The Dead

Chapter 2 of The Briefing: Tom Emmer (R-MN-06), Part One — The Cost.

More than 33,000 veterans live in Minnesota’s Sixth Congressional District. The nearest major VA medical center is in St. Cloud — about an hour’s drive from much of the district.

As of 2025, the average wait time for a new outpatient surgical appointment at the VA is 41 days — 13 days longer than the department’s own target. Some veterans drive hours to the nearest VA facility only to learn that the specialist they need has not been replaced since the last one left.

Every one of the VA’s 139 medical facilities reported severe occupational staffing shortages in 2025. Every single one. 94% cannot hire enough doctors. 79% cannot hire enough nurses. More than 64,000 positions sit vacant. In December 2025, instead of filling them, the VA announced plans to eliminate approximately 35,000 of those unfilled roles — including 4,900 nursing positions and 1,500 physician slots.

The shortage is not new. The VA has struggled to recruit and retain medical staff for decades, under administrations of both parties, through multiple reform efforts. The scale of the current crisis is new.

Veterans treated at VA facilities are 20% more likely to survive than veterans treated elsewhere, after adjusting for patient health, demographics, and prior care. Every one of the 64,000 unfilled positions is a gap between a veteran and that care.

On July 15, 2025, Congressman Emmer introduced the Veterans Burial Accountability Act. The problem it addresses is real: when a veteran dies in a VA facility, the VA clinician must sign the death certificate. But the clinicians are overworked — the same staffing shortage that delayed the veteran’s care in life delays their paperwork in death. Families wait weeks. They cannot bury their loved one. They cannot access survivor benefits. They cannot begin to move forward.

Emmer’s bill requires the VA to issue a death certificate within 48 hours. If the VA clinician cannot sign it in time, a local coroner or medical examiner may sign it instead.

“Our duty to our veterans must not end with their final breath,” he said.

The bill does not hire a doctor. It does not fund a nurse. It does not fill any of the 64,000 vacant positions that caused the delays it addresses. It addresses the delay. The staffing shortage continues.

There was another bill. It was called the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022. It is named for an Ohio National Guard combat medic who served in Kosovo and Iraq — twice named his unit’s NCO of the Year. He was diagnosed with a rare lung cancer linked to burn pit exposure in 2017. He died in 2020. He was 39 years old. He left a wife and a daughter.

The PACT Act was the single largest expansion of VA healthcare in more than thirty years. It expanded eligibility to 3.5 million veterans exposed to burn pits and other toxic substances. It established more than twenty presumptive conditions so veterans would no longer have to prove a direct connection between their illness and their service. It created a dedicated fund to cover the cost of care. And it funded the hiring — 62,000 new VA employees in 2023 alone.

The bill was bipartisan. In the Senate, it was co-led by Senator Jon Tester and Senator Jerry Moran — a Republican from Kansas. The final House vote was 342 to 88. The majority of Republicans voted yes. All 88 no votes were Republican.

A bipartisan bill, co-authored by a Republican senator, named after a soldier who died from burn pit exposure, backed by a majority of his own party. Tom Emmer voted no.

He had already voted no on the earlier version.

A review of his official press releases, floor statements, and media coverage yielded no public statement explaining his vote.

In the two years after the PACT Act became law, nearly 740,000 veterans enrolled in VA healthcare. More than 1.65 million claims were filed. Over one million were granted. The VA delivered $5.7 billion in earned benefits to veterans and their survivors.

His other veterans legislation addressed oversight and recognition. The VA Accountability First Act and Same-Day Accountability Veterans Enhancement Act focused on personnel accountability procedures at the VA. The Atomic Veterans Service Medal Act authorized a medal for veterans exposed to nuclear testing. None funded a new position or expanded access to care.

The most serious defense of his PACT Act vote is fiscal. The Congressional Budget Office scored the bill at $277 billion over ten years — roughly $27.7 billion a year. The strongest version of the argument, made by Senator Pat Toomey and shared by fiscal conservatives in both chambers, was that the bill’s shift from discretionary to mandatory spending would create a “slush fund” for unrelated programs. The concern was structural: mandatory spending, once established, is harder to control than discretionary appropriations. Congress loses the ability to adjust funding year by year. For legislators who believe federal spending must be actively governed, the mechanism mattered as much as the cause.

Fiscal responsibility is a principle, and principles apply even to sympathetic causes.

In April 2022 — between his two PACT Act votes — Emmer called for action against “our nation’s spending addiction.”

Three years later, on May 22, 2025, Tom Emmer — the Majority Whip, the man whose job is to deliver the votes — whipped the One Big Beautiful Bill Act through the House, 215 to 214. One vote. The bill does not pass without him. The bill is a budget reconciliation package covering tax policy, border security, energy, and defense — the kind of omnibus legislation that defines a congressional majority’s priorities.

The CBO estimated the bill would add $3.1 to $4.7 trillion to federal deficits over the next decade. Among its provisions: an extension and expansion of the 2017 tax cuts. The Joint Committee on Taxation estimated that nearly one quarter of the bill’s tax benefits would go to the top 1% of earners.

The bill includes tax deductions for tips and overtime — provisions that would directly benefit workers in the district. Those deductions expire in 2028. The corporate tax rate, the estate tax exemption, the business deductions — those are permanent.

The median household income in Minnesota’s Sixth Congressional District is $98,171.

The veteran served. The veteran came home. The VA could not see them — 64,000 vacancies, months-long waits. The care that reduces mortality by 20% never reached them. And then the system that could not treat them could not sign their death certificate either.

Their congressman introduced a bill to let someone else sign the death certificate. He voted against the bill that hired the doctors.

Sources

PACT Act roll calls — Roll 57 (March 3, 2022), Roll 309 (July 13, 2022), via house.gov. VA staffing — VA Office of Inspector General; GAO. VA mortality studies — NIH (peer-reviewed, risk-adjusted). PACT Act impact — VA.gov. PACT Act opposition — Sen. Pat Toomey floor statement. One Big Beautiful Bill Act — CBO; Joint Committee on Taxation (JCX-36-25); house.gov. Veterans Burial Accountability Act — house.gov press release, July 15, 2025. MN-06 veterans — Census ACS 2022.