Former Representative Doug Collins, President Trump’s nominee to lead the Veterans Affairs Department, told lawmakers in a confirmation hearing on Tuesday that he would defend a program that allows veterans to seek health services outside the V.A. medical system.
That program, introduced in Mr. Trump’s first term, allows more veterans who would need to travel longer distances to a V.A. facility to receive primary care and mental health services outside the agency’s system, a major shift.
Republicans have been critical of bureaucratic procedures that they say deprive veterans of access to more convenient care outside of V.A. facilities, violating the spirit of the initiative. Mr. Collins was repeatedly pressed on his commitment to the program during his more than two-hour hearing before the Senate Veterans’ Affairs Committee.
“The V.A. does not exist in and of itself. It exists for the veteran,” Mr. Collins said, adding that he believed its intent “was to make sure that the delivery of services to the veteran is first and foremost.”
Lawmakers also questioned Mr. Collins about how he would approach some of the department’s more intractable issues, such as its severe budget constraints and the need to overhaul outdated V.A. medical facilities.
Like many of Mr. Trump’s other cabinet selections, including Pete Hegseth, his nominee to oversee the Defense Department, Mr. Collins reflects the new president’s priorities for agency leadership in his second term, with personal loyalty central to each selection. Mr. Collins, a fast-talking Navy veteran, Air Force Reserve chaplain and former pastor, played a lead role defending Mr. Trump during his first impeachment investigation.
Mr. Collins is not expected to face a difficult confirmation fight, in part because of the bipartisan and apolitical nature of much of the department’s work managing a sprawling health system and veterans’ benefits. Mr. Collins’s hearing on Tuesday lacked the partisan tensions that boiled over during recent confirmation hearings for Mr. Hegseth and some of Mr. Trump’s other cabinet picks. Some Democrats on the panel said that they looked forward to working with him.
Dr. David Shulkin, the former V.A. secretary who was the lone Obama administration holdover in Mr. Trump’s first-term cabinet before being pushed out of the job, said in an interview that Mr. Collins would likely inherit many parts of the agenda of his predecessor, Denis McDonough.
“Because the issues the V.A. deals with are systemic and complex, and unfortunately the same ones that were there when the last secretary was in,” Dr. Shulkin said.
Mr. Collins is in some ways an unusual choice. Previous V.A. secretaries have had long military careers, or held senior roles at the Defense Department or the Veterans Affairs Department itself. In the House, Mr. Collins did not serve on the Veterans’ Affairs or Armed Services Committees.
As a member of the Air Force Reserve, Mr. Collins deployed to Iraq, visiting with injured service members at Balad Air Base.
Even with his zealous defense of Mr. Trump during his first term, Mr. Collins nurtured a reputation for working with Democrats, coauthoring criminal justice reform legislation with Representative Hakeem Jeffries of New York, now the top House Democrat.
Some of Mr. Collins’s duties at the Veterans Affairs Department may involve divisive health care policies. A second Trump administration may seek to reverse a Biden administration rule allowing the department to provide abortions to veterans when a pregnancy resulted from rape or incest, or when the life of a pregnant woman is at risk.
“We will look at this rule and see if it complies with the law,” Mr. Collins said on Tuesday.
But much of Mr. Collins’s portfolio would involve challenges that have trailed past secretaries of both Republican and Democratic administrations, including behavioral health access.
A report published by the department last month showed that there had been more than 6,400 suicides among veterans in 2022, fewer than 12 of the 14 prior years but a slight increase from the year before.
Dr. Shulkin said that atop Mr. Collins’s list of priorities would be a budget deficit that has caused the department to slow hiring. That has risked the V.A.’s ability to care for the nearly 900,000 veterans brought into the system through legislation signed by Mr. Biden that expanded medical benefits for veterans exposed to toxins from burning pits of trash on military bases.
Democrats on the panel raised concerns about potential cuts to the V.A.’s budget that Congress might seek this year; how Mr. Trump’s Elon Musk-led cost-slashing effort might target the agency; and what impact a federal hiring freeze ordered by Mr. Trump could have on an already overburdened work force.
“We’re not going to sacrifice the veterans’ benefits to do a budget,” Mr. Collins told Senator Elissa Slotkin, Democrat of Michigan.
Mr. Collins was repeatedly asked on Tuesday about his views of private medical care for veterans, which typically must be approved by the department. Senate Republicans had expressed concerns that under the Biden administration, some veterans were denied coverage while seeking to take advantage of that option.
They sought assurances on Tuesday from Mr. Collins that he would defend it. Senator Tim Sheehy, Republican of Montana, said that some veterans in his state faced a more than five-hour drive to reach the nearest V.A. facility.
“So I want to make sure that we actually take action to ensure that veterans can go into the community and get care they need,” he said.
Critics have said that a program that encourages veterans to go outside the V.A. system could compromise its integrity, and lead to worse outcomes.
“There’s this ‘grass is greener on the other side of the field’ sensibility to it,” Joe Plenzler, a retired Marine Corps officer and veterans’ advocate, said. “What the data show is that when veterans get care at the V.A., they’re happier with it and get better-quality care.”
Senator Bernie Sanders, a Vermont independent, said that veterans in his state usually came away satisfied with their department-administered care.
But he noted that the costs of veteran care in the community had exploded from $8 billion to more $30 billion between 2014 and 2024, meaning there was not enough money to fund both a strong V.A. health system and good health coverage outside of it.
“What the debate comes down to is not whether somebody should be able to access community care, but where are we going to put our resources?” Mr. Sanders said. “Are we going to allow the V.A. to wither on the vine?”
Like past secretaries, Mr. Collins will also need to tend to aging V.A. facilities with outdated medical equipment and record-keeping systems. Lawmakers on Tuesday noted that veterans often had to call specific V.A. clinics themselves to schedule appointments. The department oversees roughly 1,200 sites across the country that serve almost nine million veterans.
Senator Maggie Hassan, a New Hampshire Democrat, told him of pipes that had burst in a post-World War II-era Manchester, N.H., facility, causing the center to close for months, delaying surgeries.
Mr. Collins said that renovating the facilities would involve a “bureaucratic process,” with “major work just to hold the computer systems.”
“Construction issues are going to be one of our hardest,” he added.
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