In Battle Over Future of Veterans’ Care, Moderation Wins, for Now

In an administration rife with intramural
fights, the battle over the Department of Veterans Affairs has
stood out, not only for its vitriol but also for its
consequences. At stake is the future of the nation’s veterans
health care system.
For now at least, it appears moderation has prevailed, with
the Veterans Affairs secretary, David J. Shulkin, thwarting a
pitched conservative push to drive him out.
“It’s my job as secretary to get the organization singly
focused on making the V.A. work better for vets,” the
secretary, a physician and holdover from the Obama
administration, said in an interview on Monday, after the
latest in a string of meetings with the White House chief of
staff. “I’ve been making it clear to the organization that we
will not be distracted as we have in the last couple weeks.”

“People need to get on board with that or need to leave,” he
added.
For weeks now, Dr. Shulkin, a political moderate who was
confirmed by the Senate 100 to 0, has been locked in a bitter
and unusually public battle with a band of Trump
administration officials who he said were out to overthrow
him. The plotters included White House officials and the two
men charged with safeguarding the secretary’s public image
— who instead worked to undercut it, according to loyalists
of the secretary.

Offstage lurked Concerned Veterans for America, part of the
constellation of political groups funded by the billionaire
libertarian-leaning activists Charles G. Koch and David H.
Koch, in this case to push the department away from
government-run veterans’ care and toward private care
subsidized by the government.

Dr. Shulkin forced the fight into the open, running a one-man
media operation via his own cellphone while betting that the
White House would eventually offer reinforcements. On
Monday, after meeting with the White House chief of staff,
John F. Kelly, Dr. Shulkin signaled that his gamble had paid
off.
He said in an interview that President Trump and Mr. Kelly
supported his making changes at the department, including
the removal of any staff members who did not support him.

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Mr. Kelly made no mention of finding a new secretary, Dr.
Shulkin said, and the White House press secretary, Sarah
Huckabee Sanders, publicly expressed her support.
Staff changes could be announced on Wednesday, Dr.
Shulkin said, without providing details. Whether he can
prevail in actually firing the officials — rather than just having
them transferred elsewhere in the government — remains to
be seen. Political appointees serve at the pleasure of the
president, and it was not clear whether Mr. Kelly or Mr.
Trump would back their ouster.

At the root of the dispute is a long-running battle over how
to deliver health care to the nation’s veterans. The
department, the federal government’s second largest,
operates more than 1,200 hospitals and clinics across the
country where about nine million veterans receive treatment
at little or no cost. In limited cases, it pays for veterans to see
private doctors.

Policymakers in both parties argue that offering veterans
unrestricted choice between the public veterans health care
system and private medical providers would be too
expensive and lead to the dismantling of the Veterans Affairs
system. They have generally favored a more measured
approach that would allow the department to approve the
use of private care when waiting times are too long at
veterans’ hospitals or when veterans live too far from the
department’s facilities.

Enter the Trump administration: Mr. Trump has promoted
greater choice as a top priority and surrounded himself with
several conservative advisers supportive of greater
privatization. Darin Selnick, a former senior adviser to the
Koch-funded group, serves as the veterans affairs adviser for
the White House’s Domestic Policy Council.

Dr. Shulkin, who led the department’s health care system
under President Barack Obama, has aligned himself with the
more moderate position. As more conservative officials see
it, that has put him out of line with the White House view on
the department’s most pressing policy issue.

In addition to the two top communicators — Curt Cashour,
Dr. Shulkin’s press secretary, and John Ullyot, the assistant
secretary responsible for communications — Dr. Shulkin is
likely to target several officials close to the White House. They
are Jake Leinenkugel, the White House senior adviser on
veterans affairs, and Camilo Sandoval, a former data
manager for the Trump campaign who was given a political
post at the department.

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Mr. Leinenkugel, a former brewery executive, wrote an email
to Mr. Sandoval in December outlining his falling out with Dr.
Shulkin over policy issues. Mr. Leinenkugel proposed using a
then-continuing inspector general investigation to oust Dr.
Shulkin’s chief of staff; replacing the deputy secretary,
Thomas G. Bowman, with Mr. Leinenkugel; and replacing Dr.
Shulkin with a “strong political candidate” with ties to the
Koch-based group.

The dispute boiled over last month when the department’s
inspector general released a scathing report on a business
trip that Dr. Shulkin took to Britain and Denmark last year.
The report found “serious derelictions” related to the trip and
concluded that the secretary spent much of it sightseeing
and improperly accepted a gift of Wimbledon tickets. It also
accused Dr. Shulkin’s chief of staff at the time of altering an
email to justify the department’s paying the airfare of Dr.
Shulkin’s wife.

Political appointees trying to wrestle away control of the
department seized on the report to force the secretary’s
ouster. Shortly after its release, Mr. Cashour and Mr. Ullyot
called a prominent House staff member to ask for backup,
according to a Republican congressional aide familiar with the
call. Mr. Ullyot told the staff member, Jonathan Towers, that
Dr. Shulkin would be gone by the weekend and asked if
House Republicans would advocate the secretary’s removal,
the Republican aide said.

Mr. Towers, who works for the chairman of the House
Veterans Affairs Committee, Representative Phil Roe of
Tennessee, told Mr. Ullyot “no” on the spot, the aide said,
and pointed out that Mr. Roe had released a statement of
support for the secretary just a day before.

Mr. Cashour and Mr. Ullyot have disputed that account. The
purpose of the call, they said, was to warn Mr. Towers that
doubts raised about the inspector general report by Dr.
Shulkin were unfounded. Tiffany McGuffee Haverly, a
spokeswoman for Mr. Roe, said on Monday that the
chairman continued to have confidence in Dr. Shulkin.

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Dr. Shulkin, meanwhile, disputed the report’s conclusions
and went around his press office to personally reach out to
the news media and publicize concerns that appointees in his
office were “trying to undermine the department from
within.”

There were other examples. In recent months Dr. Shulkin
began to use a new, more inclusive motto for the
department, changing the phrase “To care for him who shall
have borne the battle and for his widow, and his orphan” so
that it included female veterans, a former department official
said.

Mr. Ullyot, carrying out orders from the White House,
reversed the decision, and Dr. Shulkin relented.
The secretary has not spoken directly with Mr. Ullyot in three
weeks, since the report’s release. His critics within the
administration said he had isolated himself and become
paranoid.

Allies of Dr. Shulkin have suspected that the same faction
could be behind ominous-sounding reports that have
appeared in the press saying that the inspector general was
on the verge of releasing another damaging report, this time
about Dr. Shulkin’s use of his in-house security detail — a
report that could provide a final blow to the secretary. A
spokesman for the inspector general did not reply to a
request for comment.

Asked about Monday’s meeting, Mr. Cashour replied with a
seemingly unrelated statement. “President Trump tasked
Secretary Shulkin with reforming the V.A. so it could better
serve the men and women who sacrificed to protect our
country,” Mr. Cashour said. “Many reforms have already
been enacted, many more are still needed, but nothing will
distract the president, the secretary and the department from
finding the best ways to provide care and benefits to our
country’s heroes.”

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