Drama surrounding Shulkin — what is the future of VA health care?

If anyone is wondering why our nation’s veterans still struggle to get access to timely and quality health care, look no further than the last few days media headlines.

Currently, the Department of Veterans Affairs (VA), which is no stranger to controversy, is struggling with questions over Secretary David Shulkin’s travel expenses on a trip to Europe, political in-fighting amongst its leadership, and claims of email hacking.

The common denominator through each of these issues is the current secretary, Shulkin.

{mosads}Is he the latest victim of Trump’s unreasonable expectations of loyalty within his administration? Or is he simply unfit to be a cabinet secretary, showing disdain for taxpayer dollars at the expense of veterans’ health care?

Although I am admittedly not Shulkin’s biggest fan, I believe the main source of VA’s current woes stem from the Trump administration, as opposed to Shulkin’s leadership.  

The House Veterans’ Affairs Committee seems to share this view, as Shulkin was largely given a pass regarding the travel issue during yesterday’s annual budget hearing.  

Chairman Phil Roe (R-Tenn.) told Shulkin that “I believe your intentions to serve and care for our nation’s veterans are clear.” Ranking Member Tim Walz (D-Minn.) added that “trust on this committee is strong,” and sent a letter to the Department of Justice to investigate Shulkin’s allegations of email tampering shortly after the hearing ended.

Trump, on the other hand, has made clear that he values loyalty, to him personally, above politics, policy and procedure. During a July 2017 speech to the Boy Scouts of America, Trump told his young audience, “we could use some more loyalty, I will tell you that.”

Further, any perceived lack of loyalty to Trump hasn’t sat well with him — just ask “Sloppy Steve” Bannon, “Leakin’ James Comey,” or “Liddle’ Bob Corker,” to name a few.

In an email leaked to the Washington Post from White House senior advisor on veterans affairs, Jake Leinenkugel, shows that the VA is not exempt from the Trump administration’s expectations of loyalty. 

The correspondence from Leinenkugel to Camilo Sandoval, a former data manager at the Trump campaign who was given a political post within the VA, indicates that his relationship with Shulkin had diminished over lack of trust, and conveyed several proposed solutions for Shulkin’s removal, including using his European travel as political cover, and ultimately removing Shulkin and his closest advisors with “strong political candidate[s].”

More importantly, however, than the gossipy headlines of who may be trying to undermine who at the VA, lies a more important issue — what is the future of VA health care?

Trump campaigned largely on veterans issues, promoting VA accountability, reform, and choice. Although stakeholders have slowly embraced greater access to veterans choice over the past few years, disagreement still exists between how much of a role VA should play in that process, as evidenced by legislation to this effect being stalled in the Senate.

Further, if the Trump administration were to terminate Shulkin, it is unclear who, if anyone, would volunteer for the job of leading the VA.

Not only has the Trump administration struggled to fill top posts across the VA and the government in general, but initially, he claimed to have interviewed “at least 100 people” for the job before nominating Shulkin.

Leinenkugel’s suggested replacement for VA Secretary, Michael J. Kussman, would likely encounter difficulty being confirmed in the Senate given his ties to Concerned Veterans of America, a group that advocates for full-scale privatization of VA care.  

Although personally, I do think that greater access to choice of private care for veterans would go a long way toward enhancing VA health care. This would allow those who do not want to be part of the VA system to go elsewhere. Politically, the Senate and influential veterans service organizations will most likely not embrace someone like Kussman with the same enthusiasm they initially had for Shulkin.

It is rare for any cabinet secretary to be universally liked across the aisle, and Shulkin, the lone holdover from the Obama administration, began his tenure as VA Secretary with a Senate confirmation vote of 100-0, an anomaly amongst Trump appointees.

However, when one starts with such high marks, the only way an approval rating can go is down, which Shulkin is learning the hard way.  

As a result, it may only be a matter of time before Trump tweets his own alliterative insult at Shulkin; “shady Shulkin” perhaps, in reference to the recent OIG report on his travel?  

With internal leadership and political appointees focused on trying to undermine each other, sadly, what gets lost is VA’s mission. At times of internal strife, organizations suffer from lost productivity, a stressful work environment, and disruption of projects.

According to numerous career civil servants and VA’s whistleblowers, this was already par for the course within an organization in dire need of a cultural overhaul, and the current drama surrounding Shulkin and the Trump administration is only furthering VA’s internal woes.

Abraham Lincoln, who is credited with VA’s motto regarding caring for those who have borne the battle, also once said that “a house divided against itself cannot stand.”  Currently, the VA is divided, and if it comes crashing down, veterans who rely on its health-care system will suffer the most.

Rory E. Riley-Topping has dedicated her career to ensuring accountability within the Department of Veterans Affairs (VA) to care for our nation’s veterans. She is the principal at Riley-Topping Consulting and has served in a legal capacity for the U.S. House of Representatives Committee on Veterans’ Affairs, the National Veterans Legal Services Program, the U.S. Court of Appeals for Veterans Claims, and the Department of Veterans Affairs.