But CVA is proving to be an influential force in the incoming Trump administration.
The leading candidates to run the sprawling Department of Veterans Affairs, the second-largest federal agency, have close ties to the group. A senior CVA adviser and a former adviser to the groop serve on the transition team. And as the Trump campaign crafted its blueprint for VA, it drew heavily from the group’s vision of a health-care system with a drastically smaller government footprint and a fast route to firing poor performers.
Traditional veterans advocates are alarmed by CVA’s rising profile in Trump’s orbit and in Congress. They reject its highest-profile proposal, to allow veterans to see doctors of their choosing outside VA medical system — an idea Trump embraced on the campaign trail. They’ve assailed this model as a first step toward turning the system over to the private sector, a change they say would lead to its collapse.
On Thursday, these tensions spilled into public view after a meeting between top transition officials and 31 veterans groups. While participants described a cordial “listening” session with 10 Trump staffers, leaders of some of the largest service organizations said they made it clear they will furiously oppose any effort to privatize veterans’ health care.
“It’s a slap in the face to what we stand for,” said American Legion Executive Director Verna Jones, whose group hosted the two-hour meeting in downtown Washington.
The established veterans organizations that have long dominated policy debates in Washington are not opposed to allowing for outside medical care when VA cannot provide it, a practice now used for specialty care. But they are pledging a united front against changes they view as a privatization effort led by CVA.
“You ain’t seen nothing yet if you send people to the private sector,” said Rick Weidman, legislative director of the Vietnam Veterans of America, noting that CVA’s proposal does nothing to address a shortage of doctors nationwide and would cost more than government care.
“Who is going to coordinate veterans’ care?” he asked. “That should be VA. Let VA be VA.”
CVA officials say their critics misrepresent their goals, which they say are not to privatize or dismantle VA but rather to give veterans more options for care.
“We’re big advocates of giving them more health-care choices,” said Dan Caldwell, the group’s vice president of policy and communications.
Leaders of traditional veterans groups expressed confidence Thursday that they will be able to influence policy during the Trump administration.
“They’re a small group with one opinion whose influence is growing,” Jones said of CVA, but she said public opinion is on the side of the large service organizations.
CVA is aligned with the American Legion and other organizations on the need for VA to address several problems, including chronic benefit backlogs, delays to patient care and a lack of accountability for VA employees who break the rules.
But in contrast with those groups, its mission is more political advocacy than helping veterans gain access to benefits and services.
Started in 2012, CVA found its voice two years later when VA managers in Phoenix and other cities were found to have instructed their staffs to falsify patient scheduling lists to cover up long wait times for care.
The group is part of a network of politically active nonprofit groups backed by the industrialist Koch brothers and other wealthy conservative donors. The Kochs have been a political lightning rod for years, drawing Democrats’s ire for using their wealth and political network to push a small-government agenda and influence Republicans.
This year, the network planned to invest about $250 million in political and policy campaigns run by CVA and affiliated advocacy groups such as Americans for Prosperity, the Libre Initiative and Generation Opportunity. CVA officials said they do not disclose individual donors.
While the Koch operation disavowed Trump during the campaign, condemning his calls for a ban on Muslim immigration, CVA sponsored numerous town-hall meetings during the presidential primaries and spent $3.5 million on GOP Senate races, including the winning campaigns of Patrick J. Toomey (Pa.) and Marco Rubio (Fla.)
The group’s influence can be seen in two of the top contenders emerging to run VA. Trump met this week with Pete Hegseth, a Fox News contributor, Iraq War veteran and former president and chief executive of CVA.
The group also has worked closely with retiring House Veterans’ Affairs Committee Chairman Jeff Miller (R-Fla.), who Trump has said he is also considering for secretary. Miller shares CVA’s commitment to faster discipline for employees and a smaller bureaucracy.
Other candidates for the secretary post include former senator Scott Brown (R-Mass.), who retired in 2014 as a colonel in the Massachusetts National Guard, and former Alaska governor Sarah Palin, whose name surfaced this week in news reports.
Like other groups, CVA has not formally endorsed a candidate for the secretary job.
“What we’re looking for is a high-energy type of individual who is unrelenting in their fight to reform VA,” Caldwell said. “Otherwise, VA bureaucracy will grind them down.”
Miller and Hegseth have been outspoken critics of the Obama administration after the wait-times scandal. They have also denounced VA’s employee union as a defender of incompetent workers and those who break the rules.
Miller, 57, was an early Trump endorser. A former real estate agent and TV weatherman, he was a deputy sheriff in Florida before his election to Congress. He would be the first secretary of the VA in its 27-year history as a Cabinet-level department who did not serve in the military.
Miller, asked about his candidacy, said in an interview that “you don’t want to speculate on anything like this.”
As a former major in the Army National Guard, Hegseth, 36, could appeal to younger veterans from the wars in Iraq and Afghanistan. He ran unsuccessfully for the GOP nomination for a Senate seat in Minnesota in 2012 and was briefly chief executive of another group called Vets for Freedom.
Hegseth resigned from CVA this year amid rumors of personality differences with the group’s backers, but Caldwell denied any friction. Hegseth did not respond to an email seeking comment on his discussions with Trump.
The transition team includes Darin Selnick, a senior adviser to CVA who served at VA in the George W. Bush administration, and Amber Smith, a Fox contributor and former CVA adviser.
Selnick co-authored a report the group released this year, with some Democratic support, called “Fixing Veterans Health Care” that calls for turning the current system into a government-chartered nonprofit corporation that would oversee construction and health insurance programs. It also advocates tightening eligibility for VA health care to give more support to disabled veterans, “to reorient VA health care system back toward its original mission of caring for the veterans with service-connected disabilities.”
After Rep. Cathy McMorris Rodgers (R-Wash.), chairman of the House Republican Conference, laid out a plan that drew from the report, more than two dozen veterans groups sent her letter in opposition, according to a report in the trade magazine Government Executive. The letter said the changes would inflict “immediate and permanent negative consequences for millions of veterans.”
The next VA leader will inherit a sprawling bureaucracy with about 350,000 employees, an $82 billion budget, almost 2,000 clinics and medical centers and a long list of challenges. They include a shortage of doctors and nurses, aging computer networks and increasing demand for care from 6 million veterans.
“I think once his team encounters the operational risks of VA, they’re going to be sobered,” a former senior VA official said of the Trump team, speaking on the condition of anonymity to talk candidly.
VA has been praised by some advocates for improving veterans’ access to care under President Obama and restoring the agency’s morale after the Phoenix scandal.
Advocates say they are expecting Trump — who said illegal immigrants are “treated better” than veterans — to follow through on his campaign promise.
“This could be the most dramatic shake-up at VA in history, and I think that’s what we’re bracing for and we’re preparing for,” said Paul Rieckhoff, chief executive of Iraq and Afghanistan Veterans of America, a more moderate voice for younger veterans.
Trump and his senior officials have released only a broad sketch of his plan for VA. The 10-point plan he released in July pledged to press for legislation to empower the secretary to discipline or terminate anyone who jeopardizes the health of a veteran and to create a commission to investigate wrongdoing and coverups. Trump also said he would protect whistleblowers, hire more mental-health experts and set up a White House hotline to answer veterans’ complaints.
A complication for the incoming Trump administration is that providing more private care outside the system will cost more money in the short term, say experts who have studied the issue. A VA report on veterans health care estimated this year that treating veterans in the private sector would cost $450 billion by 2034, almost four times what the government spends.
“You can increase access or you can save money, but you can’t do both,” said Phillip Carter, a veteran of the war in Iraq and senior fellow at the Center for a New American Security, focusing on veterans.
Karoun Demirjian and Matea Gold contributed to this report.