Project 2025’s VA Health-Care Agenda: Privatization by Audit and Attrition
Project 2025 proposes a series of operational, transparency, and personnel measures that would systematically pressure the Veterans Health Administration toward privatization—by forcing unrealistic productivity targets, expanding community care without addressing quality gaps, and leveraging a flawed infrastructure review to close underused VA facilities. These changes would erode veteran trust, fragment care for complex cases, and undercut the PACT Act’s hard-won toxic-exposure benefits.
Project 2025’s proposals for the Veterans Health Administration sound like sensible management reforms—public reporting, infrastructure audits, productivity benchmarks, and community clinic expansion. But each step is calibrated to shift care away from the integrated VA system, which consistently outperforms private alternatives for veteran-specific conditions, and toward a fragmented, for-profit network that has no mandate to train staff on combat-related trauma, burn-pit exposure, or military sexual trauma.
Take the call for an independent audit similar to the 2018 Department of Defense audit. The DOD’s first audit failed—it received a disclaimer of opinion because it could not verify billions in assets. A comparable VA audit would waste billions on consultants while providing cover to slash budgets for facilities deemed ‘underutilized.’ Meanwhile, the administration has already terminated the Asset and Infrastructure Review (AIR) commission, which Congress intended to guide facility modernization. Instead of a deliberative process, Project 2025 wants to use budget allocations to unilaterally close aging hospitals and replace them with Community Based Outpatient Clinics (CBOCs) that lack capacity for specialized care like spinal cord injury, amputee rehabilitation, and toxic-exposure treatment.
The most dangerous proposal is the mandate that VA providers see 19 patients per day—matching the Department of Defense’s target—when the VHA’s patient population has far higher rates of chronic illness, mental health comorbidity, and social complexity. RAND research shows VA providers already see fewer patients because they spend more time per visit to address these needs. Forcing a private-sector tempo would convert primary care into drive-through medicine, increase burnout, and drive experienced clinicians out of the system. Together, these policies create a death-by-a-thousand-cuts pathway to privatization: make the VA look inefficient, starve it of resources, and route veterans to community care that is more expensive, less accountable, and unprepared for their combat-related conditions.
Grounded in
- VA MISSION Act of 2018: Implementation and Impact
- GAO Report on VA Wait Times and Community Care
- VHA Asset and Infrastructure Review (AIR) Commission Termination
- VA Electronic Health Record (EHR) Modernization Delays
- Congressional Research Service: VA MISSION Act Overview
- VA Office of Inspector General on EHR Safety Concerns
- RAND Study on VHA Productivity and Staffing
- Project 2025 Chapter 21: Department of Commerce (Excerpt on VA)
Original source — excerpted
project2025 Project 2025 ch. 21: Department of Commerce (pp 679-681)"— 646 — Mandate for Leadership: The Conservative Promise 3. Section 121 (developing and administering an education program that teaches veterans about their health care options available from the Department of Veterans Affairs). 4. Section 152 (returning the Office for Innovation of Care and Payment to the Office of Enterprise Integration with a joint governance process set up with the VHA). 5. Section 161 (overhauling Family Caregiver Program expansion, which has gone poorly, so that it focuses on consistency of eligibility and awareness that the most severely wounded or injured may require the program indefinitely). l Require the VHA to report publicly on all aspects of its operation, including quality, safety, patient experience, timeliness, and cost-effectiveness, using standards similar to those in the Medicare Accountable Care Organization program so that the government may monitor and achieve continuous improvement in the VA system more effectively. l Encourage VA Medical Centers to seek out relevant academic and private- sector input in their communities to improve the overall patient experience. Budget l Conduct an independent audit of the VA similar to the…"