposing the cuts.
Overall, Collins pointed to deficiencies the VA is working to overcome, including an electronic health records system that does not easily allow a patient’s medical records to be shared between VA facilities.
Other challenges include recruiting and retaining physicians, because medical personnel can get higher salaries in the private sector, Collins said.
“We have an -ologist problem, whether it’s cardio, thoracic, or anesthesia. It’s a pay problem for these specialists,” Collins said. “I often can’t attract or keep them, because they can make $300,000 to $400,000 more than what I can offer at the VA.”
But the VA secretary said he also wanted to focus on successes, including shorter wait times to see a provider, an increased number of appointments and the opening of 35 new health facilities.
Sen. Marsha Blackburn, R-Tenn., lauded Collins for keeping the McMinnville, Tenn., VA clinic open, after it announced that it was preparing to close.
Collins described “sub-par treatment” of veterans by the former contractor that ran the clinic. “They were not taking care of veterans as they should,” he said.
The VA has taken over the clinic and is installing its own employees in the facility, he said.
Collins also said he is empowering medical center directors to take more local control of their budgets and workforce.
He noted that the construction budget includes $5 billion to modernize facilities and expand capacity.
There also are proposals to build a medical center in Manchester, N.H., replace a hospital in Indianapolis and begin land acquisition to replace a medical facility in San Antonio.
“These investments are targeted — focused on readiness, safety, and long-term sustainability of VA infrastructure,” Collins said.
“We rarely talk about the successes. We are accomplishing these things even as people are saying everything is bad at the VA,” he said.
