Darlene Fore is terrified. She’s a nurse at the Veterans Affairs Medical Center in Asheville: a hard, but stable, federal job. Last year, her family was devastated by Tropical Storm Helene. Now, as she reaches 60 years old, her job, and her retirement benefits, could be taken away at any moment.
So too her union rights to bargain.
Veterans Affairs, the federal agency responsible for providing veterans’ health care, benefits and support services, is cutting staffing by 15% in the name of efficiency.
That means nearly 2,600 people out of a job in North Carolina alone. And more than 72,000 nationwide.
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Fore is not a bedside nurse in Asheville. She reviews charts for medical documentation to judge whether a veteran should be billed for services, asking questions like: Should this person still be in the hospital? Why is this person’s chest pain not going away? Is the doctor following the right care plan?
It’s exactly the kind of behind-the-scenes job President Donald Trump intends to cut.
Some worry that this reduction in force — coupled with an executive order barring federal workers from organizing — will diminish the quality of health care for North Carolina’s 615,000 veterans and their families. North Carolina is the ninth-most populated state, but has the eighth-largest population of veterans.
Others genuinely believe the federal agency is bloated, and that a long, hard look at that bloat will directly benefit veterans: less bureaucracy and waste will mean that veterans are connected with the services they need more quickly.
For Fore, it’s a question of livelihood.
“The thing that bothers me the most is my countrymen saying I’m not worth it,” Fore told Carolina Public Press. “I’m the same nurse who worked in their local hospitals and local health departments. I’m the same nurse who’s always been there for them all this time, and now, all of a sudden, they think I’m a waste of money. I’m furious about that. I’m extremely hurt by my community.”
The Asheville VA is one of the largest employers in Western North Carolina. Since Tropical Storm Helene devastated the area last September, unemployment rates in the area have skyrocketed. The loss of even more jobs is a frightening prospect.
Fore’s daughter and sister both lost their homes in Helene. She is working not only to support herself but to help her family get back on their feet.
On the other side of the equation are the veterans themselves, who come to the VA to receive care. One of these is state Rep. Eric Ager, D-Buncombe, who served in the Navy from 1996 to 2021.
“The VA is more than just a place to show up and get medical service,” Ager told CPP. “It’s a place to support the whole veteran. The VA in Asheville is such a welcoming environment: people have the time to talk to people. That’s not something you see in the regular medical community.
“I’m worried that the cuts will make the workforce at the VA more stressed out and give them less time to actually engage with veterans who need that. Veterans should feel like they’re welcome in a place, as opposed to just getting run through like a number.”
It’s not just Asheville. The VA operates medical centers in Fayetteville, Salisbury and Durham as well.
Ann Marie Patterson-Powell, a nurse at the Durham VA, thinks that cuts anywhere in the system will make bedside nurses’ and doctors’ jobs harder. They will be the ones to pick up the slack, leaving them with less time to actually treat patients.
The right to unionize and bargain is extremely important to Patterson-Powell, who is a union leader for National Nurses United. In her view, VA nurses stand up for veterans, and the union stands up for VA nurses.
Now, President Trump wants to strip federal workers of their union rights.
“You don’t get to do that — to tell me I’m not a part of an organization that keeps me safe at work — even if you are the President of the United States,” Patterson-Powell said.
She is outraged on behalf of the veterans she serves.
“We should all feel shocked and disappointed,” Patterson-Powell said. “The level of disrespect for people who put on a uniform and risked their lives to defend this country is just wrong. Someone has to stand up for them.”
In 2024, the Office of Inspector General determined that the VA was suffering from severe occupational staffing shortages. Before any cuts were proposed, 82% of VA facilities reported nurse shortages. Now, the worry is that wait times and barriers to specialty care will increase even further for veterans.
The current VA leadership doesn’t see it that way.
“As we reform VA, we are guided by the fact that, even though the Biden Administration astronomically grew the department’s budget and number of employees, VA wait times and backlogs increased,” wrote VA press secretary Pete Kasperowicz.
“We are doing things differently. Our goal is to increase productivity, eliminate waste and bureaucracy, increase efficiency and improve health care and benefits to Veterans. We will accomplish this without making cuts to health care or benefits to Veterans or VA beneficiaries.”
Some veterans in North Carolina tentatively agree with this view. One of these is Shawn Kane, chief medical officer at UNC THRIVE, a health program for veterans.
Kane thinks that cuts could be beneficial if they target redundancy, cutting administrative or ancillary positions, while redirecting that saved money directly to patient care. Some old-fashioned inefficiencies exist, like excessive snail-mail appointment reminders, that could be modernized to save money, Kane said.
Detailed, targeted cuts really could improve the system, he thinks. But he isn’t sure that’s what’s in store.
“The devil is in the details,” Kane said.
“The bottom line is that if inappropriate cuts are made, there can be a drastic impact on the provision of health care access across the VA, in North Carolina and across the country. It comes down to nuance, and trying to stay apolitical. But currently, the leaders in our government are not very good at details.”
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