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The U.S. Department of Veterans Affairs (VA) is one of the largest and most complex federal agencies, with an annual budget of about $240 billion (FY2021) and roughly 360,000 employees operating 1,600 health care facilities nationwide. It provides medical care to around 9 million veterans each year, while also administering benefits like disability compensation, education (GI Bill), home loans, and more.
In recent years, the VA has grappled with significant challenges in delivering on its mission. Key problem areas have included health care access and quality, a backlog in processing veterans’ benefit claims, veteran homelessness, staffing shortfalls, and bureaucratic inefficiencies that hinder accountability.
Healthcare Access and Quality
Ensuring veterans can access timely, high-quality medical care has been a core VA challenge. A major scandal in 2014 exposed how long wait times and data manipulation were endangering veterans. Whistleblowers revealed that staff at the Phoenix VA hospital kept “secret” waitlists to hide delays; an Inspector General investigation found up to 40 veterans died while awaiting care, and scheduling abuses were identified at 77 VA facilities nationwide. This wait-time crisis highlighted how access to care had fallen short, even as studies show that the quality of VA-provided care can be as good as or better than private-sector care once veterans are seen. In fact, a systematic review of 37 studies (2015–2023) found VA health care equaled or surpassed non-VA care in clinical quality and patient safety outcomes. Patient experience in VA facilities was also on par with or better than outside care in the studies reviewed. However, those benefits mean little if veterans can’t get appointments when needed. The scandal prompted new policies to improve access, such as the Veterans Choice Act of 2014, which allowed veterans facing excessive travel or wait times to get treatment from private providers. This was expanded under the VA MISSION Act of 2018, which broadened eligibility for community care if wait times exceeded 20 days for primary care or if drive times were too long. Despite these efforts, accessibility remains an issue in some regions (especially for specialty or mental health care), and veteran trust in the system had to be rebuilt after the scandal.
Another critical aspect of health care quality is mental health services. The VA has struggled to address the crisis of veteran suicide, which remains at roughly 17 veteran lives lost per day despite national prevention efforts. This grim statistic underscores gaps in mental health access and follow-up care. The VA has rolled out initiatives like a Veterans Crisis Line (dial 988, then Press 1) and expanded mental health staffing, yet connecting veterans to timely therapy and support is an ongoing challenge. High rates of PTSD, depression, and substance abuse among veterans demand a robust, responsive VA health system. In summary, healthcare access and quality at VA involves a mixed picture: world-class care for many who get in the door, but difficulty getting in that door for others. Continued focus on reducing wait times, hiring providers (especially in underserved areas), and improving mental health outreach is crucial to ensure veterans receive the care they have earned.
Benefits Processing and Backlog
Beyond health care, the VA administers a wide range of benefits – notably disability compensation for service-connected injuries and illnesses. In recent years, the claims processing system has been overwhelmed by large volumes of applications, leading to a persistent backlog of pending claims. The backlog refers to claims waiting over 125 days for a decision. In the early 2010s, this problem peaked: at one point in 2013, the VA had over 600,000 backlogged claims, sparking public outcry and internal reforms. The department moved from paper files to a digital system and mandated overtime for claims processors, which helped whittle the backlog down by 2015. However, new challenges caused it to rise again. Most recently, the PACT Act of 2022 (which expanded eligibility for toxic exposure-related benefits) led to a surge of new claims as veterans of Iraq, Afghanistan, Vietnam, and other eras applied for conditions related to burn pits, Agent Orange, and more. By mid-2023, VA officials anticipated the backlog could grow “potentially up to 400,000” pending claims into 2024.
This increase comes despite the VA processing claims at record rates. In FY2022 the Veterans Benefits Administration issued 1.7 million decisions – the most ever in a year, and 12% higher than the previous year. The VA hired thousands of additional claims processors (increasing staff by about 15%) to handle the influx of PACT Act claims. They also implemented process improvements, such as automating simple claims at 16 regional offices to speed up decisions. Even so, keeping up with demand is a “delicate balancing act.” During the COVID-19 pandemic, for example, shutdowns of exams and high staff turnover caused the claims backlog to swell above 250,000. The VA responded with mandatory overtime and expedited hiring to bring it down. Now, with new eligibility expansions, the backlog is rising again – though VA aims to reduce it to 100,000 by 2025. The appeals process has also historically been slow, leaving many veterans waiting years if they contest a decision. Reforms under the Appeals Modernization Act (2017) created new review options to shorten appeal times, which has started to help. Overall, benefits processing remains a challenge of scale and efficiency: the VA must fairly evaluate millions of claims, past and present, while avoiding another crushing backlog.
Veteran Housing and Homelessness
Veteran homelessness has been a persistent challenge, but one that has seen significant progress over the past decade. Many veterans face risk factors like poverty, lack of affordable housing, mental illness, and substance abuse that can lead to unstable housing or life on the streets after discharge. In 2009, over 74,000 veterans were homeless on a given night. The VA, together with the Department of Housing and Urban Development (HUD) and community partners, launched a concerted effort to end veteran homelessness. Through programs like HUD-VASH (which provides housing vouchers and VA case management) and supportive housing grants, the number of veterans experiencing homelessness was cut by more than half. As of early 2023, the nationwide point-in-time count found about 35,000 homeless veterans, a 55% decrease since 2010. In fact, veteran homelessness reached its lowest level on record in 2023–2024. This is a notable achievement, showing what targeted resources and community outreach can accomplish.
However, the problem is not yet solved. Tens of thousands of veterans still lack permanent housing on any given night, including many living unsheltered. After years of decline, the 2022–2023 counts showed a slight uptick in unsheltered homeless veterans in some regions, likely exacerbated by the economic strains and disruptions of the pandemic. For example, the number of veterans living without shelter (on streets, in cars, etc.) rose by about 14% from 2022 to 2023. Challenges remain in reaching chronically homeless vets who may also struggle with addiction or mental health issues. Additionally, affordable housing shortages in many cities make it difficult for low-income veterans to find apartments even with a rental voucher. The VA has acknowledged it still has “a long way to go” and has renewed its commitment to ending veteran homelessness. New initiatives are focusing on homeless prevention (identifying at-risk vets before they end up on the street) and increasing the supply of subsidized housing through public-private ventures. In summary, veteran housing is a challenge marked by both substantial improvement (more than half fewer homeless vets than a decade ago) and ongoing need to get every veteran into a safe, stable home.
Staffing Shortages and Employee Morale
The VA’s ability to serve veterans depends heavily on its workforce of doctors, nurses, benefits specialists, and support staff. In recent years, the department has faced staffing shortages in critical positions and concerns about employee morale. The Veterans Health Administration (VHA) operates the nation’s largest integrated health care system, and it has struggled to attract and retain enough medical professionals to meet growing demand. Factors such as national shortages in fields like nursing and mental health, competition from the private sector, and bureaucratic hiring processes have made it difficult for VA to fully staff its hospitals and clinics. A Government Accountability Office review found VHA has ongoing challenges in hiring for both clinical roles and support positions, including those needed to coordinate community care referrals. Each year VA identifies thousands of staff vacancies; for example, VA’s Inspector General reported severe occupational shortages across nearly all medical centers, with mental health providers and primary care physicians among the most commonly understaffed roles. Rural VA facilities often have the hardest time recruiting providers, leading to gaps in care for veterans outside urban areas.
These staffing shortfalls can result in longer wait times, provider burnout, and an uneven quality of services. Indeed, burnout rates among VA health care workers have been a concern – surveys in the late 2010s found that about one-third of VA primary care providers reported symptoms of burnout, though some improvements were seen when workload issues were addressed. The VA has tried to boost morale and retention through pay incentives, loan repayment programs, and better career development for clinicians. Still, employee morale has been tested by factors like rapid leadership turnover and public scrutiny. In the four years from 2017–2021, the VA had five different deputy secretaries, and several secretaries came and went amid political friction. Such instability at the top can trickle down and affect staff confidence in the organization’s direction. Frontline employees have also faced intense pressure to meet performance metrics (as the wait-time scandal showed) and sometimes retaliation issues when raising concerns (leading to the creation of a VA whistleblower protection office). All of this can dampen morale. On the other hand, employee surveys indicate many VA staff remain deeply committed to the mission of serving veterans, even if frustrated by red tape. Addressing staffing and morale issues – by speeding up hiring, filling vacancies, supporting staff well-being, and ensuring stable leadership – is vital for the VA to improve its services.
Bureaucratic Inefficiencies and Accountability Issues
As a huge government agency, the VA has often been criticized for bureaucratic inefficiencies – complex procedures, outdated systems, and a culture perceived as overly rigid or slow to change. These inefficiencies can directly impact veterans (for instance, in the form of paperwork delays or confusing processes) and can frustrate well-meaning employees trying to get things done. A clear example was the scheduling and records system implicated in the 2014 wait-times scandal: staff felt pressured to manipulate data rather than admit the system’s inability to meet demand. In the aftermath, it became evident that the VA’s management culture had placed more emphasis on meeting bureaucratic targets than on transparency and patient well-being – a lapse in accountability. In response, lawmakers and VA leaders pushed for greater accountability and culture change. Congress passed the VA Accountability and Whistleblower Protection Act in 2017, which gave VA leaders more authority to swiftly discipline or fire employees for misconduct or poor performance. This legislation was a reaction to the “toxic workforce culture” that the wait-time crisis exposed, and it aimed to break through bureaucratic obstacles that made it difficult to remove bad actors. The VA also established an Office of Accountability and Whistleblower Protection to investigate issues and protect employees who report wrongdoing.
Despite these steps, achieving true accountability has been an ongoing challenge. Implementation of the 2017 law ran into legal complications, and some of its provisions were scaled back by court rulings. Critics note that problematic employees sometimes were shuffled around instead of removed, and that systemic issues (like confusing regulations or IT systems) require more than just firings to fix. Indeed, antiquated technology has been a major source of inefficiency: for example, the VA’s decades-old electronic health record system has been in the process of a massive upgrade. The department signed a $10+ billion contract in 2018 to modernize its health records (to better share data with the Department of Defense’s system), but the rollout of the new Oracle Cerner EHR has been plagued by delays, cost overruns, and software glitches that even caused patient safety risks. In 2023, the VA had to pause the EHR deployment to address these issues and renegotiate the contract for stronger accountability from the vendor. Such incidents highlight how bureaucracy and modernization challenges can go hand in hand. Additionally, the VA’s procurement processes and construction projects have a history of running over-budget or behind schedule – another facet of inefficiency that leaders continue to tackle. Ultimately, bureaucratic hurdles and inconsistent accountability have at times eroded veterans’ and the public’s trust in the VA. Streamlining processes, updating technology, and enforcing a culture of accountability and customer service remain top priorities to make the VA more responsive and effective.
Addressing the Issues: Opportunities for Improvement
While the VA’s challenges are substantial, there are also many opportunities for improvement underway or on the horizon. Reforms span from policy and legislative fixes to technological upgrades and collaborative initiatives. Below are several key avenues for positive change, aimed at strengthening the VA for the future and better serving veterans:
Policy Changes and Legislative Efforts
Policy reforms by Congress and VA leadership have been central to addressing the VA’s troubles. In the wake of identified problems, new laws and regulations have sought to fill gaps or overhaul failing systems. For instance, to improve health care access, lawmakers created programs to let veterans seek care outside the VA in certain situations. The Veterans Choice Act (2014) and its successor, the VA MISSION Act (2018), were major legislative efforts that expanded veterans’ health care options. Under these policies, veterans who face long wait times or live far from VA facilities can receive treatment from private doctors, with VA covering the cost. This helped relieve pressure on VA hospitals and gave veterans more flexibility, though it also raised debates about “privatizing” veterans’ care. Another area of reform was accountability and transparency. The 2014 crisis prompted the VA to institute new standards for publishing wait-time data and tracking performance. Congress reinforced this with the VA Accountability Act (2017), which, as noted, empowered the department to remove underperforming employees more easily. Additionally, the VA has been working under greater congressional oversight, with frequent hearings and reports, to ensure promises of improvement are kept.
On the benefits side, a noteworthy legislative change was the Appeals Modernization Act of 2017, which took effect in 2019. This law revamped the outdated appeals process for disability claims – giving veterans new, faster lanes to appeal decisions – in order to prevent the accumulation of massive appeals backlogs in the future. More recently, the PACT Act of 2022 stands out as a transformational policy for toxic exposure care: it extended health care and disability benefits to veterans exposed to burn pits, Agent Orange, and other hazards. While this act addresses long-unmet needs (for conditions like Gulf War illnesses and Vietnam-era diseases), it also came with a surge of new claims, as discussed, prompting the VA to seek more funding and staff to handle them. Going forward, continued bipartisan focus on veterans’ issues suggests that further helpful legislation is possible. Proposed bills in 2023–2024, for example, aim to bolster mental health care and suicide prevention resources, strengthen the VA’s ability to contract with community providers, and refine the accountability laws that encountered legal setbacks. Sustained support from Congress – in the form of adequate budgets and smart policy tweaks – is an opportunity to give the VA the tools it needs to succeed. At the same time, VA’s own policy makers can update internal regulations to cut red tape (for example, simplifying hiring rules to address staffing shortages). In summary, policy changes have been and will continue to be a critical lever for improving VA services, whether by expanding access, expediting processes, or enforcing accountability.
Technological Modernization
Modernizing the VA’s technology infrastructure is both one of its biggest challenges and greatest opportunities. Many of the VA’s problems have been aggravated by outdated IT systems – from the old electronic health record (EHR) platform to antiquated scheduling, payroll, and claims processing software. Upgrading these systems can vastly improve efficiency and veteran outcomes. A prime example is the Electronic Health Record Modernization (EHRM) program. The VA’s legacy health record system (VistA) is being replaced with a modern, interoperable system (Oracle Cerner) that will allow seamless sharing of medical records between the VA and Department of Defense. In theory, this means a service member’s records will follow them from active duty into VA care with no information lost. In practice, the rollout has been rocky – but course corrections are in progress. After serious problems at pilot sites (including reports of the new EHR causing prescription delays and other patient safety issues), the VA paused further deployments in 2023 to fix bugs and renegotiate the contract for better performance guarantees. By summer 2024, the VA expects to resume the EHR rollout with a more reliable system. If successful, this modernization will lay a foundation for better-coordinated care and data analytics to spot issues like overdue appointments or lab tests. Importantly, it could also reduce repetitive paperwork for veterans who currently have to hand-carry records between providers.
Technology offers solutions beyond health records as well. The VA has been a leader in telehealth innovation, which proved invaluable during the COVID-19 pandemic. With in-person visits restricted, the VA massively scaled up telehealth: at one point in 2020–2021, video-based medical appointments at VA were running 2,300% higher than pre-pandemic levels. Even as clinics reopened, veterans and providers have continued to embrace virtual care – by 2023, video visits stabilized at around 11–12% of all VA outpatient appointments (versus barely 1% before). This dramatic expansion of telemedicine improves access for veterans in rural or remote areas, and for those who find it difficult to travel. The VA is building on this success by investing in better telehealth platforms and training. Another modernization effort is in the benefits claims process: the VA’s claims system is now mostly digital, and the agency is introducing automated decision support for simple claims. By using algorithms to quickly validate evidence for certain conditions, VA can free up human raters to work on more complex cases – potentially shaving weeks off some decisions. Likewise, the GI Bill education benefits system was recently overhauled after a 2018 IT failure; the new system (called VA Education Platform) now processes school enrollments and housing stipends more reliably. The VA is also leveraging data analytics and artificial intelligence in areas like suicide prevention (scanning health records for risk factors) and supply chain management (predicting inventory needs). While modernizing such a large enterprise is difficult, each successful upgrade can yield faster service, fewer errors, and a better experience for veterans. Continued funding and oversight of these tech projects will be key to ensuring they deliver on their promise.
Public-Private Partnerships
Partnering with external organizations – from private companies to nonprofit groups – is another strategy the VA is using to improve services. Public-private partnerships (P3s) allow the VA to leverage resources and expertise outside of the federal government, often leading to innovative solutions that the VA might not achieve alone. One area where P3s have made a big impact is veteran housing. The VA has authority to engage in “enhanced-use leases,” essentially providing underutilized VA land or buildings to private or nonprofit developers to create housing for veterans. A notable example is the ongoing redevelopment of the West Los Angeles VA campus, where the VA teamed up with a coalition of nonprofits and developers to build over 1,000 units of affordable housing for homeless and at-risk veterans. In late 2023, the first phase of a new apartment complex (MacArthur Field A) opened on that campus, providing 74 units of permanent supportive housing with on-site services for veterans. All units are supported by HUD-VASH vouchers, and veterans living there have ready access to the adjacent VA medical center. This public-private approach transforms unused federal property into community assets, combining federal funding with private capital and know-how. Across the country, developers are working with VA and local authorities to open similar projects, recognizing that ending veteran homelessness requires housing development at scale.
Healthcare also benefits from partnerships. The VA has long-standing academic affiliations with medical schools – in fact, approximately 70% of all U.S. doctors receive part of their training in VA hospitals as residents or interns. This arrangement is essentially the largest public-private partnership in U.S. healthcare: universities supply medical trainees and faculty, and VA provides clinical training sites and patient care, to the mutual benefit of both. It brings fresh talent into VA facilities and helps VA recruit high-quality staff, while exposing new doctors to veteran-specific health issues. Beyond academia, the VA partners with private healthcare systems and clinics to extend its reach. The Community Care Network established under the MISSION Act is one form of partnership: VA contracts with regional networks of private providers so that veterans can be referred out for care that VA can’t readily provide in-house (whether due to wait times, travel distance, or specialized service). Managing these contracts efficiently is an ongoing challenge, but when done well, it expands capacity and offers veterans more timely care.
The VA has also embraced partnerships in research and innovation. It works with pharmaceutical companies and tech firms on clinical trials (many cutting-edge treatments for PTSD, for example, are tested with veterans in VA-cooperative studies). And in mental health, philanthropic organizations have stepped in to complement VA services. A good example is the Cohen Veterans Network, a nonprofit founded by philanthropist Steven Cohen, which set up mental health clinics nationwide for post-9/11 veterans and families. In 2018, the VA and Cohen Veterans Network announced a partnership to increase mental health access – coordinating care so that veterans who either aren’t eligible for VA mental health care or prefer not to use VA facilities can get free services at Cohen clinics, with referrals made between VA and these clinics as needed. Such collaborations multiply the avenues through which veterans can receive support. Moving forward, expanding public-private partnerships offers a way to fill gaps: whether it’s tech companies improving VA’s IT, community organizations reaching vets in remote areas, or businesses offering training and employment opportunities to veterans. The VA’s National Center for Healthcare Advancement and Partnerships actively seeks these alliances, recognizing that complex challenges often require cross-sector solutions.
Data Transparency and Accountability Measures
Improving the VA isn’t just about doing more; it’s also about restoring trust through transparency and accountability. After the VA’s reputation was damaged by scandals, the department made a commitment to be more open with data and more rigorous in self-evaluation. One step was launching public-facing data dashboards. Today, anyone can go on the VA’s websites and find up-to-date information on hospital wait times, patient satisfaction scores, and quality ratings for each VA medical center. By openly sharing these metrics, VA enables veterans to make informed choices (for example, seeing the average wait for a primary care appointment at their local clinic) and allows outside observers to track the VA’s progress. This kind of data transparency also puts pressure on underperforming facilities to improve, since their results are in plain view. Internally, the VA is increasingly using data to drive decisions – a shift to an analytics-driven accountability. For instance, leadership monitors trends in missed appointments, benefit claim error rates, and even employee engagement scores, to identify problems early and hold the appropriate managers responsible. The department’s High Risk list action plans (responding to GAO’s designation of VA health care as a “high-risk” area) include developing better data systems to monitor quality and ensure consistent standards across all VA facilities.
Accountability also comes from oversight entities. Independent watchdogs like the VA Office of Inspector General (OIG) and the Government Accountability Office (GAO) regularly audit VA programs and publish findings on failures or mismanagement. These reports have spurred improvements – for example, OIG reports on appointment scheduling issues and facility conditions have led to remediation plans at specific VA hospitals. The VA’s response has been to not only fix those issues but also implement system-wide changes (such as retraining staff or rewriting policies) to prevent recurrence. Additionally, Congress continues to exercise oversight through hearings and requests for information. This external accountability, combined with VA’s internal efforts, is crucial. One recent initiative is the establishment of a VA Advisory Committee on Data to recommend ways to enhance open data and transparency. The idea is that by measuring the right things and making the data public, VA will maintain focus on outcomes that matter to veterans. We have also seen the VA partner with veteran service organizations to get feedback – for instance, sharing draft policy changes with groups like the American Legion or Veterans of Foreign Wars to get their input on how it will affect vets on the ground. All of these measures build accountability. In sum, through greater transparency (showing what is working and what isn’t) and robust accountability mechanisms (from firing authority for bad actors to independent audits), the VA is working to ensure that it does not repeat the mistakes of the past and that it delivers on its promises to veterans. Transparency is not just about reporting data, but about creating a culture where problems are confronted openly and solved, not hidden, which is a positive shift for the long term.
Community and Nonprofit Collaborations
A final pillar of improvement is strengthening collaborations with the community and nonprofit sector. Veterans live in every community across America, and many of their needs – employment, social support, healthcare navigation – intersect with resources outside the VA. By working hand-in-hand with state, local, and nonprofit organizations, the VA can amplify its impact. One example is the Veteran Community Partnerships (VCP) initiative. Through VCP, local VA facilities form coalitions with community agencies, such as local healthcare providers, caregivers’ groups, legal aid societies, and veteran service organizations. The goal is to coordinate services so that veterans experience a seamless network of support. For instance, a VA medical center might partner with a local Meals on Wheels program to ensure homebound veterans get nutrition, or with a state veterans affairs department to co-host outreach events for rural veterans. These partnerships recognize that VA cannot do it all alone – but VA can be a hub linking veterans to the rich tapestry of community resources available.