Citing resistance in Congress, Kenneth Kizer, M.D., health undersecretary for the Department of Veterans Affairs, has asked President Clinton to withdraw his renomination.
As head of the nation's largest healthcare chain, Kizer radically reconfigured it from a specialty and inpatient-intensive system into an outpatient-oriented network of 172 hospitals and hundreds of clinics and nursing homes.
In a letter to Clinton, Kizer said he was stepping aside because it appeared he wouldn't be reconfirmed before his temporary term ended.
When Kizer's original four-year term concluded at the end of September 1998, Clinton signed a temporary renomination, which expired last week. Clinton sent a separate permanent renomination to Capitol Hill in January.
Kizer said he will stay on briefly to ease the transition. Deputy Undersecretary Thomas Garthwaite will serve as acting undersecretary.
The Senate Veterans Affairs Committee never voted on legislation to reconfirm Kizer. Sens. Susan Collins (R-Maine) and John Kerry (D-Mass.) had threatened that if the legislation was sent to the full Senate, they would put a "hold" on the nomination, preventing the Senate from voting on it.
In Kizer's nearly five years in office, the VA system closed thousands of inpatient beds while opening 300 new clinics. Kizer also implemented an administrative decentralization, placing more authority in the hands of 22 integrated networks, which were given capitated budgets.
That angered many veterans and lawmakers, who said the restructuring threatened access to healthcare. Among those particularly upset were veterans groups and members of Congress from the Northeast, where VA healthcare facilities lost money under capitation to the South and Southwest, partly because of the migration of retiring veterans to the Sunbelt.
Under Kizer's watch, the VA budget has grown very little, even though the number of veterans served by the VA healthcare system increased to 3.6 million in federal fiscal 1999 from 2.8 million in fiscal 1994.
The VA also was given the authority to keep third-party collections from the health insurers of veterans eligible for but not entitled to care at VA facilities because of income or disability status.
Those trends allowed Kizer to set a goal of decreasing per-patient costs by 30% while serving 20% more veterans by 2002 and deriving 10% of the healthcare system's budget from sources outside the VA's appropriated budget.