President Donald Trump's nominee Robert Wilkie sailed through a Senate confirmation hearing to clear him for the top post at the Veterans Affairs Department, despite thinly veiled sparring by Democrats and Republicans over whether his implementation of the VA Choice reforms could restart the privatization debate.
Wilkie, who stepped down from his post as acting VA secretary pending his confirmation, will have to wrangle the electronic health records overhaul for the VA and implement the massive VA Mission Act, which consolidates all seven disparate community-care programs under VA Choice. The legislation also significantly expands VA Choice, which is still plagued with logistical problems such as delayed or faulty payments for local hospitals and physicians who treat veterans in the program.
In his testimony, Wilkie attributed the problems with Choice to the hasty rollout and emphasized the integration of payment systems and EHRs as key to streamlining the program.
But tensions over how the Choice reforms could change the VA health system were still apparent as key senators pressed Wilkie on how he intends to steer the program through regulations. Veterans service organizations and conservative veterans groups are watching the regulatory process closely, particularly the quality and access standards that the VA clinics will be required to meet or else release veterans to community providers.
Sen. Jerry Moran (R-Kan.), who led the charge to require the VA secretary to set the access standards on the VA system, warned Wilkie that implementation will be "a monumental task" and asked for a guarantee that the department will follow congressional intent for the overhauled Choice program as he lays out the regulations.
Wilkie promised Moran that he would follow intent and support the community care programs, as Sen. Bernie Sanders (I-Vt.)—who opposed the VA Mission Act—asked for an absolute promise that Wilkie would not privatize the VA.
"Will you vigorously oppose, whether from the president or the Koch brothers, any effort to privatize the VA?" Sanders asked, referencing conservative megadonors Charles and David Koch, who funded the group Concerned Veterans for America, which came under fire from Democrats and unions for outsize influence on the White House and VA political appointees' work on the legislation.
Wilkie promised that he would oppose any privatization efforts, although VA officials and lawmakers say the word mischaracterizes efforts to reform the department's health system serving more than 9 million people.
The Senate VA Committee's ranking Democrat, Jon Tester, of Montana, also pressed Wilkie on whether there are any conditions attached to the job and whether Wilkie has full autonomy to appoint his own deputies.
The questioning came after former Secretary David Shulkin, fired in March by a tweet from Trump, complained that he faced hostility within the department from political appointees.
Wilkie, a member of the U.S. military reserves since 1997 who has seen active duty, has worked at the Pentagon and National Security Council, as well as assistant secretary of defense under President George W. Bush. Throughout his testimony, Wilkie touted his work as undersecretary of defense for personnel and readiness at the Defense Department, where he had to implement long-passed but neglected legislation.
Since Trump's ouster of Shulkin, Wilkie has served as acting secretary and oversaw passage of the VA Mission Act.