All of this distills down into a policy question that is at the heart of Shulkin’s first battle: What, exactly, does the nation owe to those who have served in uniform? And how should the VA deliver on that promise? On one side is the VA establishment, and major veterans organizations, who have taken a “mend it, don’t end it” stance toward VA health care. On the other side are political conservatives including the Koch brothers–funded Concerned Veterans for America and many of Trump’s allies in Congress, who would like to focus the VA on service-related care like mental health and contract for everything else from the private sector. Shulkin has tried, with some success, to forge a middle path with congressional leaders in the House and Senate.
Shulkin’s second battle—political infighting with more partisan members of the administration—inflames and complicates these policy disagreements. He is the sole survivor of the Obama administration among Cabinet officials serving Trump. A practicing physician and successful health executive, Shulkin came to the Obama administration to run the VA health care system after the 2014 Phoenix scandal. His selection came after a turbulent Trump transition, during which the president interviewed several potential candidates before settling on Shulkin. Trump reportedly gave Shulkin the job because the New Jersey physician persuaded him he could continue the slow, deliberate privatization of the VA and deliver other wins to Trump on issues like employee accountability (read: easier firing of civil servants).
Since being confirmed in February 2017, Shulkin has largely delivered on those pledges. The VA has continued to purchase private-sector care for veterans—so much so that it has needed to ask Congress for more money to fund the popular program. Shulkin made a difficult decision on electronic health records that the Trump administration has touted as an example of public-private partnership (although that contract now appears stalled). And, Shulkin has presided over the termination of hundreds of VA employees, something the president praised in his State of the Union address this year. But Shulkin has made a few missteps, too, including presiding over continuing problems at the VA’s Washington hospital and proposing to kill the VA’s support for homeless veterans, before walking back that idea in the face of public outcry.
Unfortunately, none of this success has helped Shulkin battle with more partisan appointees brought in by the Trump administration. Some of these appointees, including former beer executive Jake Leinenkugel and Trump campaign operative Cam Sandoval, began working late last year to engineer Shulkin’s exit. According to the Washington Post, these nominees have actively sought to sabotage Shulkin’s tenure, going so far as to call congressional leaders and lobby them to push for Shulkin’s ouster. In response, Shulkin has isolated himself from these senior appointees, reportedly barring their access to his 10th floor executive suite and asking White House chief of staff John Kelly for permission to fire them. (Permission has thus far been denied.) This political battle has consumed more and more of Shulkin’s time in recent months, threatening his reform agenda and ability to deliver more political wins for the president.
It is against this backdrop that Shulkin must wage his third and most personal battle: a fight over two internal ethics investigations by the VA’s inspector general. The first investigation was triggered by Washington Post reporting about Shulkin’s trip to meet with veterans officials in Europe—a trip that included a detour to Wimbledon, and a few days of vacation too. The VA’s inspector general scorched Shulkin in its report on this trip, finding that permission to bring his wife had been predicated on a falsified email from Shulkin’s chief of staff and that Shulkin had impermissibly ordered his staff into travel concierge duty. Shulkin pushed back, retaining counsel to dissect the IG report, and he even suggested that his chief of staff’s email had been hacked. (It was not.) A day later, however, Shulkin’s chief of staff announced her retirement, and Shulkin said he would repay the government for the cost of his wife’s airfare.
A second investigation, regarding Shulkin’s use of his protective security detail, is reportedly percolating in the VA inspector general’s office now. That assessment will reportedly criticize Shulkin for inappropriate use of his security detail for personal errands. On its face, the allegations aren’t that damning; they show Shulkin to be an inexperienced government executive who’s used to different rules in the private sector and also indicate his naïveté about how certain things will play on the proverbial front page of the Washington Post. But these errors come at a time when the Trump administration can ill afford another ethics scandal after similar abuses at HUD, Interior, and HHS, with the latter resulting in Secretary Tom Price’s resignation. A Cabinet secretary aligned more closely with the White House than Shulkin, or with more political allies across the administration, could probably survive these investigations with barely a flesh wound. For Shulkin’s tenure at VA, they may end up being fatal, to the extent they provide a pretext for the White House to replace Shulkin with a more trusted partisan.