Who Would Replace David Shulkin at the VA?

There is rampant speculation that President Trump is currently looking to replace Department of Veterans’ Affairs (VA) Secretary David Shulkin, MD. The doctor has overseen a difficult tenure at the head of the challenged agency: Audacious goals have been announced and delayed while issues that have been growing for decades, like a system-wide staff shortage, have continued to plague it.

Shulkin has faced a spate of personal controversies regarding the misuse of public funds. With many outlets painting his departure as inevitable, here are a few of the names that have been bandied as potential replacements.

Pete Hegseth: A contributor and host for the President’s favorite cable news channel, Hegseth used to lead a group called Concerned Veterans for America (CVA). A tenet of the group’s philosophy is private choice for veterans’ healthcare. The group has strong ties to neoconservative funders and was critical of Shulkin long before he even came to head the VA. If his views closely reflect CVA’s, expect discussion of VA privatization to bubble up.

U.S. Army Lt. Gen. Keith Kellogg: The retired general serves in the Trump administration as Executive Secretary and Chief of Staff of the National Security Council. For a week, he was acting National Security Advisor after Michael Flynn’s ouster. There’s little publicly known about Kellogg’s healthcare positions, though he’s regarded as a forceful expeditor. He also forged a controversial reputation in the early days of the Iraq occupation.

Dr. Michael Kussman: The former Under Secretary for Health at the VA in the latter years of the Bush administration, Kussman is also a member of CVA. In Congressional testimony preceding his 2007 confirmation, he didn’t express any particular inclination towards the privatization of the agency’s health system.

A fun nugget from that 11-year-old hearing? “VA and DOD have achieved a significant level of success and are currently using standards-based interoperable electronic health records to share clinical data bidirectionally,” Kussman said, before acknowledging that the 2 agencies were exploring a new common inpatient EHR system.

Toby Cosgrove: The former Cleveland Clinic CEO was actually offered the job by Barack Obama in 2014. Trump also spoke to him about it early in his administration, although he declined “because of commitments” to the Cleveland Clinic post that he has since vacated. Cosgrove was once a practicing surgeon, and he led the acclaimed medical institution from 2004 until 2017.

In previous comments, Cosgrove has supported health system consolidation, the move from volume to value, and a “21^st century” EHR system for VA.

Leo Mackay Jr.: Another former VA executive from the Bush administration, Mackay served as Deputy Secretary of the agency from 2001 until 2003. He was also considered for the Secretary job in the early days of Trump’s transition, although he was ultimately not selected. Since 2016, he has served as a Senior Vice President for Lockheed Martin.

Rep. Jeff Miller: A former Representative for Florida’s 1^st congressional district (covering much of the western Panhandle), Miller actually won his seat after future TV host (and Trump foe) Joe Scarborough resigned the position in 2001. Miller did not seek reelection in 2016, leaving the post at the beginning of 2017. Miller is the only non-veteran on this list, although for his last 6 years in the House he chaired the House Veterans’ Affairs Committee.

For his part, Secretary Shulkin has appeared relatively unfazed by the swirling speculation. This month, he spoke both at the HIMSS conference in Las Vegas, Nevada, and the smaller Population Health Colloquium in Philadelphia, Pennsylvania. During his speech at the latter, he emphasized his belief in VA’s ability to lead the way for all of American healthcare, and the importance of maintaining the military’s independence when providing care for veterans.

“I did not want to ever get involved in the politics of Washington,” he said. “I fundamentally believe the Department of Defense and the Department of Veterans’ Affairs must not become politicized.”

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