A plan by the incoming Trump administration to slash government funding could kneecap Department of Veterans Affairs health care.

In an op-ed for the Wall Street Journal this week, Elon Musk and Vivek Ramaswamy, who President-elect Donald Trump tapped to lead the so-called “Department of Government Efficiency,” confirmed that they plan to target “unauthorized” federal spending, a category that includes the VA’s medical services.

“DOGE will help end federal overspending by taking aim at the $500 billion-plus in annual federal expenditures that are unauthorized by Congress or being used in ways that Congress never intended,” they wrote, specifically citing funding for nonprofit grants and PBS.

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The pair did not specifically call out the VA. But the type of spending they’re taking issue with includes about $120 billion for the VA’s medical services, according to a report issued earlier this year from the Congressional Budget Office.

Historically, in order for a federal agency to operate, Congress passes two different types of legislation: an authorization bill to authorize funding and an appropriations bill to actually allocate the funding.

For example, for the Pentagon, Congress passes the National Defense Authorization Act and a Pentagon appropriations bill every year.

But for most federal agencies, Congress hasn’t bothered with the authorization bills in years, instead streamlining its work by considering the appropriations bills to be self-authorizing.

A 2023 report from the Congressional Research Service notes the distinction between authorization and appropriations bills “is based on chamber rules, rather than a constitutional or general statutory requirement.”

For VA medical services, the last authorization bill was 1996’s Veterans Health Care Eligibility Reform Act, according to the Congressional Budget Office report.

The op-ed from Musk and Ramaswamy about their plans for DOGE, which is the same name as a cryptocurrency Musk has previously touted, confirmed they will pursue an idea Ramaswamy first floated on social media last week.

“We can and should save hundreds of billions each year by defunding government programs that Congress no longer authorizes,” he wrote on X, previously known as Twitter. “We’ll challenge any politician who disagrees to defend the other side.”

Asked about the DOGE proposal at a hearing Wednesday, VA Under Secretary for Health Shereef Elnahal said he would be “highly concerned” about any cuts to the agency and that the department’s lawyers believe it has the legal authority to operate.

Veterans’ demand for care is “actually substationally increasing,” said Elnahal, a Biden administration appointee. “Despite these increases in demand, we’ve seen wait times go down, instead of up, for primary care and mental health. We’ve seen historic performance on quality, patient safety, veterans satisfaction and trust. We want to make sure we maintain those outcomes while we provide accessible high-quality care to vets.”

Lawmakers in both parties have already promised to protect the VA.

“If Republicans in the majority follow through on Ramaswamy’s wishes, it will mean that veterans would no longer be eligible for in-patient services, like surgeries, acute care and injuries that may require urgent care, and out-patient services, like health appointments, immunizations and nutrition and education,” Rep. Debbie Wasserman Schultz, D-Fla., the ranking member of the House Appropriations Committee’s VA subcommittee, said at the hearing before asking Elnahal about DOGE.

Later in the hearing, subcommittee Chairman John Carter, R-Texas, assured that he’s “not going to be standing for anybody trying to abolish anything to do with our Veterans Administration.”

Proposing to cut unauthorized appropriations is “an amateur’s comment,” he added.

“We all are here to support the veterans of our country, and there’s no one on this committee that is trying to do anything to wipe out our veterans or the veteran care. And we will be soldiers in the field fighting on your behalf if something like that comes along,” Carter said.

But in their op-ed, Musk and Ramaswamy also said they plan to circumvent Congress. While a 1974 law called the Impoundment Control Act generally requires a president to spend money that Congress appropriates, the pair noted Trump opposes that law. Trump ignoring that law was part of his first impeachment over withholding congressionally approved aid to Ukraine.

“Mr. Trump has previously suggested this statute is unconstitutional,” they wrote, “and we believe the current Supreme Court would likely side with him on this question.”

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