The GAO Handed the VA 30 Priority Fixes. Veterans Pay for the Ones It Ignores.

On May 22, 2026, the Government Accountability Office — Congress’s nonpartisan auditor — released its annual letter to the Secretary of Veterans Affairs listing the recommendations it considers most urgent. The tally: 30 open priority recommendations, up from 29 the year before. In the twelve months in between, the VA closed out exactly two.

These are not bureaucratic nitpicks. GAO sorts its priority recommendations into three buckets for the VA: improving the quality and timeliness of veterans’ health care, modernizing the department’s information technology, and fixing an acquisition operation GAO has flagged as high-risk. Each one is a fix the auditor says would protect veterans, save taxpayer money, or both — and each one is still sitting open.

The most expensive of those open items is the Oracle-Cerner electronic health record — a project that started as a $10 billion contract in 2018 and now carries a lifecycle cost estimate of roughly $37billion. GAO has made 18 recommendations to fix it. The VA, by Congress’s own count, has implemented two. Veterans, meanwhile, have absorbed the failures: hundreds of patient-safety incidents and, in the VA’s own admission, four deaths tied to the new system.

• 30 — open priority recommendations GAO is pressing the VA to implement as of May 2026 — only two of the prior year's 29 were closed · Source: GAO-26-108978
• $37B — current lifecycle cost estimate for the Oracle-Cerner EHR — up from a $10 billion contract signed in 2018 · Source: Government Executive / GAO-25-108091
• 4 deaths — the VA has acknowledged were linked to its new electronic health record, alongside hundreds of patient-safety incidents · Source: FedScoop / VA Office of Inspector General

Every year the Comptroller General of the United States, Gene Dodaro, sends each major federal agency a letter flagging the GAO recommendations it should prioritize. For the VA, the 2026 letter — GAO-26-108978, signed out on May 15 and publicly released a week later — identified 30 open priority recommendations. GAO added three new ones this cycle and credited the department with implementing two of the 29 carried over from 2025.

GAO groups the recommendations under three headings it says “warrant timely and focused attention”: improving quality and timely access to health care, modernizing information technology, and enhancing acquisition management. The framing matters — these are the areas where the auditor believes the gap between what the VA promises veterans and what it delivers is widest.

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No single item in GAO’s portfolio better illustrates the cost of ignored recommendations than the VA’s electronic health record. The department signed a $10 billion contract with Cerner in May 2018 to replace its aging records system; the contract was later revised upward past $16 billion, and the most recent lifecycle estimate provided to lawmakers reached roughly $37 billion. An independent 2022 analysis for the VA pegged the ultimate cost as high as $50 billion.

In its March report, GAO concluded the VA “is making incremental improvements to the new electronic health record system, but much more remains to be done,” and pressed the department to produce an updated cost estimate and a credible integrated master schedule. In all, GAO has issued 18 recommendations on the EHR program, 12 of them designated priorities. At a December 2025 House subcommittee hearing, GAO testimony indicated the department had not fully implemented 16 of those 18.

“VA is making incremental improvements to the new electronic health record system, but much more remains to be done.”

U.S. Government Accountability Office · GAO-25-108091

The price tag is the abstract part. The concrete part is what happened to patients. The VA has acknowledged that issues with the Oracle-Cerner system contributed to four veteran deaths — one at the Mann-Grandstaff VA Medical Center in Spokane, where the system first launched, and three in central Ohio after the April 2022 go-live. A VA Office of Inspector General review found the system failed to deliver more than 11,000 orders for specialty care, lab work, and other services, causing nearly 150 cases of patient harm at Spokane alone.

Between October 2020 and March 2024, the EHR logged 826 “major” performance incidents — outages, slowdowns, and incomplete functionality. As recently as December 2025, VA staff were flagging dangerous errors to a federal watchdog just ahead of the renewed rollout. The problems GAO has been documenting for years are the same ones front-line clinicians keep reporting from inside the hospitals.

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After a three-year pause that began in April 2023, the VA restarted EHR deployments in April 2026, bringing the system live at four Michigan health systems — Ann Arbor, Battle Creek, Detroit, and Saginaw. VA Secretary Doug Collins (R), confirmed at the start of the Trump administration, has pushed an accelerated schedule: nine more sites in Indiana, Kentucky, Ohio, and Alaska across 2026, with the department aiming for 20 to 25 facilities in 2027 and full deployment as soon as 2031.

That acceleration is exactly what worries the auditors. GAO’s open recommendations on cost estimating, scheduling, user satisfaction, training, and trouble-ticket resolution were written for a slower rollout. Pressing forward to more hospitals while those fixes remain open, GAO and members of both parties have warned, risks repeating Spokane at scale. The Trump administration’s budget has matched the ambition with money — a $3.5 billion EHR request for FY26 and roughly $4.2 billion for FY27.

“The clock is ticking down in Michigan for this to go live, and the time for promises is over.”

Rep. Tom Barrett (R-MI), Technology Modernization Subcommittee chair · December 2025

The EHR is the headline, but GAO’s priority list reaches further. In January 2026, GAO separately identified 38 open recommendations under the VA Chief Information Officer alone, four of them priorities. Other open work covers the Veterans Community Care Program — the network of private providers that now serves about 2.8 million veterans, up from roughly 1.1 million in 2014 — where GAO has pushed for better oversight of access and timeliness.

GAO has also flagged how the VA estimates its health-care funding, warning that weak processes could leave the department short or over-budgeted, and it has urged the VA to align its acquisition reorganization with leading practices — the same acquisition function GAO keeps on its high-risk list. Each open recommendation is a documented gap between current practice and what the auditor says veterans are owed.

GAO is not a partisan operation, and its letter is not an indictment — it is a checklist. But a checklist that grows year over year tells its own story: 29 priority items in 2025, 30 in 2026, two closed in between. The recommendations exist because, in GAO’s judgment, the VA could be safer, faster, and cheaper for veterans than it currently is — and isn’t, because the fixes keep getting deferred.

The accelerated EHR rollout will be the test. If the VA can close GAO’s open recommendations before it brings the Oracle-Cerner system to dozens more hospitals, the next letter should get shorter. If it doesn’t — if the rollout outruns the fixes — the people who absorb the difference will be the veterans waiting on a lab order that the system never delivered.

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Last updated June 7, 2026