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April 26, 2018 01:00 AM

VA Choice reforms face tight timeline as focus turns to Trump's next nominee for secretary

Susannah Luthi
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    AP
    Dr. Ronny Jackson

    Amid the noise over Dr. Ronny Jackson withdrawing from consideration for secretary of Veterans Affairs, key lawmakers and stakeholders vow the long-stalled VA Choice reforms will move forward as planned even as the timeline grows shorter and the focus has shifted to finding the next nominee.

    The House VA Committee this week was supposed to debate the bipartisan agreement reached last month, but that has been postponed until early May, and not all parts of the deal are set in stone, according to aides close to talks.

    The legislation has not yet been introduced, but aides say it currently tracks closely with the draft obtained by Modern Healthcare last month, which includes a White House-backed provision pushed by Sen. Jerry Moran (R-Kan.) that would let veterans opt for private care if their VA medical facility failed to meet certain access standards. Revised community care legislation has not yet been introduced, but it reflects the bipartisan agreement reached earlier last month that was not included in the omnibus spending bill.

    Challenging times at the VA

    February 2017: Dr. David Shulkin confirmed as the third secretary of Veterans Affairs in four years.

    December 2017: The House and Senate VA committees release two different bills that would combine all the community care programs into one and expand access. February 2018: Shulkin's troubles start as he faces off with Sen. Jerry Moran (R-Kan.) over VA Choice legislation. Meanwhile, the Government Accountability Office releases a scathing report claiming that Shulkin misspent taxpayer funds on his wife's airfare to Europe, inappropriately accepted Wimbledon tickets, and unnecessarily flew on private jets. And a damning Inspector General's report reveals shoddy care at the VA's Washington Medical Center. March 2018: Rumors fly that Shulkin will get the boot. President Donald Trump fires him in a 5 p.m. tweet that nominates White House physician Dr. Ronny Jackson as his replacement.April 2018: Three days before his scheduled confirmation hearing, Jackson sees his nomination crumble as anonymous allegations of bad behavior emerge. The House VA committee postpones its planned markup of the VA Choice compromise because changes are still being made to the bill.

    The White House has stepped up pressure on lawmakers to pass the package before funding for the current Choice program runs out in June. Lawmakers and the administration want it done by the end of May. According to a GOP Senate aide, the Senate VA Committee has not worked with the White House policy team on the legislation since the deal was struck.

    The legislative push arrives as President Donald Trump expressed his dissatisfaction with how the Senate handled the Jackson allegations.

    Shortly after Jackson bowed out of the nomination Thursday morning, Trump called into the Fox News show "Fox & Friends" to defend his pick and blast Senate VA Committee ranking Democrat Jon Tester (D-Mont.) for his role in derailing the nomination.

    Tester on Wednesday released a summary of scathing interviews with 23 current and former Jackson colleagues at the White House Medical Unit that painted the White House physician as a reckless prescriber of medicines, who was nicknamed the "Candyman," and as a toxic leader.

    Trump defended Jackson's character and said there should be a "big price to pay" for Tester over his handling of the allegations.

    "I think this is going to cause him a lot of problems in his state," Trump said, referencing the upcoming midterm elections. Tester is considered one of the vulnerable Democratic incumbents, running in a state that went for Trump in 2016.

    Tester told reporters he was "absolutely" comfortable with his decision to release the report.

    "It was very, very clear these came from people in the military," Tester said. "It was very clear that we were investigating."

    Senate VA Committee Chairman Johnny Isakson (R-Ga.) did not comment on Tester's handling of the process, but said he respected Jackson and is now focused on finding a good new nominee. He dismissed the idea that the turmoil will further stymie the Choice legislation.

    "We're moving forward in the committee and we have a good acting director of the VA so I think we'll be fine, and no, I don't think it will inhibit it at all," Isakson said.

    Yet all eyes are now on who the next nominee could be.

    "The end of the line is, we have men and women we service all over the country who have been living without great leadership now for a number of weeks," said Sen. Patty Murray (D-Wash.), who sits on the VA Committee. "This is a nomination that needs to happen, it needs someone credible who can step in immediately, who doesn't need to go through a long process, and it needs to happen soon because this is affecting men and women on the ground."

    Veterans service organizations have also been vocal about the next candidate.

    Joe Chenelly, executive director of AMVETS, is calling for a nationwide search.

    "The VA is worth saving, and the right man or woman for the job is out there," Chenelly said. "It's going to take the president's full effort to find the right person, but veterans are worth that effort, and frankly, they've always deserved nothing less."

    He added that "personally, I'd like the president to consider a woman veteran for the position."

    Dan Caldwell, CEO of the conservative Concerned Veterans for America, which worked closely with the White House and Moran on community care provisions in the Choice bill, also called for a high level of scrutiny from the administration.

    "The White House should take its time to carefully select and vet a new nominee for VA secretary," Caldwell said. "The VA currently has a competent acting secretary in Robert Wilkie who can manage the VA along with the rest of his leadership team while the White House selects a new VA secretary nominee and the Senate goes through the confirmation process."

    An edited version of this story can also be found in Modern Healthcare's April 30 print edition.

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