The coming year will be a time of major change for the Department of Veterans Affairs, with new leadership, new priorities and likely its largest budget in its history. But the impact of all this on veterans’ benefits and health care is less clear.

The ministry, which now has a budget of $350 billion and more than 400,000 employees, will begin 2025 with VA Secretary Denis McDonough and his administration ending four years of expansion and outreach efforts.

That of President-elect Donald Trump The inauguration in January will at least mean the elimination of this Democratic leadership, replacing political appointees with its own choices.

During his last administration, VA issues were a focal point of the Trump White House. On the campaign trail last summer, he hinted at a repeat when he returns to office, with plans to further expand medical care options for veterans and pursue reforms to federal health care practices. hiring (and firing).

Here are some of the top Veterans Affairs stories to watch in 2025.

A new VA secretary

In November, Trump appointed Doug Collins, former Georgia Congressman as his choice to be the next Secretary of Veterans Affairs. The choice came as a slight surprise among veterans advocates, given that Collins did not serve on the Veterans Affairs Committee or champion many veterans bills during his eight years in Congress.

But Collins, 58, has already been endorsed by several veterans groups and is not expected to face the same level of opposition as some of Trump’s other Cabinet picks.

Collins served in the Navy on active duty for two years as a chaplain and re-enlisted in the Air Force Reserve after the terrorist attacks of September 11, 2001. He was deployed to Iraq in 2008 as a member of the 94th Airlift Wing and still serves in the reserves.

His confirmation hearing before the Senate Veterans Affairs Committee, scheduled for January, will offer insight into the next administration’s policy priorities. Shortly after his appointment, Collins released a statement promising to “streamline and reduce regulations within the VA, root out corruption, and ensure that every veteran receives the benefits they have earned.”

Although he doesn’t have any problematic policy positions toward veterans on his resume, Democratic lawmakers could question his efforts to help Trump overturn the 2020 election results, as well as his public positions undermining the validity of these results.

But Republicans in the Senate have already shown strong support for Collins’ nomination, and he could be approved by the chamber in time to take office right after the inauguration.

Departmental budget battles

One of the first issues Collins will face as VA secretary will be the department’s budget, both for the current fiscal year and the 2026 fiscal year.

For several months, lawmakers and VA planners have been wrangling over departmental budget estimates, with members of Congress promising a closer look before new funds are approved.

In November, VA officials announced they expected to need at least $6.6 billion in additional funding for the current fiscal year to cover increased costs associated with increased use of VA medical facilities over the past year.

That figure was revised down from an estimate of $12 billion over the summer. Republican lawmakers in the House of Representatives bristled at the numbers, accusing planners of playing politics with their estimates and inappropriately guessing what future needs will be.

Lawmakers in the next session of Congress will need to approve a comprehensive annual budget for VA and most other federal agencies as one of their first priorities. VA operations are largely funded a year in advance, which primarily protects them from shutdown struggles.

But officials said without the additional $6.6 billion in emergency funding in early 2025, some services and operations could be affected. One of Collins’ first tasks will be to decide whether that’s accurate and whether to convince lawmakers to issue another check.

Community Care Concerns

Expanding “choice” in medical benefits for veterans – particularly regarding VA paying for veterans’ appointments outside the department’s health system – was a major goal of the first term of President-elect Donald Trump. Republican lawmakers have already reignited this debate.

In early December, House Veterans Affairs Committee Chairman Mike Bost, R-Ill., introduced the “Accomplish the mission” lawwhich would further expand veterans’ ability to access private sector medical care options using taxpayer funds. Bost has promised to make this legislation a key priority in 2025.

The bill would expand community care options for Veterans Health Administration patients to include nearly all expanded care services, such as residential mental health rehabilitation, and prevent VA from offering telehealth appointments with department physicians instead of outpatient care options.

It would also impose new reimbursement rules for outside medical practices and require VA leaders to better share private sector options with patients.

At Trump’s request, Congress in 2018 approved the VA MISSION Act, which revised eligibility rules for veterans’ outside care options. Community care options have increased significantly since then, from approximately 27% of total scheduled VA medical visits in 2017 to approximately 39% in fiscal year 2023.

But Republican lawmakers have accused VA of keeping too many patients in the department’s health system, even when outside care options could be more beneficial.

Democratic lawmakers have responded with concerns that GOP leaders are working to privatize the department, pumping taxpayer money into private-sector companies and undermining the security of the VA health system.

Trump’s pick for VA deputy health secretary will be a major voice in this debate, but the president-elect still has not announced the names being considered for the position.