"But What About Choice?" — Answering the Arguments They'll Make
A preemptive FAQ on the CCN Next Gen contract, for veterans who want the facts before the spin starts.
The Gist
They’re going to tell you this contract is about “choice,” that no employees were fired, and that oversight mechanisms are built in. Here’s what the evidence actually says — twelve arguments, twelve answers, every one sourced.
After publishing “The Trillion-Dollar Handoff Nobody Voted On,” I expect pushback. Not from veterans — from the people who stand to profit from this contract and the people paid to defend it.
Here are the arguments they’ll make, and what the evidence actually says.
“This isn’t privatization. It’s choice.”
That’s been the talking point since the MISSION Act passed in 2018. And at 20% of veteran health care flowing to the private sector, it was defensible.
It’s not 20% anymore. Community care now consumes over 40% of all veteran health care. The FY2026 budget request puts community care spending at $48 billion — a 26% increase from $38 billion the year before. Secretary Collins just authorized full-year referrals for 30 medical conditions, eliminating the requirement that veterans return to VA periodically for reauthorization.
When half the system runs through private contractors, “choice” starts looking a lot like “default.”
A supplement is choice. A parallel system replacing the original is a structural shift. Call it what it is.
“No VA employees were removed. We eliminated unfilled positions.”
Technically true. Strategically devastating.
VA lost approximately 30,000 employees in 2025 through attrition, early retirements, and a hiring freeze. Another 25,000 vacant positions were eliminated in December. The department that hired 62,000 people in a single year to implement the PACT Act is now running with fewer staff than it had before the law passed.
An unfilled position isn’t an abstraction. It’s a nurse who didn’t get hired. A mental health provider who isn’t seeing patients. A claims processor who isn’t reducing the backlog.
Eliminating the vacancy doesn’t make the need disappear. It just guarantees the need goes unmet — and that the veteran gets referred to community care instead.
That’s the ratchet: fewer staff → longer wait times → more community care referrals → bigger contracts → less justification for VA staffing. It only turns one direction.
“The contract includes quality metrics and oversight mechanisms.”
Show me.
Chairman Bost — a Republican, not a partisan critic — told the January 22 hearing that his staff and the ranking member’s staff were told “some topics are off limits because of the sensitive nature of the contract and solicitation.”
If Congress can’t see the oversight mechanisms, they aren’t oversight mechanisms. They’re marketing language in a procurement document.
The committee named its own hearing “One Trillion Dollars of Oversight” — after the oversight failure, not before. When the body constitutionally charged with overseeing VA spending learns the contract details at the same time the insurance companies do, the word “oversight” is doing a lot of heavy lifting.
“Federal procurement law limits what VA can disclose during an active solicitation.”
They’ll lean hard on this one, and it’s partially true. Federal Acquisition Regulation does restrict what agencies can discuss publicly during an active procurement to prevent unfair competitive advantage.
But there’s a difference between protecting competitive integrity and keeping Congress in the dark about a trillion-dollar structural shift in veteran health care. The House and Senate Veterans Affairs Committees have classified briefing capabilities. They receive sensitive information on military and intelligence matters routinely. The idea that VA couldn’t brief the oversight committees before posting the RFP — while simultaneously providing details to potential vendors — doesn’t hold up.
A source told Military Times that the VA provided no information to the committee’s Democratic leadership before the December 15 announcement. They chose who to tell and when. Congress wasn’t on the list.
“Community care saves lives in rural areas. You want to take that away?”
No. And the article says so explicitly.
Here’s what I actually wrote: “The question isn’t whether community care has a role — it does, and it should, especially in rural areas where VA facilities don’t exist. The question is whether you build a system that creates those facilities, or one that profits from their absence.”
Community care as a bridge while VA builds capacity in underserved areas? Absolutely. Community care as the permanent replacement for a system that could serve those veterans directly with better outcomes and lower overhead? That’s a different conversation — and that’s the one they don’t want to have.
At $70 billion per year, you could build hundreds of new VA clinics and hire hundreds of thousands of staff. A major VA health care center like the one in Charlotte cost $104 million. A new community-based outpatient clinic like the one Congress just authorized for Hampton Roads cost $79.7 million. At the low end of this contract, you could build dozens of new medical centers and hundreds of new clinics every single year. In five years, there wouldn’t be a rural veteran in America more than 45 minutes from a VA facility.
They’ll tell you it can’t be done. What they mean is it’s not as profitable as routing the money through private insurance companies.
“VA’s administrative cost comparison is misleading. You’re not counting facility costs.”
Fair point — and worth addressing honestly.
The 1.3% vs. 12-18% comparison (VA/Medicare administrative costs versus private insurers) comes from Dr. Rachel Madley’s testimony to the House Veterans Affairs Committee and reflects how administrative overhead is typically measured across health care systems. It’s a standard comparison used by CMS, GAO, and health policy researchers.
Critics will argue that VA’s low administrative percentage doesn’t account for the cost of maintaining an entire federal hospital system — capital investment, building maintenance, pension obligations — which are budgeted separately. That’s a legitimate accounting question.
But it cuts both ways. Private insurers’ 12-18% overhead also doesn’t capture the full cost of their system: the lobbying, the litigation, the executive compensation, the shareholder returns. UnitedHealth Group reported $25.7 billion in adjusted profit in 2024. Its CEO earned $26.3 million. The six major health insurance CEOs earned a collective $159.4 million. None of that shows up in the overhead calculation either.
Even if you double or triple VA’s administrative cost estimate to account for facilities, it’s still dramatically lower than the private sector. The gap narrows but doesn’t close.
“The MISSION Act passed with bipartisan support. Congress already voted for this.”
Congress voted for community care as a component of veteran health care. The MISSION Act expanded access standards and established a framework for community care referrals. It did not authorize a trillion-dollar contract that restructures the entire VA health system into a payer model.
There’s a difference between “veterans should be able to see a private doctor when VA can’t see them quickly enough” and “let’s route half of all veteran health care through private insurance companies for the next decade.”
The MISSION Act set eligibility criteria. CCN Next Gen sets the infrastructure. They’re not the same thing — and the scale of this contract goes far beyond what Congress debated in 2018.
“Veterans are satisfied with community care.”
Some are. Especially veterans in rural areas who’d otherwise drive three hours to a VAMC. That’s real, and it matters.
But satisfaction surveys don’t capture what veterans lose when the system shifts underneath them. They don’t measure the research that won’t happen because VA’s bench-to-bedside pipeline shrinks. They don’t measure the specialty expertise that disappears when VA spinal cord injury centers and blind rehabilitation programs lose patient volume. They don’t capture the institutional memory lost when your health record stops being tracked by one integrated system across your entire post-service life.
Kyleanne Hunter, CEO of IAVA, told Congress: “Community care is a vital part of overall veterans’ health care, but especially as we consider rising costs, we need to be clear that the evidence does not bear out that community care is a meaningful replacement for all direct VA care.”
Satisfaction with an individual appointment isn’t the same as satisfaction with losing the system that was built to take care of you for life.
“The cost savings in the contract will actually reduce spending.”
VA projects $54 to $100 billion in savings over the contract’s life through better care management and EHR interoperability.
Those projections depend on VA’s electronic health record modernization actually working. The same VA has already spent $13.8 billion on the Oracle Health EHR project, which was paused in 2023 after deploying to just five sites. As of February 2025, 94% of VA medical centers still don’t have the new system. GAO has made 18 recommendations on the project, 16 of which remain unimplemented.
Projecting $54-100 billion in savings on a technology foundation with a $16 billion track record of underdelivering isn’t fiscal responsibility. It’s faith-based budgeting.
“TriWest settled those DOJ allegations. That’s old news.”
TriWest paid $179.7 million to the Department of Justice in 2020 to resolve allegations it retained overpayments from the VA, including cases where VA paid twice for the same services. That was the second settlement in eight years — the first was $10 million in 2012 for allegedly defrauding TRICARE.
Calling it “old news” is a choice. The DOJ press release is still on their website. The settlement is a matter of public record. And the company is bidding on a contract worth up to a trillion dollars in veteran health care spending.
If you applied for a VA job and had two fraud settlements in your background, you wouldn’t get hired. But if you’re a corporation, apparently you get to bid on the biggest contract in government history.
“You’re fearmongering. Nobody’s closing VA hospitals.”
Nobody has to close them. You just defund them gradually.
Cut staff through attrition and hiring freezes. Eliminate vacant positions so replacements can’t be hired. Expand community care eligibility so more veterans are seen outside VA. Watch internal patient volume drop. Use the declining volume to justify further staff reductions. Repeat.
The building stays open. The sign stays on the wall. But the doctors, the researchers, the specialized programs — they’re gone. And by the time anyone notices, the contract is ten years in and the political cost of reversing it is higher than the cost of letting it continue.
That’s not a conspiracy theory. It’s a budget cycle.
“You’re just anti-private sector.”
I’m anti-accountability vacuum. I’m anti-trillion-dollar contract with no congressional vote. I’m anti-insurance companies managing health care for 9 million veterans when those same companies deny 4.1 million prior authorization requests per year and count on 88.5% of those denials never being appealed — even though 80.7% of the ones that areappealed get overturned.
The private sector has a role in veteran health care. But that role should be defined by Congress, overseen by Congress, and accountable to veterans — not defined by a procurement document posted two weeks before Christmas while nobody was watching.
“So what do you actually want?”
Six things:
Pause. Delay the March 16 proposal deadline until Congress has conducted full oversight. A decade-long contract worth up to a trillion dollars can survive a 90-day review. If it can’t, that tells you something.
Transparency. Full congressional briefing on contract terms, cost projections, and quality metrics before any contract is awarded. No more “off limits” topics.
Investment. Redirect a meaningful portion of community care spending into VA staffing, facilities, and research. Build the system instead of outsourcing around its gaps.
Accountability. Past performance — including DOJ settlements — should be a weighted factor in contract evaluation. Companies that overcharged taxpayers shouldn’t be rewarded with bigger contracts.
Oversight. Real-time reporting to Congress on community care spending, veteran outcomes, and contractor performance. Not annual reports filed after the money’s been spent.
A vote. A structural change of this magnitude — potentially converting the VA from a health care provider to a health care payer — should require legislation, not just a procurement action. If it’s good policy, it can survive a vote.
Tbird is a Navy veteran (VAQ-34, 1983-1990) and founder of HadIt.com, one of the oldest veteran-run VA disability claims communities on the internet (est. 1997). For 29 years, HadIt.com has operated on one principle: Leave No One Behind. Contact: founder@hadit.com
This article is for informational purposes only. HadIt.com does not provide legal advice. For assistance with your specific VA claim, consult an accredited Veterans Service Organization (VSO) or VA-accredited attorney. Find accredited representatives at VA.gov’s eBenefits.
I use AI as a research and editing assistant—the same way I’d use a good reference book or a sharp editor. Every word published here is reviewed, verified, and approved by me. The perspective, accuracy, and editorial decisions are mine. — Tbird
Sources cited in this FAQ are drawn from the original article, “The Trillion-Dollar Handoff Nobody Voted On.”Full source list available there.