The new leadership of the Department of Veterans Affairs (VA) in Washington has taken a lot of heat lately from VA patients, their care-givers, and members of Congress opposed to cuts in jobs and services for veterans.

VA Secretary Doug Collins, the right-wing Air Force Reserve colonel now running a public health care system serving nine million former service members, has tried to allay their concerns.

According to Collins, even if more than 80,000 VA jobs are eliminated this year (as projected by his chief of staff), veterans will have no trouble accessing doctors, nurses, or therapists elsewhere.

That’s because they will get faster referrals to a network of equally qualified private sector providers, who now number 1.7 million nationwide and receive more than $30 billion in annual reimbursements for treating eligible veterans outside the VA.

Thanks to President Trump, Collins says, “VA is providing veterans with more health care choices…while making it even easier for veterans to get their health care when and where it’s most convenient for them.”

Reno Reality Check

On Friday, May 30, members of American Federation of Government Employees (AFGE) Local 2152 challenged this rosy scenario at a noon-time rally in Reno that brought together VA patients and their families, local labor allies, and political activists from Indivisible Northern Nevada.

As retired Army officer Scott Maryott, a University of Nevada history professor, told a local TV station, VA care-givers “do amazing work for veterans in our community.” And that’s why he and 200 others came out “to show them how much we appreciate what they do.”

Rally organizers warned about the possible loss of specialized care provided by their local VA hospital, its counterpart in Las Vegas, eighteen out-patient facilities in Nevada, three community-based counseling centers, one nursing home, and a residential treatment program for substance abusers.

According to VA defenders, local private hospitals, clinics, and medical practices will struggle to meet veterans’ needs, if more VA care is outsourced and its own facilities are downsized or closed.

VA patients will have longer wait times for appointments. They will drive further to get far less “veteran centric” treatment. And they will be deprived of the wrap-around services currently available to over 120,000 Nevada residents who have qualified for VA coverage due to their low-income, service-related conditions, or recent service in combat zones.

Private Sector Shortages

A recent assessment of the state’s healthcare access problems, by the University of Nevada Medical School in Reno, makes this danger quite clear, particularly for vets in rural areas. As the authors of another research paper found, Nevada ranks nationally “among the lowest states in terms for available primary care doctors and general surgeons per capita, resulting in limited access to essential services and an increased reliance on emergency departments and hospitals.”

Currently, none of the state’s 17 counties have enough primary care providers, while 12 report a severe shortage of mental health providers. In 2023, nearly 87 percent of all Nevada residents lived in a federally-designated “mental health professional shortage area.”

According to the Nevada Health Workforce Research Center,  the state  ranked “last in the country for overall youth mental health based on the prevalence of mental illness, as well as access to services” for problems like anxiety and depression.

Since 2005, several of the state’s rural hospitals have closed and more than half of those remaining have curtailed some critical services. Others remain at risk of going out of business, particularly if Medicaid cuts, just backed by the House Republican majority soon win Senate approval as well.

By one estimate, Nevada needs 1,700 more therapists, social workers, and substance abuse specialists just to reduce drug over-dose and age-adjusted suicide rates that, in recent years, have exceeded national averages. To improve primary care access, experts say the state also needs to replace its aging physician workforce and significant proportion of inactive providers with more than 1,100 new primary care docs in the next five years.

More Challenging Patients

None of these projections anticipate any big influx of new patients from the VA with more mental health problems, chronic illnesses and pain, more back, neck, and shoulder injuries, and higher rates of hypertension and diabetes than non-veterans.

 Those who experienced combat display more symptoms of traumatic brain injury or Post-Traumatic Stress Disorder (PTSD). Veterans also suffer from higher rates of substance abuse and suicide, than the general population. Nearly a million post-9/11 vets have qualified for VA care recently due to past toxic exposures – from burn-pits in the Middle East or military bases in the U.S. with poisoned soil or water.

         Right now, a major employer in Nevada—the VA—stands ready and able to serve this challenging patient population, with a skilled and committed workforce numbering more than 4,200 (a third of whom are veterans themselves). And their patients appreciate this.

Says Vietnam veteran Reggie Lee: “These people are experienced, knowledgeable, and loving. They’re taking care of me.” As AFGE president Jeanine Packham, a nurse practitioner, reminded the press on May 30, “the VA also does a lot of cutting-edge medical research which benefits all Americans.”

In addition, the two VA medical centers in Nevada provide clinical training for many young doctors, nurses, and other healthcare professionals who either decide to stay at the VA or migrate to private sector jobs, where, as noted above, they are much needed locally.

         If President Trump proceeds with his planned downsizing of the VA and the services it provides, one thing is certain. Military veterans promised better “customer service and convenience” outside the VA will find themselves in the same “medical deserts” (and long lines) familiar to patients already under-served by the private healthcare industry.

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