Rear Adm. Ronny L. Jackson, the personal physician to President Donald Trump, was not his first choice to replace fired VA Secretary Dr. David Shulkin, the White House said Thursday.
"The president did have some early individuals that he was looking at but continuously went back to Dr. Jackson to fulfill this role as VA secretary," White House deputy press secretary Lindsay Walters told reporters.
She said Trump "ultimately decided that his [Jackson's] health care experience, his distinguished career in the medical profession, was something that would be beneficial at the VA."
Walters added that Trump "has full confidence in Admiral Jackson" to fulfill the demanding job at the Department of Veterans Affairs despite his lack of experience in running large organizations.
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Walters did not name the others who were considered to head the VA, but they reportedly included Toby Cosgrove, former head of the $8 billion Cleveland Clinic health care system, and Pete Hegseth, an Army National Guard veteran of Iraq, former head of the advocacy group Concerned Veterans of America and co-host of the weekend "Fox & Friends" program.
Cosgrove, a Vietnam veteran, was among those invited in 2016 to Trump's Mar-a-Lago estate in Florida to be interviewed for the VA post before Trump settled on Shulkin, a holdover from the Obama administration.
Others who were under consideration as VA secretary included former Rep. Jeff Miller, R-Florida, who had been chairman of the House Veterans Affairs Committee; retired Army Lt. Gen. Keith Kellogg; Michael Kussman, a former VA undersecretary of health; and Leo Mackay Jr., a former VA deputy secretary who is now senior vice president at Lockheed Martin Corp., The Associated Press reported.
The surprise announcement of his nomination Wednesday afternoon, his status as a relative unknown on Capitol Hill, and the ongoing turmoil at the VA indicate Jackson will have little in the way of a honeymoon period if he is confirmed by the Senate.
Shulkin wasn't even out the door when Jackson faced a barrage of conflicting demands from the White House, Congress and the major Veterans Service Organizations (VSOs).
The immediate concern is the upcoming decision by the VA to award a contract that could run up to $10 billion and is aimed at finally giving the agency electronic health records. There are also the perennial disagreements on what to do about benefits, wait times, suicides, PTSD, corruption, caregivers and the crumbling infrastructure at VA hospitals.
However, at the top of Jackson's to-do list is reaching a final resolution on the extension and expansion of the Veterans Choice Program, which allows vets to opt for private health care.
Proponents, including Trump, see Choice as guaranteeing that vets get the best health care available; opponents, including the VSOs, see overreliance on Choice as threatening the core mission of VA as the primary provider and payer for the care of nine million vets annually.
In leaving, Shulkin sidestepped the scandal over his travel expenses. He portrayed himself as the victim of palace intrigues hatched by White House political appointees advocating the full "privatization" of VA health care.
In an op-ed for The New York Times, Shulkin wrote that the political appointees, at the White House and within the VA, "saw me as an obstacle to privatization who had to be removed."
"That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans," he said.
In testimony to the House Veterans Affairs Committee earlier this month, Shulkin warned that the Choice program could run out of money as early as June.
Sen. Johnny Isakson, R-Georgia, chairman of the Senate Veterans Affairs Committee, had co-sponsored a bill that would have extended Choice while keeping the decision on whether vets could go to private doctors within the VA, but the bill was not included in the $1.3 billion omnibus spending package signed by Trump last week.
Isakson has pledged to renew his efforts on Choice when Congress returns after the Easter recess. In a statement Thursday, he also hinted at the conflicts with the White House by heaping praise on Shulkin and pointing to improvements at the VA in the past year.
Shulkin "has made a tremendous impact toward improving the lives of veterans," Isakson said. "He has been instrumental in all that we have accomplished in the last year, and I thank Dr. Shulkin for his dedicated service to our country and our veterans."
As for Jackson's nomination, Isakson said, "I look forward to meeting Admiral Jackson and learning more about him."
If confirmed by the Senate, Jackson, who has little administrative experience and none in running an organization such as the VA, could be expected to rely on the insider knowledge of the No. 2 at the agency, Deputy VA Secretary Thomas Bowman. The VA, the largest healthcare system in the United States, has 370,000 employees and a budget of nearly $200 billion.
However, Bowman, a retired Marine colonel and military attorney, has already been targeted for removal by Jake Leinenkugel, a former brewery company executive and now a senior White House adviser on veterans issues.
In December, Leinenkugel wrote in an email to Camilo Sandoval, a political appointee at the VA, that they should lobby for the ousters of both Shulkin and Bowman. The email was first reported by The Washington Post and later obtained by Military.com.
Isakson and the VSOs came to the defense of Bowman, a long-time former staffer on the Senate Veterans Affairs Committee.
"Tom Bowman is a veteran and a patriot, a public servant and a good man," Isakson said in a statement. "If this is true, it will be a mistake, and I am deeply disappointed in the president. Veterans will suffer because of this decision if it's true."
The VSOs have partly blamed the moves against Shulkin and Bowman, and the efforts at privatization, on the work of the advocacy group Concerned Veterans for America, which is funded by the conservative Koch brothers organization.
In a statement, CVA's executive director, Dan Caldwell, said that Shulkin "made significant headway in reforming the department, but ultimately became a distraction from the important task of improving health care for our veterans."
Without mentioning Choice, Caldwell said, "Congress needs to continue work with the president to pass legislation that will give veterans more health care options and better access to care through the VA."
In a statement, Sen. John McCain, R-Arizona, chairman of the Senate Armed Services Committee, said of Choice that "much more work remains to improve the Veterans Choice Program and ensure our nation's heroes have access to the best possible services."
"Let me be very clear: none of us committed to reform wants to privatize care. We simply believe the VA must put the needs of veterans first, and ensure they receive timely, quality and uncompromised health care, whether that's in the VA or in the community," McCain said.
Sen. Jack Reed, D-Rhode Island, ranking member of the Senate Armed Services Committee, said, "I admire Dr. Jackson's service to the nation, but I don't know if he is the right person to lead the VA.
"One thing is clear -- the Trump administration seems to devolve further into turmoil by the day," Reed said. "I hope the level of dysfunction that has engulfed other parts of the administration does not impact the care that our veterans receive."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.