A public outcry by veterans’ service organizations and lawmakers on Capitol Hill has spared certain core health-care personnel at the Veterans Health Administration (VHA) from the worst of President Trump’s blanket hiring freeze.
But veterans who rely on the VA for benefits, pensions, compensation, and health care are still in big trouble. Chronic staff shortages and underfunding have been at the heart of a VA crisis centered on long wait times for care. Though doctors, nurses, and certain other essential health-care professionals and support staff have been exempted from the freeze, that still leaves the VA with a multitude of vacancies that will hamper its ability to deliver high-quality care.
To be sure, the recent exemptions have led some who are worried about the VA’s future to breathe a sigh of relief. When Trump announced his blanket federal hiring freeze, it did not exempt anyone at the VA. That led lawmakers and veterans’ advocates to protest that the freeze would cripple the VHA. In response, acting VA Secretary Robert D. Snyder sent out a memorandum on January 27 exempting doctors, nurses, and other health-care professionals and clinical support staff from the freeze.
But that still leaves the VA, the nation’s largest health-care system, substantially shorthanded. The agency needs to fill more than 41,000 vacant positions, and also must be free to replace employees who die, retire, or leave for jobs elsewhere. It takes administrators, as well as human relations staff—neither of them exempt from the hiring freeze—to hire sufficient numbers of front-line caregivers and medical support staff to meet the urgent health-care needs of veterans. Under the Trump freeze, these positions, when they become vacant, will die. That will make VHA hiring delays even longer, and the agency’s already bureaucratic hiring process even more cumbersome.
The VHA also depends on researchers and research assistants to fulfill its mission to conduct cutting-edge research—research that helps not only veterans, but all Americans. The current freeze has generated considerable uncertainty over who can and cannot be hired to assist with this research.
In August, the VHA opened the 61,000-square-foot Simulation, Learning, Education and Research Network (SimLEARN), which uses high technology simulations to enhance health-care training and outcomes. Such simulations are now central to cutting-edge patient safety and care. This $20 million investment has produced one of the ten largest medical simulation facilities in the country. But now, under the Trump freeze, SimLEARN cannot hire educational technicians, curriculum developers, simulation operators, researchers, or project managers.
Moreover, the VA’s two Veterans Crisis Lines—one in rural Canandaigua, New York, and a newly opened facility in Atlanta, Georgia—may now hire emergency responders but not other staff important to the mission of helping potentially suicidal veterans. Hiring staff to help the VHA fulfill the mandate of the CARA (Comprehensive Addiction and Recovery Act), as of this writing, is also frozen.
Throughout the VHA, clinical leaders are petitioning to add new occupational categories to the list of VA personnel exempted from the hiring ban. But as one administrator told the Prospect, “We are in limbo and may have to renege on offers to candidates who have already been selected.”
Another casualty of the VA hiring freeze: more delays for veterans trying to process claims at the chronically understaffed Veterans Benefits Administration. This agency determines whether a veteran has a service-connected disability and is therefore eligible for compensation and for access to such VHA services as housing assistance, home loans, vocational rehabilitation, and educational benefits. Veterans have complained for years about delays at the Veterans Benefits Administration. These waits are also about to get a lot longer.
Things will get even worse for veterans if Trump and congressional Republicans repeal the Affordable Care Act, which covers hundreds of thousands of veterans. Without the ACA, many veterans will turn for care to the VHA, thus further increasing the burdens on the system. With more vets seeking care, and not enough professionals to serve them, access will only get worse, and veterans’ frustration will mount.
Notwithstanding the recent exceptions, the hiring freeze has created demoralization and confusion at the VA. Instead of spending all their time on patient care, administrators, researchers, and clinicians are now trying to figure out whether they will have the staff to deliver that care, and begging for additional exemptions to the freeze.
One chief of medical staff member at a large VHA medical center observed privately that no other hospital system could be expected to conduct business in such a chaotic environment. This physician, who asked not to be named, worried that news of the freeze would also discourage people from even applying for jobs at the system. Given the choice between a job offer from the VHA and from a private-sector employer, the physician wondered, who would choose to work in a place where the future is so uncertain?
All of this is hurting morale among VA staff already demoralized by three years of VA bashing from politicians and the media—which, combined with new hiring restrictions, will certainly impact services. But maybe that’s the point. The worse things get at the VA, the more justification Trump will have to push for his real goal: privatization—despite the opposition of the vast majority of veterans and veterans’ service organizations.
The VA may have gotten a temporary reprieve, but Trump is still playing politics with veterans’ health. Those who have served their nation deserve better.