As the federal government moves to shrink the Department of Veterans Affairs, frontline workers in Iowa City warn that a system known for delivering high-quality care to veterans may be pushed past its limits.

The Department of Veterans Affairs, or VA, consists of three main branches: the Veterans Health Administration for medical care, the Veterans Benefits Administration for financial and educational support, and the National Cemetery Administration for burial and memorial services.

Patrick Kearns, a VA nurse and president of Iowa City’s chapter of the American Federation of Government Employees — the union representing VA workers — said the local facility operates under the Veterans Health Administration as a tertiary referral hospital, receiving patients from other VA centers.

What sets VA health care apart from traditional models is its streamlined approach, Kearns said. Instead of sending patients to multiple providers, the VA delivers comprehensive care in a single system — covering everything from preventive services and chronic condition management to mental health support, not just treatment for service-related injuries.

“Pretty much the only thing we don’t do is open heart surgery,” Kearns said.

In 2023, the VA reported 67 percent of its hospitals earned four or five stars in federal quality ratings — compared to 41 percent of non-VA hospitals. The following year, 91.8 percent of surveyed veterans said they trusted the VA with their care, following a record year for appointments and benefits.

“Most people don’t realize, just because we don’t advertise it, that VA health care is the largest, but we also have the highest quality scores and best outcomes across the health care spectrum, [and] our costs are lower,” Kearns said.

But Kearns said those successes are now at risk under Project 2025, a sweeping conservative plan to overhaul the federal government — including significant changes to the VA.

Chapter 20 of “Mandate for Leadership: The Conservative Promise,” the policy agenda at the center of Project 2025, recommends narrowing eligibility for VA health care to only veterans with service-connected disabilities, low incomes, or other special needs.

It also calls for dis-enrolling an estimated 50 percent of veterans who don’t meet these criteria, meaning they would no longer be eligible to receive any care through the VA, and implementing means testing and copay requirements.

“Veterans with the ability to pay should not receive free care at taxpayer expense,” the chapter reads.

While Kearns said the services offered through the VA typically come at low or no cost for veterans, he specified that he does not consider the services free.

“We like to say it’s prepaid,” Kearns said. “That was the deal — you served in the military, and we will take care of you when you get out. That’s been the social contract forever.”

Kearns, who has worked as a VA nurse for 30 years, said he has seen firsthand the long-term suffering of veterans who return from combat zones.

Having cared for veterans from World War I, World War II, and the Korean War — some of whom survived prisoner of war camps — Kearns emphasized that veterans need and deserve high-quality health care for decades following their service.

“You cannot imagine the damage that was done to them that they were dealing with [decades] later, every day of their life,” Kearns said. “To think that the cost of war stops when people come home is ludicrous.”

While Trump’s push to downsize the federal government presents new challenges for the VA, underfunding has long been a problem.

A 2023 report by the Veterans Healthcare Policy Institute and the National VA Council of the American Federation of Government Employees described what it called “a legacy of underfunding.”

It traced how, after the launch of former President George W. Bush’s “War on Terror,” Republican lawmakers pushed for cuts to veterans’ programs and blocked efforts to expand VA funding, even as demand for care surged.

According to the report, these funding shortfalls contributed to care deficiencies later used to justify increased privatization through the VA Access, Choice and Accountability Act of 2014.

But Kelly Freilinger, who began her career as a pharmacy technician at the Iowa City VA in 2015, said the VA has always worked hard to be resourceful.

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“They make the best of everything that they’ve got and try to get the best services for the veterans,” Freilinger said. “If funding is cut, they find a way to still meet the needs of the veterans.”

However, Freilinger said she worries the VA under Trump’s administration is approaching a “breaking point” where it may no longer be able to serve veterans effectively.

A March 4 memo from VA Chief of Staff Christopher Syrek, issued in line with Trump’s February 11 executive order establishing the Department of Government Efficiency, or DOGE, Workforce Optimization Initiative, announced plans to lay off more than 80,000 VA employees by August — a cut that would shrink the agency’s workforce by more than 16 percent.

“For a facility the size of Iowa City, that’s around 300 people,” Kearns said.

Freilinger, also an officer with the VA union, remembered receiving the first deferred resignation offer from the Office of Personnel Management on Jan. 28 — offering employees a chance to resign in exchange for full pay and benefits through September.

The message emphasized a new vision for government employees, calling for a “reliable, loyal, and trustworthy staff” and warning that stricter standards for conduct and performance would soon take effect.

“It was extremely insulting,” Freilinger said. “Part of who I am is to put everything I’ve got into the job that I do.”

At the Iowa City VA, Freilinger said she and her colleagues are driven by a deep commitment to serving veterans and a shared belief that their work advances a greater good — something she believes Trump and DOGE director Elon Musk fail to understand.

“I don’t think they’ve ever done things for the greater good,” Freilinger said, referring to Trump and Musk. “I think it’s been for their personal gain, and that comes out in their treatment of veterans and people who take care of veterans.”

Echoing this sentiment, Kearns said he believes Musk sees the VA as a threat because it’s a publicly run, non-profit system that delivers more efficient, higher-quality care than private health care — which Kearns does not think Trump and Musk want Americans to realize.

“If you could do that with the [VA,] why couldn’t you have single-payer health care insurance,” Kearns said. “I think that they see that as a threat to this model of the world where health care is a privilege that’s limited to a few, and nobody should be guaranteed health care, regardless of whether they were veterans or not.”

In an email statement to The Daily Iowan, Justin Hardt, public affairs officer for the Iowa City VA, wrote he could not speak on ongoing national issues.