The value of federal government contracts with temporary help service agencies has more than doubled under the Trump administration, according to a new report.

The study by the National Employment Law Project, a nonprofit that advocates worker rights, found the government spent $1.7 billion on the contracts in 2018, five times the amount it spent in 2008. The largest increase came in the past two years — from $812 million in 2016 to $1.7 billion in 2018.

“The Trump administration’s desire to privatize government-provided healthcare services is the largest factor driving increased use of temporary help services,” the report stated. Such contracts cover traveling doctors and nurses, as well as contract dentists, pharmacists, therapists, social workers and medical billing staffers.

This is especially true at five agencies: The Veterans Administration, the Indian Health Service, the Department of Defense, the Bureau of Prisons, and the Federal Occupational Health clinics. Healthcare-related temporary help service contracts for these five entities totaled $884 million in 2018, accounting for 47% of all federal temporary help contracts last year. That is a dramatic jump from 2008, when similar contracts for these five agencies totaled just $69.3 million; The increase, totaling $814.7 million represents 59% of all new federal temporary help contracts in the past decade.

The White House Office of Management and Budget defended the use of contractors, saying they are needed “to bridge staffing shortages or to bring in highly-specialized labor for specific projects,” The Washington Post reported. Using the Department of Veterans Affairs’ 50,000 medical professional vacancies as an example, the budget office said employing contractors “to fill that immediate need ensures our veterans can get the care they need and deserve.” Statements from the Indian Health Service, which is a division of the Department of Health and Human Services, and the Bureau of Prisons made similar points.