After a prolonged period under intense investigation, the VA seems to be one of the few parts of the federal government not under intense scrutiny these days. VA Secretary David J. Shulkin, MD, became the first appointee of the Trump administration to receive a unanimous vote in the Senate. Given Dr. Shulkin’s experience as VA Under Secretary of Health, he is not expected to need much time to get up to speed on VA operations.
Little turmoil is expected in Defense Health either. Defense Secretary James Mattis was one of the first Trump administration confirmations with a 99-1 vote. A new Assistant Secretary of Defense for Health Affairs has not been named, but David J. Smith, MD, is currently performing the duties of that position and VADM Raquel C. Bono is continuing as the Director of the Defense Health Agency.
Positions in other agencies are less settled. Tom Price was confirmed on a party-line vote (53-47) as Secretary of Health and Human Services on February 10th following a bruising confirmation process. At HHS, many of the senior level positions are filled with acting directors, who have limited authority, including a director for Indian Health Service. No name has been officially put forward for the FDA Commissioner position, though former deputy commissioner Scott Gottlieb is rumored to be a leading candidate. One exception is Surgeon General VADM Vivek H. Murthy, MD, MBA, who remains in place as does much of the PHS senior leadership.
At IHS, the lack of a permanent director is particularly concerning, as the agency confronts chronic understaffing and now a federal hiring freeze. “Any freeze in hiring for Indian initiatives, whether temporary or permanent, threatens to make the challenges facing Indian Country worse,” Sen. Jon Tester, (D-Mont), said in a statement .
“Today’s confirmation of Dr. David Shulkin places the first non-veteran to lead the very lifeline to veterans’ health care and benefits—particularly within VA spinal cord injury/disease centers,” said Al Kovach, Jr., president of the Paralyzed Veterans of America. “But it also places a doctor who is intimately familiar with the value and challenges of the VA health care system as it stands at the crossroad of private health care for veterans and veteran-centric care with Congressional oversight… We look forward to working with Dr. Shulkin on the future of veterans’ health care, and ensuring the voices of the most catastrophically injured veterans are heard above the political din.”