Behind Trump’s Big-Money Battle to Shake Up the VA: “I Think It’s an Existential Threat”

Investigators scrambled to find connections between the shocking violence in New Orleans and Las Vegas. Fortunately, they discovered no evidence of a larger terrorist plot linking Shamsud-Din Jabbar, who allegedly murdered 14 people on Bourbon Street with his pickup truck, to Matthew Livelsberger, who shot himself in the head and then blew himself up behind the wheel of a Tesla Cybertruck parked in the driveway of the Trump International Hotel in Las Vegas. But the two men did have one significant thing in common: years serving in war zones with the US Army. Livelsberger was explicit about how his time in uniform contributed to his state of mind, leaving a note that said, “I need to cleanse my mind of the brothers I’ve lost, and relieve myself of the burden of the lives I took.”

Whether Jabbar’s military experience shaped his motivations remains unclear. Yet the deaths of both men were a reminder of the epidemic of mental health troubles plaguing American veterans: Approximately 6,000 vets commit suicide every year, according to the Department of Veterans Affairs. “We actually just lost one of our best veteran leaders in December,” says Allison Jaslow, the CEO of Iraq and Afghanistan Veterans of America. “I don’t know a vet who doesn’t know someone, another vet, who has died by suicide.”

As if that picture weren’t troubling enough, the second Donald Trump administration looks poised to bring major changes to the VA, the agency that provides health care to 9 million vets. And critics say these changes appear to be driven by big, right-wing money from the likes of the Koch brothers, the billionaire-backed donor network that for decades has promoted libertarian causes through think tanks, legal groups, and advocacy organizations.

“What the Koch brothers are trying to prove is that privatization works and government is bad,” says Paul Rieckhoff, an Army veteran who fought in Iraq before becoming a veterans advocate and podcaster. “And the VA is their test case.” Senator Tammy Duckworth—who lost both legs in 2004 when the Army Black Hawk helicopter she was piloting was shot down over Iraq—is even blunter. “It’s money-driven,” the Illinois Democrat says. “The last time Trump was president he had this shadow VA Cabinet at Mar-a-Lago. This bunch, people who never served themselves, they’re just trying to make money off the backs of veterans.”

Trump’s previous handling of the VA was tumultuous. Initially he elevated Dr. David Shulkin, an Obama administration official who had run major hospital systems, to lead the agency. A little more than one year later, though, Trump abruptly tweeted that he was replacing Shulkin with his White House physician, Dr. Ronny Jackson. That move collapsed under the weight of misconduct allegations against Jackson. (At the time, Jackson called the allegations “baseless and anonymous attacks on my character and integrity.”) Trump’s next choice, Robert Wilkie, was successfully installed but was later accused of trying to help discredit a victim who made allegations of sexual assault inside a VA medical center. (Wilkie has called the accusations against him “false.”)

Meanwhile, a plan to privatize more of the VA’s services was being debated. Shulkin tells me he was startled, during a 2018 White House meeting on the subject, when Trump demanded to get Pete Hegseth on the phone to ask his opinion. At the time, Hegseth was a Fox News contributor and the former executive director of the Concerned Veterans for America—an advocacy group funded by the Koch brothers. CVA championed giving vets increased access to private doctors; the bills, either way, would be paid with tax dollars.

Shulkin says Hegseth—who Trump has now nominated to become Secretary of Defense—endorsed greater privatization, and when Shulkin pushed back by pointing to his assessment that it could cost the government at least $50 billion a year, Trump agreed to a less extensive version of the Veterans’ Choice Program. “Part of what every health care executive has to balance is doing the right thing with limited resources,” Shulkin says. “But if you’re a political ideologue, you don’t worry about that. You just say, ‘This is the way the world should be and it’s going to be somebody else’s problem to figure out how to pay for it.’”

To the CVA’s strategic director, John Byrnes, this line of criticism is misguided. “CVA is looking to provide more options for veterans in how and where they get their health care. We believe that one of those options should be access to community care, and this is already the law,” says Byrnes, a former Marine who was deployed to Somalia in 1993. “We would certainly be in favor of a law that opened up more options for veterans. But calling it privatization, as a lot of people like to do as a scare tactic, is just frankly untrue.” The real goal, he says, is providing supplements and alternatives to the VA’s “broken bureaucracy.”

As for Trump 2.0, the president-elect has nominated Doug Collins, a former Georgia Republican congressman who loyally battled against Trump’s first impeachment, to lead the VA. “He’s a complete blank slate,” says Randy Reese, the executive director of the Washington headquarters of Disabled American Veterans, which has nearly more than 1 million members. “Normally, when you have a political appointee, they reach out. I’ve never had it occur before where we didn’t have any contact at all. It could be an indicator that he’s coming in to do the White House’s bidding.” (A Trump transition representative did not immediately respond to a request for comment.)

Collins is scheduled for a Senate confirmation hearing on January 14. That session will receive drastically less attention than Trump’s rantings about Greenland, but it will deal with issues affecting millions more American lives. In November, Collins told Fox News that if veterans “want to go back to their own doctors, then so be it.” Duckworth, for her part, is also in favor of vets having some ability to see private doctors and knows that VA treatment is far from perfect; one reason she is joining the Senate Veterans’ Affairs Committee in the new Congress is to press the agency to upgrade its antiquated technology. At the same time, Duckworth greatly values the VA’s breadth of specialized medical knowledge and services, and she’s vehement that they shouldn’t be gutted for the sake of private profit.

Republicans will likely attempt to sell an overhaul as promoting choice, which may sound appealing. “Who doesn’t like choice?” says Congressman Pat Ryan, a New York Democrat who has a personal stake in maintaining an effective VA: He served two Army tours in Iraq, where he was exposed to toxic burn pits. However, the reality, Ryan believes, is that privatization gives you “no choice, because there’s no actual realistic option—our private health care networks are totally overwhelmed already.”

“I think it is an existential threat to the entire VA system, and to ensuring proper care for veterans,” Ryan argues. “To me, it all goes back to the heart of who Donald Trump is—his history of draft dodging, his selfishness, and his inability to understand those who serve something larger than themselves.”