Health

With VA secretary out, LA veterans are faced with unanswered questions

WASHINGTON, DC - MARCH 15:  Veterans Affairs Secretary David Shulkin appears before the House Appropriations Subcommittee on March 15, 2018 in Washington, DC.
WASHINGTON, DC - MARCH 15: Veterans Affairs Secretary David Shulkin appears before the House Appropriations Subcommittee on March 15, 2018 in Washington, DC.
Mark Wilson/Getty Images

Another cabinet member has exited the Trump administration.

Veterans Affairs Secretary David Shulkin had been rumored to be on the chopping block for weeks, but now it's official. President Trump tweeted yesterday that his presidential physician, Dr. Ronny Jackson, would replace Shulkin.

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Here's a closer look at what happened and what it could mean for veterans in L.A.

Was Shulkin really fired because he improperly took his wife to Europe on the taxpayer's dime?

It doesn't appear so.

The conflict that really seemed to take Shulkin down is the debate about how much private health care veterans should have access to.

Republicans in Congress and the Trump Administration have been pushing to expand a program called Veterans Choice. It lets vets go to private doctors if they have a wait at the VA that's longer than 30 days or a commute to the nearest VA hospital over 40 miles.

Democrats say they want to fix wait times, too, but they're worried about a quick fix that will be a slippery slope to full privatization of the VA. They argue that would drain resources away from an agency that does a lot of important work for veterans.

Secretary Shulkin, who's a holdover from the Obama administration, spoke to NPR on Thursday. He accused VA political appointees of pushing him out because he stood in the way of privatizing VA care.

The timing also comes right after a deal in Congress fell apart that would have added Veterans Choice reforms to the omnibus spending bill.

Shulkin said the program is flawed and needs to be fixed, but he believes fully privatizing veteran health care would end up funneling money to special interests at the expense of patients.

How could the debate over Veterans Choice affect veterans here in Los Angeles?

Los Angeles County alone is home to over 300,000 veterans, the most in the country, and the West L.A. VA is the largest veterans center in the country. The director told KPCC last year that wait times here are lagging behind the national average.

If the Veterans Choice program expanded, that could mean L.A. veterans could start to look for private care closer to home.

But opponents say this wouldn't necessarily mean better care. Shulkin said recently it's not clear veterans see better wait times when they go to private doctors. And local doctors have said that the VA is the best place to care for veterans suffering from battlefield injuries, traumatic brain injury, or mental health challenges like PTSD — conditions that are rarer in the civilian population.

Will this shakeup change how many homeless veterans get housing here?

When he took the helm at VA, Shulkin made it clear that he was moving away from the previous secretary's top policy priority, which had been to end veteran homelessness.

Shulkin focused instead on mental health care and preventing veteran suicides.

The national picture of veteran homelessness is different from Los Angeles, where the number recently shot up to about 4,800 unsheltered individuals, according to L.A. County's 2017 official count. In contrast, veteran homelessness has been reduced or, in some limited cases, eliminated in other communities across the country.

Local homeless veteran advocates were worried several months ago when Shulkin tried to change the way money was earmarked for paying case workers who assist homeless veterans. These case workers do things like checking up on vets who've been placed in supportive housing using the rental vouchers.

Shulkin wanted to give local VA health care systems more flexibility with the spending, but people who work with Southern California homeless vets said it would weaken these housing vouchers. Shulkin eventually backed off that funding change.

How does the recent overhaul of the West LA VA campus affect that effort?

One of the biggest sources of permanent supportive veteran housing here in Southern California could be the 388-acre West LA VA campus in Brentwood.

A few years ago, the VA settled with homeless and disabled veterans who sued to force reforms in the way the land is used, and they actually got a promise from then-VA Secretary Bob McDonald that housing for veterans would be built on the campus.

Eventually, that campus is supposed to have 1,200 units of housing for vets. Several years after a legal settlement, there are only 54.

Shulkin did oversee some steps in fulfilling the pledge to overhaul the West L.A. VA campus. He assigned a new manager to oversee the project, and there have been some agreements signed with developers to begin building more housing. The City of L.A. is chipping in — HHH funding has also been secured for the next two housing developments. And proceeds from the County's Measure H sales tax boost are already in action on the campus, providing supportive services to veterans.

But most observers say things need to move faster, and Shulkin may have taken his eye off the ball when it comes to homelessness.

Do we know where the nominee to replace Shulkin stands on these issues?

We have no idea. Veterans groups and legislators are definitely curious about this.

Dr. Ronny Jackson is an active duty Navy admiral, though he plans to resign his commission. Jackson has been a physician to several presidents and is reportedly well-liked by Democrats and Republicans alike. But he has no policy record.

Senator Johnny Isakson of Georgia is the chairman of the Senate Veterans Affairs Committee. He released a statement thanking Shulkin for his service to the country and added, "I look forward to meeting Admiral Jackson and learning more about him."

And that'll be important, because the Senate needs to confirm the next VA secretary.

This story has been updated.