President Trump on Wednesday fired David Shulkin, the embattled head of the Department of Veterans Affairs, the latest high-profile ouster to roil the White House.
In a Twitter message, the president named Dr. Ronny L. Jackson, the chief White House physician, as the next VA secretary. Until Jackson can be confirmed, the acting head of the agency will be Robert Wilkie, the undersecretary for personnel at the Defense Department, Trump said.
Shulkin has been besieged by allegations of ethical lapses coupled with a determined campaign against him by conservatives who favor greater privatization of the huge VA healthcare system.
In a White House statement Wednesday, Trump said Shulkin “has been a great supporter of veterans across the country and I am grateful for his service.”
Jackson, who also served as White House physician for Presidents George W. Bush and Obama, is a rear admiral in the Navy. In 2005, he served with the Marines as an emergency doctor in Iraq.
“Admiral Jackson is highly trained and qualified, and as a service member himself, he has seen firsthand the tremendous sacrifice our veterans make and has a deep appreciation for the debt our great country owes them,” Trump said in the statement.
Jackson has no apparent experience managing massive bureaucracies like the VA. He is best known to the public for his exhaustive news briefing in January, detailing the results of Trump’s recent physical.
“Dr. Jackson is a good and honorable person, fine doctor and career military, but you do get the sense that this has as much to do with his boffo press conference on the president’s physical as anything else,” said former Obama advisor David Axelrod in a Twitter message.
One veterans group voiced concern about Jackson's lack of management experience.
“We are disappointed and already quite concerned about this nominee,” said Joe Chenelly, national executive director of AMVETS. “The administration needs to be ready to prove that he’s qualified to run such a massive agency, a $200-billion bureaucracy.”
At the news briefing where he praised Trump’s health, Jackson also offered a clue to why Trump may have chosen him for the Cabinet job.
"I've seen him every day. I see him one, two, sometimes three times a day, because of the location of my office,” Jackson said. “We have conversations about many things, most if not — most don't revolve around medical issues at all. But I've got to know him pretty well."
In his other recent high-level personnel moves — replacing Rex Tillerson with Mike Pompeo as secretary of State, for example — Trump has seemed to put a premium on finding people with whom he is personally comfortable — a trait he also followed as a businessman.
Another factor in choosing Jackson may have been Trump's penchant for people who look the part. "He's like central casting, like a Hollywood star," Trump told guests about Jackson at a fundraiser at his Mar-a-Lago estate in Florida last month, according to audio of his remarks obtained by CNN.
Shulkin, the one Obama administration holdover in the Cabinet, was a Trump favorite early on. Trump called him the "100-to-nothing man" — a reference to the unanimous Senate vote to confirm him in early 2017 — and joked that Shulkin was safe from being fired because he helped push legislation through Congress last year to speed disability appeals at the VA.
But he came under fire after he took his wife on a government-paid trip to Europe last year that appeared to involve more tourism than work. He also was the focus of an inspector general inquiry into whether he used his security detail to perform personal errands.
Shulkin ran afoul of some conservatives for his go-slow approach to expanding government-paid private care for military veterans outside the VA system. Shifting more veterans to private care is a top priority for the influential network of conservative groups funded by Charles and David Koch.
An effort to expand the existing Veterans Choice program, under which veterans can get government reimbursement for seeing a private doctor in certain circumstances, failed this month when Congress did not include it in the massive government spending bill that Trump signed into law.
The Koch-backed Concerned Veterans of America has pushed for the legislation, but most other major veterans organizations opposed it.
Concerned Veterans for America Executive Director Dan Caldwell said in a statement Wednesday that Shulkin’s replacement may put the agency back on track.
"We are hopeful that this change will end the recent distractions at the VA and put the focus back on advancing policy that will ensure veterans get the healthcare and other benefits they have earned,” Caldwell said.
Sen. Bernie Sanders (I-Vt.) said the Senate should examine Jackson's views on privatization of VA care. "Every major veterans organization in this country vigorously opposes the privatization of the VA," Sanders said. "I stand with them. Our job is to strengthen the VA in order to provide high-quality care to our veterans, not dismember it."
Despite the criticism, Shulkin retained support from many traditional veterans organizations and key members of Congress, who shared his ambivalence about privatization at the federal government’s second-largest department.
The disarray at the VA created a quandary for Trump, who repeatedly vowed during the 2016 campaign to improve veterans’ services, especially for the generation who fought in the post-Sept. 11 wars in Iraq, Afghanistan and elsewhere.
Trump wavered on replacing Shulkin for months, at times openly touting potential replacements while his aides insisted there were no plans to make a change.
The decision to replace him now comes after Shulkin helped broker a deal, supported by major veterans groups, that expands options for veterans to seek private medical treatment while keeping intact the VA system of government-run hospitals.
Shulkin said the deal would focus on building “world class services” for veterans and improving specialized care for post-traumatic stress disorder and other behavioral health issues that primarily affect members of the military.
He said he would seek partnerships, not competition, in areas where the private sector already offers high-quality services, such as maternity care.
A physician and former hospital executive, Shulkin served as undersecretary for health at the VA during the Obama administration.