“Get Pete Hegseth on the phone!”

It was March 2018, and then-President Donald Trump was meeting with his Department of Veterans Affairs Secretary, Dr. David Shulkin, about how to reform veteran health care. But it was Hegseth, then a Fox News personality, whose opinion Trump really wanted.

Hegseth, now Trump’s nominee to serve as secretary of defense, had been a vocal and persistent advocate for veterans having unfettered access to private health care, rather than having to go through the VA to keep their benefits. He’s also lobbied for policies that would restrict VA care and believes veterans should ask for fewer government benefits.

“We want to have full choice where veterans can go wherever they want for care,” Hegseth told Trump on speakerphone as Shulkin listened, according to Shulkin’s 2019 memoir.

Trump’s pick to serve as the next VA secretary, Doug Collins, has also expressed support for greater privatization of veteran health care, which advocates characterize as giving veterans greater choice over their doctors. If veterans “want to go back to their own doctors, then so be it,” he told Fox News last month.

For Shulkin, a rare “holdover” from President Barack Obama’s administration to Trump’s, this was “the worst-case scenario” for veteran health care, and one he had repeatedly warned Hegseth against.

“Your version of choice would cost billions more per year, bankrupting the system,” Shulkin recalls telling Hegseth in his memoir. “How can we responsibly pursue this? Unfortunately, he didn’t want to engage at the level of budget and other aspects of day-to-day reality. He seemed to prefer his sound bites on television.”

If confirmed, Hegseth and Collins will have the opportunity to push for a dramatic overhaul of the military and veteran health care system, one that could significantly cut government health benefits for servicemembers and veterans – many of which Hegseth says veterans should not be asking for at all.

Veterans groups “encourage veterans to apply for every government benefit they can ever get after they leave the service,” he told Fox News’ “Fox and Friends” in 2019. “To me, the ethos of service is, I served my country because I love my country and I’m gonna come home and start the next chapter of my life. If I’ve got a chronic condition – mental, physical, otherwise – the government better be there for me, but otherwise I don’t want to be dependent on that.”

CNN has reached out to Hegseth and the Trump transition for comment on this story.

‘A typical swampy feedback loop’

The fight by pro-small government conservatives to privatize VA health care is not a new one, particularly as the VA has long been plagued with bureaucratic challenges, resulting in long wait times and sometimes dangerously delayed medical care for veterans.

Hegseth told the “Shawn Ryan Show” podcast last month that he is not explicitly advocating for privatizing the VA, but rather “to effectively let the dollars follow the veteran” to their preferred doctor.

Critics, though, say the “unfettered choice” narrative is a trojan horse for privatizing and ultimately dismantling the VA system altogether, whose budget was over $300 billion in 2024.

Hegseth told Shawn Ryan that the VA “hates” conversations about more private options “because their budget might get reduced.”

“It’s a typical swampy feedback loop,” he said. He added that when he was being considered for VA secretary in 2016, he heard from huge numbers of veterans who supported his ideas.

But Amy McGrath, a retired Marine fighter pilot who challenged Sen. Mitch McConnell for his seat in Kentucky in 2020, emphasized in a conversation with CNN that while the debate around privatization of care has been “going on for years,” there hasn’t been a “wide-spread outcry from veterans to privatize the VA.”

“I’m not saying the VA is perfect, it’s certainly not,” McGrath, a Democrat, said. “But I don’t think there’s this huge outcry to privatize it.”

A senior Biden administration official told CNN that within the VA, there are a number of career civil servants “who have dedicated their lives to the health and welfare of the veterans our nation has sent to war repeatedly.” Those civil servants are now deeply worried about “the continued health care and earned benefits of the veterans they serve,” the official added.

As secretary of defense, Hegseth would oversee the Military Health System, which is separate from the Veterans Health Administration. But Hegseth is broadly skeptical of government-provided health care, and has argued that health care benefits for both active duty servicemembers and veterans should be cut significantly so that the Pentagon can spend more on “war-fighting capability,” according to a Wall Street Journal op-ed he wrote in 2014.

“If this continues, the Defense Department will eventually be a health care and pension provider that also happens to fight wars,” he wrote.

McGrath also said that while she understands the idea of trying to cut costs, there’s been no data “that shows me that privatizing it is going to cut costs significantly.”

“Health care is expensive, no matter how you go about it,” she said. “And I fear, and I think a lot of people fear, you will lose quality of care, because now you’re switching over veteran care to the private sector, the private sector has an incentive to make money…health insurance makes money by denying care. Is that what we want?”

Restricting VA care

As CEO of the veterans organization Concerned Veterans for America, a group backed by conservative billionaires Charles and David Koch, Hegseth lobbied for providing VA health care only to veterans with service-connected disabilities and specialized needs.

That policy would significantly restrict the number of future veterans eligible for VA care at all. Hegseth’s skepticism of the wide array of government benefits veterans have at their disposal has prompted outrage from veterans’ groups.

Max Rose, an Army Reserve officer and Democratic former congressman who now serves as a senior adviser for progressive veteran organization VoteVets, called Hegseth’s remarks “massively disrespectful” to veterans, who have been trusted “to go to war, to protect the homeland, defend our rights, and our way of life – and then we think they will come home and be an abusers of health care services?”

In an interview with CNN on Wednesday, Shulkin said some of Hegseth’s ideas were not outlandish – he agrees that veterans should have some access to private care, particularly if VA wait times for an appointment are excessive. But he also said that Hegseth, as an outsider with no experience at the VA or in health care, didn’t understand the “complexities” of the system he was trying to completely reshape.

“At the time, I was telling him, ‘I’m here on the ground, I know the reality,’” he told CNN in an interview on Wednesday. “I see the patients, the veterans with PTSD. I’ve been a doctor my whole life in the private sector. I know my hospitals that I ran didn’t have the capability to care for these patients. I’m not just going to give [veterans] a voucher and say, ‘Good luck.’”

As Shulkin’s memoir demonstrates, Hegseth – and Concerned Veterans for America – has asserted significant influence over Trump on this issue. Trump considered tapping Hegseth for VA secretary in 2016, Hegseth told Ryan.

By the time Trump took office, Hegseth had already stepped down from CVA amid reported accusations of financial mismanagement, frequent drunkenness and sexual harassment, all of which Hegseth denies. Still, CVA “was at the White House on a regular basis and showing up at meetings when I hadn’t invited them,” Shulkin wrote in his memoir. “At every turn, White House staff made sure CVA was given a strong voice.”

The progressive government watchdog American Oversight also documented CVA’s influence over Trump on this issue in the early years of his first administration.

‘That is our responsibility’

Kate Kuzminski, the director of the military, veterans, and society program at the Center for a New American Security (CNAS), said there is a conversation that could be had about moving some veteran health services – particularly those services that are not for things directly linked to military service – into communities and outside of the VA. For example, an annual check-up, or getting a regular vaccination shot.

But, she said, it brings up more questions particularly about how veterans in vulnerable communities, like those with low income, could continue accessing care if the VA is no longer an option for them.

“There is a potential for individuals who need access to care, either being delayed in accessing that or not being able to access it at all … and we as a nation have philosophically said, yeah, that is our responsibility,” Kuzminski said.

When it comes to the military health system that the defense secretary directly oversees, the Pentagon this year began to re-evaluate its policy over the last decade of trying to reduce health care costs by cutting staff at military health facilities and outsourcing care to private doctors and hospitals.

That move toward privatized care was making it harder for servicemembers to access doctors because of staffing shortages at military facilities and the fact that TriCare, which allows troops and their families to access private doctors and clinics, was either not being accepted by many private providers or only allowed access to subpar facilities, a DoD inspector general report found last year.

“I can appreciate that it sounds good to advocate for people to have the most freedoms and abilities to choose,” Shulkin said. “There’s no question that that’s an important part of health care. But you have to have a system you can send them to that knows how to deal with toxic exposures and post-traumatic stress, and the injuries that were happening to our young men and women who were coming back after IED explosions, and needed that type of complex prosthetic care.”

Rose echoed the same concerns that veterans may not be able to get the kind of holistic care they may need from a civilian health provider. Problems with VA health services – of which there are examples of, “undeniably” – are “reason to build upon our existing system, not to decimate it.”

“Being able to walk into an institution and speak to someone who understands not just the experience of combat, but the experience of just being in the military – a private health care facility couldn’t replace that,” Rose said.

Kuzminski agreed there are issues the VA excels beyond civilian health care in treating, but said there has been “a lot of progress” in the last decade on electronic health records, which would allow military and civilian health providers to have a more well-rounded image of a veteran’s health care needs.

Shulkin said that he will reserve judgment on Hegseth’s nomination until he sees him address the issues of servicemember and veteran care during his confirmation hearings. But he indicated that he hopes Hegseth’s views have changed.

“I do believe that what any good leader needs to do is to be able to recognize when their opinions should change or need to change,” he said, “and then to be able to articulate and express what their vision for leading the agency actually is.”