The Department of Veterans Affairs plans the largest restructuring of the Veterans Health Administration since 1995, cutting the number of Veterans Integrated Service Networks from 18 to five and eliminating the VHA Chief Operating Officer role. Central Office staff would be realigned to report to the Under Secretary for Health to standardize policy, technology and communications. The VA also proposed eliminating 25,000 vacant VHA positions and is soliciting up to $1 trillion in community-care contracts over 10 years. Implementation is scheduled to begin in early 2026 and take about two years, and reactions from lawmakers and veterans groups have been mixed.
VA Unveils Sweeping Overhaul of Veterans Health Care — VISNs Cut From 18 to 5
A nurse performs a test on a Department of Veteran Affairs patient at Naval Hospital Jacksonville, Oct. 24, 2025. (Julie M. Lucas/U.S. Navy)
The Department of Veterans Affairs has announced the most extensive restructuring of the Veterans Health Administration (VHA) since the VISN system was created in 1995. The plan would reduce Veterans Integrated Service Networks (VISNs) from 18 to five, eliminate the VHA Chief Operating Officer role, and realign central-office staff to report directly to the Under Secretary for Health and senior deputies. VA officials say the overhaul is aimed at reducing bureaucracy, improving policy consistency and streamlining technology and communications across the system.
What the Reorganization Would Change
VISNs Reduced and Central Office Rebalanced: The number of VISNs would drop from 18 to 5, with those regional networks reporting directly to the Under Secretary for Health. The VHA Chief Operating Officer position would be eliminated, and many VHA Central Office staff would be reassigned to report to the Under Secretary, the Deputy Under Secretary for Health, or the Associate Deputy Under Secretary.
Central Office Responsibilities: The VA Central Office in Washington would be charged with setting policy, managing finances, and overseeing compliance and quality standards. Regional and local operations centers and VISNs would focus on implementation, performance, and local patient care.
Community Care Contracts and Regions
The VA also unveiled proposed changes to its Community Care program, seeking competitive bids to expand non-VA provider networks. Those contracts could total as much as $1 trillion over 10 years. Under the proposal, the number of community care regions would be reduced from five to two, although each region may be supported by multiple health networks. Currently, the program is managed by two contractors: TriWest Healthcare Alliance and Optum Serve.
Staffing, Vacancies and Impact
VA officials said the reorganization is not intended as a reduction-in-force for current employees. Separately, the department announced plans to eliminate 25,000 vacant VHA positions, which the VA describes as largely COVID-era roles that remain unfilled. Critics note the department's last public vacancy report from July showed more than 39,000 open positions, including thousands of clinical roles.
VA Statement: VA Secretary Doug Collins said the current VHA leadership structure contains redundancies that slow decision making and create competing priorities, and that the reorganization will let policymakers set policy while regional leaders focus on implementation and clinical leaders focus on patient care.
Reactions From Lawmakers and Veterans Groups
Reaction has been mixed. House Veterans' Affairs Committee Chairman Rep. Mike Bost (R-Ill.) expressed support and offered alternative legislative proposals that would reduce VISNs to eight. Ranking Democrat Rep. Mark Takano (Calif.) criticized the rollout process and urged hearings, saying congressional and veterans service organization input was limited during the plan's development.
Veterans service organizations offered cautious optimism. Carl Blake, CEO of Paralyzed Veterans of America, said the plan sounds promising if it eliminates administrative barriers. Disabled American Veterans National Commander Coleman Nee said his organization supports efforts to strengthen care for service-connected veterans and wants more details.
Sen. Tammy Duckworth (D-Ill.) warned that cuts could strain the VA workforce and increase wait times, while VA press secretary Peter Kasperowicz said no current employees will be removed as part of the reorganization and that targeted vacancies have largely been unfilled for over a year.
Oversight, History and Timeline
The proposed changes echo recommendations from the 2016 Commission on Care and recent Office of Inspector General reports that found unclear roles and inconsistent accountability within VISNs. The current VISN model was designed in 1995 to decentralize decision-making but grew far beyond its original staffing expectations.
The VHA reorganization is slated to begin in early 2026 and is expected to take about two years to implement.
Note: The plan remains subject to further review, contract procurement procedures for community care, congressional oversight, and input from stakeholder groups.
