The health and well-being of veterans have always been a top priority for the Department of Veterans Affairs (VA). Under the leadership of Shereef Elnahal, the current Under Secretary for Health, the VA has seen unprecedented growth and reform, particularly through the expansion of health care and benefits under the 2022 Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act. This legislation has transformed the VA’s ability to serve veterans, expanding eligibility and reducing barriers to care while also improving productivity and reducing wait times for the millions who rely on the system for their healthcare needs.
Signed into law on August 10, 2022, Shereef Elnahal understands that the PACT Act represents the largest expansion of veteran health care and benefits in a generation. Designed to address the long-overlooked issue of toxic exposure during military service, the act extends coverage to veterans from any era who were exposed to hazardous materials such as Agent Orange, burn pits, and other toxins during their time in the service. The importance of this act cannot be overstated, as it aims to provide long-overdue care to veterans who have suffered from illnesses directly related to their service.
According to the JAMA article that reviews the implementation of the PACT Act, the legislation has introduced sweeping reforms, including expanding the enrollment windows for post-9/11 combat veterans and extending presumptive service-connection for a wide range of conditions related to toxic exposure. Shereef Elnahal understands that veterans who may have previously been denied care now have the opportunity to enroll and receive necessary treatments, bringing much-needed relief to those who have suffered from the long-term health effects of their service.
Under Shereef Elnahal’s leadership, the VA has aggressively pursued implementing the PACT Act, launching national awareness campaigns, and ensuring newly eligible veterans know about the expanded benefits. Between August 2022 and June 2024, more than 680,000 veterans enrolled in VA health care—a significant increase of over 87,000 from the prior 21-month period. These efforts are particularly noteworthy given the size and complexity of the VA system, the largest integrated healthcare system in the United States.
More than 300,000 of these new enrollees come from PACT Act-eligible cohorts, highlighting the importance of this legislation in expanding access to care. Nearly two-thirds of these veterans were placed in the highest priority groups (Groups 1, 2, or 3), allowing them to access the most comprehensive health benefits available within the VA. Furthermore, approximately 5.6 million veterans have undergone toxic hazard exposure screenings as of June 2024, ensuring that they are informed about their eligibility for VA care and benefits related to toxic exposure.
One of the most significant challenges facing the VA has been the issue of long wait times for veterans seeking care. This issue has plagued the system for years, but during Shereef Elnahal’s tenure, there has been remarkable progress in reducing these delays. By implementing the PACT Act’s provisions and investing in additional resources, the VA has improved access to timely care for veterans nationwide.
According to a recent report, the average wait time for new patients seeking primary care at VA facilities has decreased by 11% compared to the previous year. Mental health care wait times have also dropped by 7%, an especially important improvement considering the high demand for mental health services among veterans. Additionally, the VA has increased the total number of medical appointments by 11% year-over-year, including a 13% rise in mental health appointments for new patients. This achievement is particularly impressive given the increased demand for services stemming from the aging veteran population and the influx of new enrollees under the PACT Act.
To meet the growing service demand, the VA has also focused on bolstering its workforce and modernizing its infrastructure. The PACT Act authorized broader recruitment and retention tools for VA employees, such as higher pay caps and additional hiring incentives, allowing the VA to hire nearly 62,000 employees in fiscal year 2023 alone. This growth rate is the highest the VA has experienced in 15 years and has helped the department manage the surge in patient volume more effectively.
The VA’s ability to recruit and retain high-quality healthcare professionals has also directly impacted patient outcomes and satisfaction. For example, 58% of VA medical centers now hold four- or five-star ratings from the Centers for Medicare and Medicaid Services (CMS), outperforming non-VA hospitals in many regions nationwide. This demonstrates an improvement in access to care and a commitment to maintaining high standards of care quality and patient safety.
Another key aspect of Shereef Elnahal’s approach to expanding veteran care has been increasing access to community-based services and telehealth options. Veterans who live far from VA facilities or require more timely care can now access care through community providers, thanks to expanded eligibility under the 2018 Mission Act and continued efforts under the PACT Act. Between 2019 and 2024, the number of veterans accessing community care has increased by 45%, with a 16% rise in referrals to community providers in the past year alone.
Telehealth has also seen significant growth, particularly in the wake of the COVID-19 pandemic. It continues to play a vital role in ensuring that veterans can access care from the comfort of their homes. VA telehealth appointments increased by nearly 15% in fiscal year 2023, further reducing the burden on VA facilities and allowing veterans to receive timely care without long travel distances or extensive wait times.
Despite these impressive achievements, challenges are still ahead for the VA and its leadership. Shereef Elnahal and his team have emphasized the need for additional funding to sustain the growth in services and ensure that veterans do not face longer wait times. The VA has requested additional budget for fiscal year 2025 to help cover the rising costs of pharmaceuticals, prosthetics, and additional staff necessary to meet the increasing demand for care.
Without these funds, the VA may be forced to make difficult trade-offs, such as delaying payments to veterans or scaling back on critical services. Shereef Elnahal has taken full responsibility for ensuring that the VA meets its obligations to veterans, and he remains focused on finding solutions to these challenges while continuing to improve productivity and reduce wait times.
Under Shereef Elnahal’s leadership, the VA has made historic strides in expanding health care and benefits for veterans, particularly through implementing the PACT Act. This transformative legislation has provided millions of veterans with the care and benefits they deserve while also improving the productivity and efficiency of the VA system. While challenges remain, Dr. Elnahal’s commitment to innovation, workforce development, and reducing barriers to care ensures that the VA will continue serving veterans effectively for years.
