Dr. David Shulkin, the current secretary of veterans affairs and the only Democrat in President Donald Trump’s Cabinet, has done fairly well running the VA. At a signing ceremony for veterans legislation in June, Trump said of Shulkin, “We’ll never have to use those words [‘You’re fired’] on our David.”
Eight months later, that declaration may prove ironic. [Update, March 28: Indeed, Trump has now ousted Shulkin.] Fissures have emerged and deepened between Shulkin and the president’s political allies over what, exactly, the VA should be doing. On top of this, two relatively minor scandals involving Shulkin have blown up his tenure and stalled major reform. Now, Shulkin faces conflict on three overlapping fronts, leaving him at the precipice of being fired and replaced by a closer Trump ally as the administration seeks to reduce the chaos in its Cabinet.
The first battle Shulkin is fighting has deep roots in veterans population demographics and the evolution of VA benefits over the past several decades. From the time they join up to their moment of discharge, service members belong to the Department of Defense. After that, they become eligible for a broad array of veterans programs that are administered by the VA’s three large administrations: health, benefits, and cemeteries. These programs have evolved from stingy pensions for seriously disabled veterans after the Revolution to the generous, comprehensive system of health care, disability compensation, and economic programs that exists today. All eligible veterans—meaning primarily those who serve on active duty and leave with an honorable discharge—can avail themselves of these benefits, not just combat veterans or those who were wounded in the line of duty.
To meet these obligations, the VA consumes a massive amount of money each year. Its 2019 budget request is $198.6 billion—a big increase over previous years at a time when most agencies are facing cuts and totaling more than the budgets of the State Department, Homeland Security, and the entire intelligence community combined. Roughly half of these funds go to disability compensation for 4.4 million veterans; the next biggest chunk goes to fund VA’s huge health care network comprising more than 1,000 facilities nationwide.
Since 9/11, the VA’s budget has steadily increased at a rate far greater than inflation, even as the total population of veterans has decreased. Older veterans of the Vietnam and Cold War eras rely heavily on VA services. So too does the post-9/11 generation, of whom more than 3 million have deployed to Iraq, Afghanistan, or other theaters of war. These retired service members are using the VA at much higher rates than previous generations. This demand from young and old veterans alike is putting enormous pressure on the VA—which failed to adequately predict any of this increased demand, let alone prepare and budget for it.
In 2014, this problem erupted in Phoenix, where veterans endlessly waited for appointments while VA employees played a shell game with veterans to deceive them and their bosses in Washington. That scandal forced the ouster of VA Secretary (and retired Army Gen.) Eric Shinseki and prompted the creation of a program to purchase VA care from the private sector.
If the VA couldn’t provide timely appointments for all veterans, Congress mused, the VA could instead purchase health care the way the Pentagon does for retirees. First as the VA’s undersecretary for health, and then as secretary, Shulkin has devoted most of his energies toward implementing this new contracted-care system and making it work.
All of this distills down into a policy question that is at the heart of Shulkin’s first battle: What, exactly, does the nation owe to those who have served in uniform? And how should the VA deliver on that promise? On one side is the VA establishment, and major veterans organizations, who have taken a “mend it, don’t end it” stance toward VA health care. On the other side are political conservatives including the Koch brothers–funded Concerned Veterans for America and many of Trump’s allies in Congress, who would like to focus the VA on service-related care like mental health and contract for everything else from the private sector. Shulkin has tried, with some success, to forge a middle path with congressional leaders in the House and Senate.
Shulkin’s second battle—political infighting with more partisan members of the administration—inflames and complicates these policy disagreements. He is the sole survivor of the Obama administration among Cabinet officials serving Trump. A practicing physician and successful health executive, Shulkin came to the Obama administration to run the VA health care system after the 2014 Phoenix scandal. His selection came after a turbulent Trump transition, during which the president interviewed several potential candidates before settling on Shulkin. Trump reportedly gave Shulkin the job because the New Jersey physician persuaded him he could continue the slow, deliberate privatization of the VA and deliver other wins to Trump on issues like employee accountability (read: easier firing of civil servants).
Since being confirmed in February 2017, Shulkin has largely delivered on those pledges. The VA has continued to purchase private-sector care for veterans—so much so that it has needed to ask Congress for more money to fund the popular program. Shulkin made a difficult decision on electronic health records that the Trump administration has touted as an example of public-private partnership (although that contract now appears stalled). And, Shulkin has presided over the termination of hundreds of VA employees, something the president praised in his State of the Union address this year. But Shulkin has made a few missteps, too, including presiding over continuing problems at the VA’s Washington hospital and proposing to kill the VA’s support for homeless veterans, before walking back that idea in the face of public outcry.
Unfortunately, none of this success has helped Shulkin battle with more partisan appointees brought in by the Trump administration. Some of these appointees, including former beer executive Jake Leinenkugel and Trump campaign operative Cam Sandoval, began working late last year to engineer Shulkin’s exit. According to the Washington Post, these nominees have actively sought to sabotage Shulkin’s tenure, going so far as to call congressional leaders and lobby them to push for Shulkin’s ouster. In response, Shulkin has isolated himself from these senior appointees, reportedly barring their access to his 10th floor executive suite and asking White House chief of staff John Kelly for permission to fire them. (Permission has thus far been denied.) This political battle has consumed more and more of Shulkin’s time in recent months, threatening his reform agenda and ability to deliver more political wins for the president.
It is against this backdrop that Shulkin must wage his third and most personal battle: a fight over two internal ethics investigations by the VA’s inspector general. The first investigation was triggered by Washington Post reporting about Shulkin’s trip to meet with veterans officials in Europe—a trip that included a detour to Wimbledon, and a few days of vacation too. The VA’s inspector general scorched Shulkin in its report on this trip, finding that permission to bring his wife had been predicated on a falsified email from Shulkin’s chief of staff and that Shulkin had impermissibly ordered his staff into travel concierge duty. Shulkin pushed back, retaining counsel to dissect the IG report, and he even suggested that his chief of staff’s email had been hacked. (It was not.) A day later, however, Shulkin’s chief of staff announced her retirement, and Shulkin said he would repay the government for the cost of his wife’s airfare.
A second investigation, regarding Shulkin’s use of his protective security detail, is reportedly percolating in the VA inspector general’s office now. That assessment will reportedly criticize Shulkin for inappropriate use of his security detail for personal errands. On its face, the allegations aren’t that damning; they show Shulkin to be an inexperienced government executive who’s used to different rules in the private sector and also indicate his naïveté about how certain things will play on the proverbial front page of the Washington Post. But these errors come at a time when the Trump administration can ill afford another ethics scandal after similar abuses at HUD, Interior, and HHS, with the latter resulting in Secretary Tom Price’s resignation. A Cabinet secretary aligned more closely with the White House than Shulkin, or with more political allies across the administration, could probably survive these investigations with barely a flesh wound. For Shulkin’s tenure at VA, they may end up being fatal, to the extent they provide a pretext for the White House to replace Shulkin with a more trusted partisan.
At this point, Shulkin’s fate rests with Trump. Although Trump has largely benefited from Shulkin’s service, the president must now decide whether he’s better off with a competent leader like Shulkin, or a closer political ally who might march more in step with the base. The potential contenders include Energy Secretary Rick Perry (who said Wednesday he doesn’t want the job), one of the 88 retired generals who endorsed Trump in 2016, or veterans in Congress like Sens. Joni Ernst or Tom Cotton, whose chances are lower because of their importance to the Republicans’ razor-thin Senate majority. Whether Shulkin stays or goes, the primary battle he waged, over the future of the VA, will continue. Trump is arguably better off keeping Shulkin around to keep waging this battle, and veterans are arguably better off with that outcome too.