Key Takeaways
- •VA officials confirmed that only 25 of 72 Dole Act provisions are fully implemented, drawing sharp criticism over delays in homeless services and physician pay waivers.
- •Thomas O'Toole (Acting Assistant Under Secretary for Health for Clinical Services, Veterans Health Administration) cited funding shortages and administrative reorganizations as primary obstacles to meeting the law's mandates.
- •Rep. Ramirez (D, IL-3) challenged O'Toole regarding the VA's failure to utilize Section 142 pay waivers for physicians despite the Secretary's public claims of lacking recruitment authority.
- •Democrats condemned the VA for cutting thousands of filled medical positions, while Republicans expressed frustration with the slow rollout of caregiver grants and rural home health services.
- •The subcommittee will track the VA's commitment to finalize pending regulations for homeless veteran per diems and transportation benefits within the next two months to ensure compliance.
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Hearing Analysis
Key Testimony
The House Veterans' Affairs Subcommittee on Oversight and Investigations held a hearing on March 4, 2026, to evaluate the Department of Veterans Affairs' (VA) progress in implementing the Senator Elizabeth Dole 21st Century Healthcare and Benefits Improvement Act (Dole Act) one year after its enactment. The hearing focused on the VA's internal reorganization, significant staffing reductions, and delays in deploying critical resources for homeless veterans and caregivers. Chair Jennifer Kiggans (R, VA-2) and Ranking Member Delia Ramirez (D, IL-3) led the session, which featured testimony from officials within the Veterans Health Administration (VHA), the Veterans Benefits Administration (VBA), and the Government Accountability Office (GAO).
Dr. Thomas O'Toole, Acting Assistant Under Secretary for Health for Clinical Services at the VHA, testified that the VA has fully implemented 25 of the 72 sections of the Dole Act. He highlighted successes such as Section 101, which allows veterans to access community care when in their best medical interest, and Section 120, which increased coverage for non-institutional care alternatives. However, Dr. O'Toole acknowledged that a lack of specific funding and the complexity of the 40 mandated enhancements have slowed progress. He noted that oversight has been moved to the newly created Office of Strategic Initiatives to ensure senior-level accountability.
A central point of contention involved Section 146, which requires the VA to develop and implement staffing models. Ranking Member Ramirez and Rep. Timothy Kennedy (D, NY-26) criticized the VA for cutting approximately 26,000 to 30,000 positions—including thousands of doctors and nurses—without having these mandated staffing models in place. While Dr. O'Toole argued these were "old COVID-era vacancies" that did not result in active employees losing jobs, Ranking Member Ramirez cited data suggesting over 18,000 of the cut positions were occupied as recently as 2025. Rep. Kennedy highlighted specific cuts at the Buffalo VA Medical Center, linking staffing shortages to dangerous delays in community care consults and at least one veteran death.
Overview
The subcommittee also examined Section 142, which authorizes pay waivers for up to 300 highly skilled medical staff to improve recruitment. Despite Secretary Collins previously testifying that the VA lacked the authority to compete with private-sector salaries, Dr. O'Toole admitted that the VHA has not yet approved any pay waivers under this provision, though he anticipated establishing criteria within the next two months.
Policy Proposals
Regarding veteran homelessness, Ranking Member Ramirez expressed frustration over delays in implementing Sections 402 and 403. She noted that while the law authorized increasing the grant per diem rate for transitional housing from $85 to $128 (and up to 200% in some cases), many providers are still receiving the lower rate. She accused the VA leadership of "meddling" in the implementation and expressed concern over a new proposal called "BRAVE," which she argued might undermine the successful HUD-VASH permanent supportive housing program.
Key Testimony
Ms. Sharon Silas, Director of Health Care at the GAO, provided testimony on the Veterans Community Care Program and the Caregiver Support Program. She noted that community care now represents 42% of all VA healthcare appointments, yet the VHA has failed to fully implement GAO recommendations regarding staffing assessments for referral processing. On caregiver support, Ms. Silas shared preliminary findings that while the VA has expanded virtual psychotherapy, it lacks effective performance management to ensure caregivers are aware of available mental health services.
Overview
Partisan dynamics were marked by sharp criticism from Democratic members toward the leadership of Secretary Collins. Ranking Member Ramirez characterized the delays as "negligence" and "defying congressional authority," while Republican members, including Rep. Keith Self (R, TX-3) and Rep. Juan Ciscomani (R, AZ-6), focused on the need for accountability and the impact of reimbursement rate changes on rural veterans. Rep. Self specifically questioned how a 43% reduction in home health aide reimbursement rates in rural Texas could possibly align with the Dole Act’s goal of improving home-based care.
The hearing concluded with a demand for more transparent data regarding staffing cuts and a faster timeline for the remaining 47 sections of the Dole Act. The VA committed to providing an organizational chart delineating accountability for at-risk sections and promised further updates on the implementation of pilot programs for assisted living (Section 127) and veteran outreach grants (Section 302).
Transcript
...veteran homelessness. In the Dole Act, we included bills from my Democratic colleagues that gave VA crucial authorities that communities need to address and end veteran homelessness. We actually increased the grant per diem rate and authorized the VA to purchase basic necessities for homeless veterans. Having been the executive director of a homeless service agency myself, I understand that oftentimes these organizations have to do more with less, and I know that every resource and every dollar matters when you're trying to provide the best service possible with very limited means. VA worked with committee staff for over a year to refine the homeless sections of the Dole Act before it was signed into law. The VA assured us that providing these increased resources to community providers and to homeless veterans would be simple as a quote, turning on a light switch, once the bill would pass. Under the Biden administration, VA was prepared, yet under Collins's disappointing dysfunctional and delinquent leadership, it has taken over a year to implement the most critical parts of the Dole Act. Homeless service providers are left receiving a paltry $85 a day to provide transitional housing services to veterans instead of the $128 a day we had actually authorized in the law. Community providers have left the GPD program in droves while they waited for the relief promised by Congress. And those exits create service gaps that are impacting our veterans every single day. Communities view VA Under Secretary Collins as an unreliable partner in the fight to end veteran homelessness and frankly, I agree with them. Because due to his delays, homeless veterans are also left without access to their basic needs, another critical resource Congress authorized in the Dole Act. We gave VA the authority to use funds to be able to pay for food, for shelter, for clothing, for transportation, for homeless veterans to get to and from job interviews or for medical appointments. And every single day that passes and Doug Collins fails to implement approved provisions of the Dole Act, he's defied congressional authority. Every day that passes that a veteran experiences homelessness on the streets of our country, they are left without the resources that they need to become stably housed and that to me is shameful. It's irresponsible and it's harmful failure of this secretary. But let me talk to you about another shameful note. I want to discuss the staffing provisions of the Dole Act that have yet to be implemented. You see section 146 required VA to develop and implement staffing models to ensure VA has the workforce it needs to provide care and benefits to the veterans. And staffing models are essential for aligning personal resources so they can be used efficiently so that workers with the right skills are in the right place at the right time. Folks listening may recall that the VHA is currently undergoing a massive reorganization which we discussed at a full committee hearing just last month. One would think that a reorganization of this magnitude of the largest integrated health system in the country would incorporate staffing models. But by VA's own admission, they have not complied with the Dole Act and lack staffing models for the vast majority of the medical facility service lines. Which begs the question. What is the evidence that the VHA reorganization is in fact needed? How can we be sure that the VA is making the correct changes if its leadership doesn't even know how many staff it needs and where they need them? Even worse, let me ask you this question. Why is VA cutting vacant positions if they do not have staffing models developed? VA provided data to my staff a couple weeks ago on over 26,000 positions that were cut from the books. The details of those cuts are alarming. For months VA has told us that these are quote, old COVID era vacancies for positions that are no longer needed at the agency, but let me tell you that the data, it paints an entirely different picture about the same nature of these cuts. You see over 18,000, not hundred, 18,000 of the positions VA cut had a person in that job in 2025 or even 2026. This included positions for nearly 3,000 nurses, 800 social workers, 300 psychologists, and over 1,000 physicians who were on the job in 2025. These VA positions were discarded at the hands of the secretary's reckless leadership and they're not going to be backfilled. Chair Kiggans, the medical center that serves your constituents had the most cuts of any VA facility in the country. 733 of the positions VA cut were at the Hampton VA Medical Center. At the facilities that serve my constituents in Chicago, Jesse Brown and Hines, 717 positions were cut. In addition to those 26,000 positions that were wiped from VA's books since Secretary Collins was sworn in at the VA, he has shed a net 30,000 employees representing centuries worth of experiences. Those losses included over 1,100 doctors, 2,300 registered nurses, 700 more social workers, and nearly 300 psychologists. All of these cuts and losses were made with no staffing models in place as required by the law. Cut after cut after cut with no analysis of how veteran care and benefits would be affected. It is the definition of negligence. The secretary and his political appointees intentionally misled and lied to Congress about the nature of these cuts. Secretary Collins is failing at the most fundamental part of his job, ensuring that veterans have access to world class care at the VA. It's why this hearing is so important. It's why we have to hold them accountable and I look forward to the conversation that we have in this hearing today and with that, chair, I yield back.
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