The period between the election and the inauguration of a new U.S. president can be chaotic with new announcements for key positions coming in nearly every day. Because the media tends to focus on cabinet seats with broader powers, like Attorney General, Secretary of State or Secretary of Defense, it’s not unusual for the selection of a new Secretary of Veterans Affairs to go largely unnoticed.
But after passing on several other viable candidates — like Cleveland Clinic CEO Toby Cosgrove or Luis Quinonez, who took himself out of the running for the cabinet position — President Trump’s choice of Dr. David Shulkin to head the Department of Veterans Affairs garnered attention for several reasons.
The first is that, as a current administrator, Shulkin represents the only Obama Administration holdover picked for the Trump cabinet. In addition, Dr. Shulkin is the first non-veteran to hold the VA Secretary seat since its inception in 1989. Finally, Shulkin is not a strong proponent of VA privatization, which has been a long-time goal for many conservative Trump supporters.
In addition to the overwhelming responsibility of managing one of the largest agencies in government, Secretary Shulkin will be responsible for carrying out President Trump’s aggressive agenda for the VA. As early as July of 2015, then-candidate Trump criticized the Department of Veteran Affairs on the campaign trail, calling it “the most corrupt agency in the United States” and going on to say, “I’d fire everybody.”
It’s because of statements like these that observers were surprised when Trump chose an insider selected by the Obama Administration as his new VA Secretary. On February 13, however, the Senate unanimously voted Shulkin to the top VA position — a noteworthy departure from some of the other, much closer, party-line votes that have characterized President Trump’s cabinet picks.
Who Is David Shulkin?
Until President Trump’s appointment, David Shulkin was the Undersecretary of Health for the Department of Veterans’ Affairs and was responsible for overseeing the healthcare of 8.8 million veterans and the operations of 1,600 clinics and 168 medical centers. President Obama appointed him to his previous position in the VA in 2015 in the wake of one of the largest scandals in the department’s history.
Dr. Shulkin was born in 1959 in Highland Park, IL. Shulkin graduated from college in 1982 and went on to attend the Medical School of Pennsylvania, which is now part of Drexel University. Despite being born on a military base, his father serving as an Army psychiatrist and both of his grandfathers serving in World War I, David Shulkin is not a veteran himself. Early in his medical career, however, he trained and treated sick and injured veterans in VA hospitals.
Whether his lack of direct military experience will be a hindrance to Secretary Shulkin as he steps into his new role remains to be seen, but carrying out Presidents Trump’s campaign promises will be a demanding assignment for any administrator.
The Role of the VA Administrator
To understand the challenges facing Dr. Shulkin, an overview of his responsibilities as the new VA Secretary will be helpful. The United States Department of Veterans’ Affairs assists military veterans in accessing the benefits to which they’re entitled. Some of these include:
- Physical and mental healthcare
- Disability compensation
- G.I. Bill
- Vocational rehabilitation and employment
- Dependents’ educational assistance
- Survivor benefits
- Home loans
- Life insurance
In addition, the Veterans’ Administration dedicates and maintains military cemeteries and official memorials dedicated to members of the armed services.
There are three divisions within the VA, each headed by an undersecretary reporting to the VA Secretary:
- The Veterans’ Benefit Administration
- The Veterans’ Health Administration (vacated by Dr. Shulkin’s promotion)
- The National Cemetery Administration
According to the VA, there are approximately 22 million veterans living in the United States, most of whom are entitled to VA benefits. The overall 2017 budget for the Veterans’ Administration is set at $182.2 billion. The VA employs approximately 300,000 workers, making it the largest single government agency by employee count if the branches of the military are tallied individually. As a cabinet member, in addition to overseeing this massive federal bureaucracy, the VA secretary is seventeenth in the line of succession for the presidency.
In addition to the normal administrative responsibilities of the post, President Trump has promised to revamp the VA — and as VA Secretary, Shulkin will take point on effecting that change.
The Challenges Facing Trump VA Secretary David Shulkin
Secretary Shulkin assumes his new role at a particularly tumultuous time for the massive federal agency. Here’s a look at some of the recent history of the VA.
The Scheduling Manipulation Scandal: In 2014, the Veterans’ Administration came under fire for allegedly developing secret waiting lists to conceal the fact that veterans had to wait for months for required medical services. Concurrently, VA facility administrators were receiving bonuses based on certain metrics, including the average wait time for an appointment at their respective facilities.
Many of the hospitals and clinics experienced a high volume of patients due to the multiple military engagements over the past two decades. Because wait times were so long, VA employees were entering patient information on their computer screens, using the print screen function to obtain a paper copy of the information, and then deleting it without entering it into the system. The workers would maintain the hard copies until the patients’ appointments were fewer than fourteen days away and then they would transcribe the information back into the computer and submit it.
This gave the appearance that veterans were waiting a maximum of two weeks for medical services, when in reality the average wait time was much longer. The scandal came to a head when CNN reported: “At least 40 U.S. veterans died waiting for appointments at the Phoenix Veterans’ Affairs Health Care system, many of whom were placed on a secret waiting list.”
The deaths and ensuing scandal resulted in the VA Secretary, Eric K. Shinseki, tendering his resignation to President Barack Obama, who accepted.
Credibility Issues of His Predecessor: President Obama replaced Shinseki with Robert A. McDonald, a former CEO for Proctor & Gamble, who was Undersecretary Shulkin’s superior during end of the Obama administration. Under McDonald’s tenure, the number of patient appointments increased by the millions while patient wait times shortened.
Secretary McDonald wasn’t without his share of controversies, however. In February of 2015 — several months before Shulkin was brought into the VA as an undersecretary — McDonald claimed that 60 VA employees had been fired over the secret waiting lists. The number was later revised to eight, and then eventually to three.
Additionally, in a November 2015 speech to the National Press Club, Secretary McDonald said, “We have proposed disciplinary action against 300 individuals for manipulating scheduling.” The report from which McDonald received his information listed over 300 disciplinary actions against VA employees, but those weren’t all related to schedule manipulation or to the employees involved in schedule manipulation.
Despite the media exposing some of his statements as factually inaccurate, several veterans’ groups urged President-elect Trump to retain McDonald as the VA head, citing his limited success in cutting wait times.
Low Quality Ratings: In December of 2016, USA Today published internal documents that listed internal ratings for various VA facilities. The hospitals and treatments centers were rated one to five stars. According to Shulkin, who was the Undersecretary of Health at the time, the star system was developed as a tool to determine which locations required the resources needed for improvement.
There was a number of one-star facilities, including the one in Phoenix that was found responsible for the veteran deaths. Shulkin expressed concern about the public seeing the lists, as veterans might assume the quality of healthcare at the one-star facilities was substandard and might decide to forgo necessary treatment.
Throughout his campaign, Donald Trump promised to make it easier to fire VA employees — a measure that McDonald had resisted during his time as the head of the Veterans’ Administration. With this in mind, the selection of David Shulkin, who was there for most of McDonald’s tenure as Secretary, might be seen as a compromise to McDonald supporters who feared a shakeup could forestall the positive momentum the agency is experiencing.
In addition to restoring its reputation, the Veterans’ Administration continues to face the challenge of providing healthcare and benefits to an increased body of military veterans due to nearly 16 years of combat operations and outdated technology, and to reduce the rate of suicide among military veterans, which has been trending upward since 2000.
Expectations of the New VA Secretary Under Trump
During his campaign, Mr. Trump released a 10-point plan specifically targeting the Department of Veterans’ Affairs. The following is a truncated list of those points:
- Appoint a VA Secretary whose “sole purpose will be to serve the veterans.”
- Use the powers of the presidency to punish and/or fire VA employees who fail to carry out their duties on behalf of veterans.
- Encourage Congress to pass legislation empowering the VA Secretary to discipline or terminate employees who jeopardize the health and well-being of veterans.
- Create and commission to investigate the “fraud, cover-ups and wrong-doing” that has taken place in the VA.
- Protect and promote honest employees who report wrongdoing within the VA.
- Implement a VA hotline for veteran complaints of wrongdoing.
- Cancel bonuses to VA employees who are “wasting money” and reward those who improve services for veterans.
- Improve the visa system so veterans “move to the front” for health services.
- Increase the number of mental health professionals and allow veterans to get mental healthcare from non-VA professionals.
- Give veterans the choice to use private care.
With the exception of the enumerated points that pertain specifically to his appointment and actions taken by the President and Congress on his behalf, it would stand to reason that the implementation and administration of this plan would fall to Secretary Shulkin.
The Issue of VA Healthcare Privatization
Mr. Trump’s campaign promises included allowing veterans access to private healthcare providers. Candidate Trump explained that to make the VA a smaller and more efficient organization, he would put the VA’s healthcare centers in competition with private healthcare providers and give veterans the option to choose from any facility that accepts Medicare.
Opponents of privatizing veterans’ healthcare argue that VA facilities are better suited to treat combat-related injuries and other medical needs of veterans than private institutions that offer more generalized medical services. During his prepared remarks at his Senate confirmation hearing, Dr. Shulkin said, “VA is a unique national resource that’s worth saving, and I am committed to doing just that.”
Shulkin has suggested that he would consider closing underused VA centers and examine the use of private facilities in areas where it would be too slow or inefficient to wait until a VA healthcare facility is built and staffed to care for waiting veterans.
Shulkin’s Senate Confirmation Hearing
Article 2, Section 2 of the U.S. Constitution is known as the “Appointments Clause.” It establishes the authority of the President to appoint department heads with the “advice and consent of the Senate,” which is why all cabinet selections must face a Senate confirmation hearing before they give an up or down vote to the nominee.
For the position of Secretary of Veterans’ Affairs, the VA Committee conducts the confirmation. While several of President Trump’s selections have faced very close and largely partisan votes, as the only cabinet holdover from the Obama administration, David Shulkin received a unanimous vote from the Senate.
In his opening statement to the Senate Committee on Veterans’ Affairs, candidate Shulkin reiterated his pledge to expand the role of private healthcare in treating veterans: “I’ve demonstrated my commitment to moving care into the community where it makes sense for the veteran. When I began my tenure as Undersecretary for Health, 21 percent of care was delivered in the community. Today, that figure stands at 31 percent.”
While promising the Committee vast improvements to the VA, Shulkin stated his opposition to fully outsourcing veterans’ healthcare: “But the Department of Veterans’ Affairs will not be privatized under my watch.”
After hearing his testimony, the Veterans’ Affairs Committee, comprised of eight Republican and seven Democratic senators, voted unanimously to approve Dr. Shulkin for the overall Senate vote.
What to Expect From the New VA Secretary
Secretary Shulkin has been clear about his opposition to allowing the full privatization of the VA, but as a new department head in a new administration, both the Trump administration and the various VA advocacy groups will be focusing on his initial actions to improve the agency.
Shortening waiting times for appointments and increasing the efficiency of the Department of Veterans’ Affairs are top priorities for the Secretary, but he’s also committed to increasing the quality of care for our veterans. Additionally, the President has indicated that Shulkin will be tasked with rooting out the individuals responsible for past scandals and either discipline or terminate them.
It’s impossible to know right now how effective Secretary Shulkin will be in his new role, but his promise to put the welfare of veterans before all other considerations and his wide bipartisan support are both encouraging signs.
Keep reading our blog for additional resources and further updates as this story develops.