In December 2025, the Department of Veterans Affairs announced plans for what it called the largest reorganization of the Veterans Health Administration in three decades. The proposal carries an optimistic acronym: RISE, for Restructure for Impact and Sustainability Effort. Its central change is dramatic. The VA will reduce its Veterans Integrated Service Networks, the regional administrative hubs that support over 1,300 medical facilities, from 18 to just 5.

Collins told the Senate Veterans Affairs Committee that the current structure is “riddled with redundancies that slow decision making, sow confusion, and create competing priorities.” He framed the overhaul as empowering local hospital directors by stripping away layers of middle management. Under the new structure, VISNs would focus on policy implementation and oversight, while a new layer of Health Service Areas (HSAs) would work directly with medical center leadership.

There’s a case for reform here. Multiple reviews from the Government Accountability Office and the VA Inspector General have identified governance weaknesses in the VISN structure for nearly a decade. A 2016 blue-ribbon commission recommended that the VA clarify VISN roles and ensure networks operated within national standards. Even some Democrats have acknowledged the administrative bloat.

But the timing and scale of this overhaul have made both veterans and their advocates deeply uneasy.

Before the reorganization even begins its 18-to-24-month implementation, the VA has already shed a staggering number of employees. A report released in January by Senate Democrats found the department lost more than 40,000 workers in fiscal year 2025. Of those, 88% came from the Veterans Health Administration. That includes 3,000 registered nurses, 1,000 physicians, 700 social workers, nearly 2,000 claims processors, and 1,100 custodians.

Senator Richard Blumenthal, the committee’s ranking Democrat, called it a “systematic destruction of the VA workforce.” The losses represent the first net decrease in VA staffing in the department’s history. Collins had originally floated cutting 83,000 positions through a combination of voluntary and involuntary measures before walking the target back to 30,000 through attrition and retirements.

VA Press Secretary Pete Kasperowicz disputed the 40,000 figure, saying the department achieved its 30,000-person reduction goal. He also challenged findings on mental health wait times. But Blumenthal’s staff noted their calculations came from the VA’s own public-facing data and invited the department to share its internal numbers, a request the VA has declined since May.

Perhaps the most alarming finding in the Blumenthal report concerns mental health care. As of early January 2026, the national average wait time for new patients seeking individual mental health appointments was more than 35 days. That’s well above the 20-day threshold that qualifies veterans to seek care in the community instead.

In 14 states, new-patient wait times exceeded 40 days. Those states include California, Colorado, Connecticut, Iowa, Idaho, Kansas, Maryland, Maine, North Carolina, North Dakota, Nebraska, New Hampshire, New Mexico, and Virginia. Several of those are home to competitive 2026 races where veteran care is already a campaign issue.

The VA has lost 1,500 schedulers since January 2025. Mary Jean Burke, first executive vice president of the AFGE National VA Council, warned that by the end of 2026, most VA facilities are on track to lose 2-5% of their psychologists. Some locations, including Seattle and Buffalo, face double-digit attrition. Burke blamed the losses on job cuts, the elimination of remote work, and “overcrowded” office conditions.

Collins disputes that wait times have worsened significantly. Through FY2025, he says, mental health appointment waits averaged under six days for established patients and 19 days for new patients. The discrepancy between Collins’ numbers and the committee’s data remains unresolved because the VA won’t share its internal metrics with Congress.

For many veterans advocates, the reorganization raises a familiar specter: privatization. Currently, about 40% of all VA care is delivered through community providers rather than VA facilities. The department issued a request for proposals in early 2026 for its Community Care Network Next Generation contracts, worth up to $1 trillion over 10 years. The new structure will consolidate from five contract regions to two, managed by large private health plans.

VA Chief Financial Officer Richard Topping emphasized that the department plans to spend $2 trillion on care within its own facilities during that same decade. He also noted the VA is opening new facilities and invested $800 million in direct care capabilities last year. But Representative Delia Ramirez (D-IL) wasn’t convinced. During a House hearing, she accused Collins of “driving the VA towards privatization” in a way that “only serves corporate interests, and puts profits over veterans.”

The concern isn’t theoretical. When the VA sheds healthcare staff and simultaneously expands community care contracting, the practical effect is a shift in where veterans receive treatment. For complex conditions like PTSD, traumatic brain injury, and toxic exposure illnesses, VA facilities have developed specialized capabilities that most private providers simply don’t match. Critics at the Veterans Healthcare Policy Institute have warned that dismantling the VA’s internal capacity amounts to a demolition job disguised as modernization, targeting the administrative scaffolding that holds the system together.

Veteran Democrats in Congress have made VA staffing and care access central to their oversight efforts. Senator Tammy Duckworth, a disabled Army veteran who lost both legs in Iraq, has challenged Collins at every turn. She warned in December that Trump is “guaranteeing that our VA won’t have the number of staff needed to handle the influx of new claims” while also “ensuring that our veterans will wait even longer to get treated.”

Senator Maggie Hassan (D-NH) pushed back directly on the framing of front-line workers as bureaucratic overhead. “The doctors and nurses aren’t overhead,” she told Collins during a January hearing. She warned that the department risked imposing “arbitrary caps” that restrict its own capacity to serve veterans.

In the House, members of the Democratic Veterans Caucus have used the VA’s staffing crisis to reinforce a message they’ve been building since the killing of VA nurse Alex Pretti by federal agents in January: the administration’s treatment of VA workers and the veterans they serve represents a fundamental betrayal of the promises made to those who served.

According to the VA’s implementation timeline, leadership consolidation begins in mid-2026. VISNs start their realignment toward the end of the year, with the process finishing by mid-2027. Meanwhile, the department plans to roll out its troubled Oracle-Cerner electronic health record system at 13 additional sites in 2026, starting with four Michigan facilities in April.

Collins insists the reorganization won’t reduce direct care for veterans. He says mission-critical positions will be protected and that staffing can be shifted to growing regions where veteran demand is highest. Republicans on the Veterans Affairs Committees have broadly supported the restructuring. House VA Committee Chairman Mike Bost introduced legislation that would reduce VISNs to eight, three more than Collins proposes.

But the track record since January 2025 gives veterans little reason for confidence. Promises about protecting care haven’t matched outcomes. The VoteVets-backed candidates running in 2026 are building their campaigns around exactly this gap. When the administration says “efficiency” and veterans experience longer wait times, canceled appointments, and fewer providers, that disconnect becomes a powerful electoral argument.

For Democrats, the VA reorganization is both a policy crisis and a political opportunity. It’s one thing to argue abstractly about government spending. It’s another to tell voters that the administration cut 3,000 nurses from the system that treats their fathers and mothers who served. In competitive districts with large veteran populations, that’s the kind of story that changes elections.