The nominee to lead the Veterans Health Administration hopes to streamline Veterans Affairs medical care so patients face fewer obstacles when they seek treatment, whether at a VA facility or with a community provider.
During his confirmation hearing for VA under secretary for health, Air Force Reserve Maj. Gen. John Bartrum addressed the ongoing debate over the future of VA health care -- the role the federal government has in managing and providing care for veterans, either within VA facilities or by paying private doctors.
Bartrum told the Senate Veterans Affairs Committee on Wednesday that he sees "an opportunity to revisit the balance of direct care and community care" by removing what he described as a bureaucracy that prevents veterans from getting medical care from community providers.
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"If veterans want community care, we need to allow them to have community care," Bartrum said. On the other hand, he added, "we also need to allow that if a veteran chooses that they want to use the VA health care system -- the direct care system -- that they have that choice to use that direct health care system."
The VA's proposed fiscal 2026 appropriations bills call for $34 billion for community care, the program that pays non-VA doctors to treat veterans. The amount is $12 billion higher than was allocated for fiscal 2025, but only slightly higher from the previous year's allocation of $31 billion.
Given that the proposed community care budget would account for 37% of the department's medical services budget, the amount has raised concerns among Democrats that the current administration is moving in a direction to privatize VA medical care.
Under the first Trump administration, Congress passed the Mission Act, which expanded access to community care by establishing lower thresholds for travel times to VA facilities. Since the law was enacted, however, Republicans have argued that the VA, under the Biden administration, limited that access to care by creating a system that mandated a review of community care requests by a supervisor before they could be approved.
Last December, then-President Joe Biden signed a law that prohibited VA administrators from overriding a VA doctor's referral for a patient to get outside care. VA Secretary Doug Collins announced the implementation of that law in May.
In May, Collins also shifted millions of dollars from canceled contracts to the community care program.
Bartrum, who currently serves as a senior adviser to Collins, told senators that the department recently expanded a new scheduling process that has allowed schedulers to triple the number of community care appointments it can assign per day.
But, he added, he believes there is more that can be done to reduce the bureaucracy that he says stands in the way of accessing private health care.
"There are things that we do that make veterans want to keep coming back and using us over and over, especially if they live within the area where they can get to us. But if they don't live within that area, they need to be able to use community care without jumping through a thousand hoops," Bartrum said.
He has previously worked at the VA on health care policy and the budget, and served in the national security division of the Office of Management and Budget. He is a former professional staff member of the House Appropriations Committee, which has a portfolio that includes health. In that capacity, he contributed to the effort to fund the emergency response to Ebola, the Zika virus and Superstorm Sandy.
He also has served as an associate director and budget director for the National Institutes of Health.
A former airman, Bartrum enlisted in the Air Force in 1984 and rose through the ranks in the active and reserve forces, mobilizing for Operations Desert Storm and Iraqi Freedom. Notably, he was called up in 2020 to serve as deputy incident manager for the COVID-19 pandemic and played an instrumental role in the federal effort to accelerate development of a COVID-19 vaccine, dubbed Operation Warp Speed.
Bartrum's nomination comes as Congress considers revising the standards for veterans to access community care. The Access Act, which passed the House Veterans Affairs Committee last week, would solidify existing standards for accessing care and would make it easier for other veterans to qualify for private care by stipulating that the availability of telehealth cannot play a role in calculating wait times.
It also states that wait times cannot be reset if the VA cancels an appointment or veterans do not show up for a scheduled appointment, and introduces a pilot that would allow veterans to get private care without a referral.
But Democrats, including House Veterans Affairs Committee ranking member Rep. Mark Takano, D-Calif., say it would further erode VA care by taking resources away from Veterans Affairs facilities and actually harms overall care.
"Leaving veterans untethered in the community with no way for VA providers to know how a veteran is doing and whether they are continuing care or treatment is harmful to the veteran. Requiring referrals keeps that connection, that relationship, in place, and it can be live-saving," Takano said.
Republicans insist that the measures are needed to ensure that veterans, especially those in rural areas, have access to medical services.
"In a state like Montana, where we have almost 10% of our state veterans in a frontier health care market -- not just rural health care, frontier health care -- to assume that we can build a clinic close enough to every veteran and make sure they have the access in a time of urgent emergency need is fantasy," said Sen. Tim Sheehy, R-Mont.
Roughly 39% of all VA scheduled medical appointments in fiscal 2023 were in the private sector.
A vote on Bartrum's nomination could be held by the committee as early as the end of this week. It would then proceed to the full Senate for final approval.
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