J. Scott Applewhite/AP Photo
Doug Collins speaks at his confirmation hearing before the Senate Veterans’ Affairs Committee, at the Capitol in Washington, January 21, 2025.
At the mid-January confirmation hearing for Doug Collins to be secretary of veterans affairs, many senators, including Republicans, directed his attention to the problematic results of past VA outsourcing to private-sector vendors.
First up for discussion was the $31 billion annual cost of referring 40 percent of the VA’s patient population to 1.4 million outside health care providers, under guidelines developed by Collins’s Republican predecessor, Robert Wilkie, who led the VA during most of Donald Trump’s first term. As Sens. Bernie Sanders (I-VT), Angus King (I-ME), and Richard Blumenthal (D-CT) all warned Collins, this mostly unnecessary outsourcing was a formula for what King called “creeping elimination of the veterans’ healthcare system” as a high-performing public option for nine million former service members.
The second and more bipartisan concern was the ballooning cost overruns resulting from Trump awarding a 2018 no-bid contract to the Cerner Corporation (now owned by Oracle) for a $10 billion overhaul of electronic medical recordkeeping by the VA.
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As Sen. Tommy Tuberville (R-AL) informed Collins, this “updating of our VA’s electronic records” has “nothing to show for it” but a $20 billion price tag. His colleague Sen. Thom Tillis (R-NC) was even more scathing: “The implementation of electronic health records is a bipartisan, multi-administration disaster.”
Sen. Patty Murray (D-WA) filled in the details about this well-connected vendor’s rollout in her own state: “It was disastrous. VA and Oracle endangered patients by rushing the deployment, not making sure the system was technically sound, not working with the clinicians on the ground, and not providing sufficient training. Veterans and providers are still paying the price for that.”
Under questioning about this ongoing mess, Collins agreed that “we’ve got to get our health records straight,” and promised that the VA’s biggest wayward vendor would soon be performing better.
With such big game to pursue—after bipartisan backing for his Senate confirmation—did Secretary Collins then target real waste, fraud, and inefficiency in his own agency? Or did he, as a dutiful Trump cabinet member, take the now familiar performative press release path of the Department of Government Efficiency (DOGE)?
In early March, we got an initial answer to those questions. Collins announced his cancellation of 875 VA-related contracts, none of which had anything to do with the above-mentioned outside vendors. Instead, Collins canceled contracts with companies that, among many other things, train rural health nurses and doctors, provide software that supports VA research, and help VA facilities adhere to state and federal standards allowing hospitals to “stay in operation and ensure that patients are not harmed by air quality issues.”
Collins has actively trivialized the work done by hundreds of VA contracts, suggesting that these contracts are all devoted to frivolous projects.
“When assessing a contract, one needs to first determine if the work the contract supports is important, is something that needs to be done, and if so, then one has to assure it will continue to be done if the contract is canceled,” Kenneth W. Kizer, former undersecretary of health for the VA, told the Prospect. This kind of careful analysis has not been made, and there is no indication that the VA is developing alternatives to providing much-needed critical services.
In fact, in a social media post, Collins has actively trivialized the work done by hundreds of VA contracts, suggesting that these contracts, which totaled $2 billion (out of a $300 billion annual budget), are all devoted to frivolous projects that pay “consultants to do things like make Power Point slides and write meeting minutes.”
Per usual in the second coming of Trump, the reality is quite different, while changing day by day. A day after Collins’s initial announcement, the VA paused the cuts, and a week later said it would only cancel 585 contracts that were “non-mission-critical” and “duplicative.” And thanks to reporting in the Prospect and congressional blowback, the VA has put a three-month moratorium on the firing of researchers on renewable appointments, and also rescinded the decision to eliminate without-compensation appointments.
As Collins considers his next set of cancellations—firing 83,000 VA workers—let’s consider the adverse impact of the VA’s new highly selective cancel culture, amid what is actually very essential, lifesaving work.
ONE MAJOR CASUALTY ALREADY IS THE DISRUPTION of the kind of public-private partnerships to fund VA research projects that congressional Republicans have long favored.
In 2024, Congress allocated $984 million to fund VA research. On top of this, nonprofit and industry “extramural” partners contributed $300 million to the VA’s research portfolio. These partners include the Prostate Cancer Foundation (PCF) and the Patient-Centered Outcomes Research Institute (PCORI), as well as pharmaceutical and biotech industry sponsors like Bristol Myers Squibb, Cognition Therapeutics, Genentech, Johnson & Johnson, Mitre, and Siemens Healthineers.
The collaboration between PCF and the VA illustrates the importance of these kinds of relationships. In December of 2016, PCF announced that it had donated $50 million to the VA, the largest outside donation the agency had ever received. Jonathan Simons, then CEO and president of PCF, explained how valuable the VA was to advancing cutting-edge care. The VA has highly qualified researchers who work with a large and stable patient population. The new alliance, Simons said, “has just increased the aperture to get answers to critical questions in prostate cancer research.” Answering these questions not only helps veterans, who have very high rates of prostate cancer, but also the 1 in 8 men in the U.S. who are diagnosed with prostate cancer each year.
According to PCF, over the past nine years that aperture has only widened. PCF “partners with VA Centers of Excellence around the country to speed research, treatments, and cures to Veterans with prostate cancer.” The foundation “asks veterans to reach out to receive news about the prostate cancer-VA partnership,” and highlights the fact that VA delivers “care to veterans that is as good or better than any private treatment available, while providing a roadmap for the application of cutting-edge precision oncology for all forms of cancer, to benefit everyone.”
Hawk Tran, chief operating officer of the National Association of Veterans’ Research and Education Foundations (NAVREF) and himself a veteran, says that partnerships like the one with PCF were hard-won. When NAVREF tried to promote public-private partnerships, Tran explained, nonprofit and industry representatives worried that the VA would not be a reliable collaborator and would be unable to safeguard research data. These fears were finally overcome, Tran said, and extramural efforts have flourished. Now, Tran says, they could all be in jeopardy.
He cites as an example the abrupt cancellation of a contract that had been in place for years with Qualtrics, a highly respected software company that provides, Tran says, “a communication and tracking tool used to monitor efficacy of medical treatment and protocols, as well as to improve outreach and tracking of veterans enrolled in studies or trying to enroll in studies.”
On Tuesday, February 25th, VA researchers across the country received an email from Joseph Holston, of the VA Office of Research and Development (ORD). “ORD was just informed,” Holsten wrote, “that the Qualtrics SaaS contract will be terminated immediately. If you have project data in the system that’s not backed up, it is extremely urgent that you remove your data before access to the application is blocked” (emphasis in original).
On a social media post, the wife of a VA researcher, undoubtedly fearful of retaliation, expressed an anguish felt by many. Qualtrics, she wrote, “contains thousands of hours of VA research on anything from improving the quality of care at the VA, tracking the effectiveness of VA programming, suicide prevention projects, and other very important research done by the VA. Years of data from across the entire country just gone with less than a business day given to download what needs to be preserved.”
The day after Holsten sent out his initial email, he followed it with a by now familiar course correction—of sorts. Researchers, Holsten advised, had access to Qualtrics till May, when it would be replaced with a new platform called REDCap.
Qualtrics, researchers have told the Prospect, is a far better tool than REDCap, which may not require payment for a license but does require hiring staff who know how to use it correctly. Moreover, switching from one data platform to another is not that simple. Anytime a research protocol is amended, that change must be approved by an institutional review board. Researchers must submit detailed requests justifying that change and wait for them to wind their way through the approval process, which has been made even more complicated by the fact that some IRB staff have just been fired and many more may be eliminated over the coming months.
ONE VA RESEARCHER SENT THE PROSPECT a text listing a number of project cancellations. These included studies on the lifetime outcomes of traumatic brain injury, and how employment can help veterans with spinal cord injuries. Two canceled studies were funded by the Department of Defense: One studies interventions to help caregivers of veterans who suffered from moderate to severe traumatic brain injury, while another investigates where active-duty service members have access to PTSD care.
“A VA in Northern CA had a contract with the affiliated prestigious private medical school to use their bio safety committee. Contract canceled. No human clinical trials can be performed as human samples are considered biohazardous and they cannot get reviewed,” the researcher wrote.
Tran told the Prospect that at only one VA site in Durham, North Carolina, 23 research staff had just been fired. At another site, VA has lost an IRB Committee coordinator/program analyst research, senior data analyst, and nine “longstanding and highly valued investigators and staff,” Tran said.
Probationary employees like Christopher Schmid, a professor of biostatistics who was working on a project to help veterans with breathing problems at the Providence VA, have also been fired. And no one knows how many research staff will lose their jobs in Collins’s efforts to downsize the agency and reduce its “footprint.” Many clinical staff like psychologists are already voluntarily quitting because Collins is so faithfully fulfilling Trump official and Project 2025 architect Russell Vought’s dream of making working for the federal government a nightmare. In February, 28 senior Veterans Benefits Administration staff announced their resignations, and last week the director of the San Francisco VA Health Care System unexpectedly announced her retirement.
One of the researchers who spoke to the Prospect told us that some of their colleagues have actually been put on administrative leave because of what was described as “inappropriate contacts.” These actions, the researcher added, were not initiated by the VA Office of Research and Development, or a medical center director or chief of staff, but by “higher-ups.” Was it at the behest of VA central office or DOGE or the White House? Was it because researchers desperate to improve the care of veterans reached out to senators like Patty Murray, whose state of Washington has been disproportionately impacted by these attacks? No one knows.
“If you lose a principal investigator, or a coordinator, or a research nurse, you can’t just transfer the workload to other people and expect the same results,” Tran said. At worst, you might have to cancel entire studies.
What is particularly ironic about this ongoing attack on VA researchers is that some of the studies they conduct are designed to implement the purported mission of DOGE cost-cutters. With its vast reservoir of quality improvement and operations research, the VA dedicates enormous energy to ensuring that taxpayer dollars are wisely spent.
VA quality improvement researchers scour data from electronic health records to figure out what treatments cost, whether they work, and what the veteran experiences while on them.
Christian Helfrich, a health services researcher who worked at the VA Puget Sound Health Care System in Seattle for 20 years, learned that his contract was terminated in February. He was survey team lead for a rather important study evaluating the new Oracle Electronic Health Record, mentioned above. In spite of its billion-dollar problems, Doug Collins just announced that the new system is being rolled out at nine additional sites in 2026. His evaluation study, Helfrich told the Prospect, “is actually part of congressionally mandated reporting that VA has to do on the medical record.” Another study Helfrich was working on was one designed to improve care for veterans suffering from chronic obstructive pulmonary disease and HIV.
All of this work has been disrupted not only by the termination of VA researchers but by the Qualtrics contract cancelation. “That was just ridiculous,” Helfrich comments.
None of this, Helfrich says, seems to be much affected by the news of a 90-day suspension of the firing of researchers on term appointments. “It would be reassuring to researchers’ futures if VA said we’re not doing this anymore. Instead, this just tells researchers to start preparing for firings to resume in 90 days.”
Tran described the situation as “horrifying.” What makes the VA so unique, he explained, is that it integrates so many services into one system. “As a veteran, I know, that if God forbid I were to get cancer, I could get access to cutting-edge research.”
Collins, Trump, and Musk and company seem to have no understanding of any of this. In fact, in his confirmation hearing, Collins explicitly stated that “the VA is special but not unique … health care is done in this country everyday outside of the VA.”
Fortunately, even many Republican voters are beginning to disagree. In a recent town hall conducted by Sen. Roger Marshall (R-KS), one irate constituent raised his hand and announced forthrightly, “I’m not a Democrat, but I’m worried about the veterans.” In response, Marshall scurried out of the room.
