Trump’s VA Team Could Bring Big Changes to Vets’ Health Care, Employee Rights

President-elect Donald Trump is taking advice on how to run the Veterans Affairs Department from conservatives with ties to a group that has sought to drastically reduce the government’s role in providing health care to veterans.

Trump on Tuesday named Darin Selnick, a senior adviser to Concerned Veterans for America, to his VA landing team and met with the group’s former CEO Pete Hegseth at Trump Tower in New York City. The meeting comes as Trump is considering Hegseth for VA secretary, according to multiple reports. Trump has previously said he would look for a secretary who would be a “person of great competence” and “not a political hack.”

CVA has since its inception in 2012 pushed for reform at VA that would give veterans more private sector choices in health care and make it easier to fire misbehaving or poorly performing employees. Critics of the organization, which has received funding from the Koch brothers, say it is advocating for privatization of the VA, though Selnick and CVA officials have taken great pains to explain they do not support eliminating the government’s role in providing care to veterans.

The group met with members of Trump’s staff this year prior to the election. Dan Caldwell, CVA’s vice-president for policy, said Trump’s aides were receptive to the reforms CVA outlined. Prior to that meeting, Trump unveiled his own plan for VA reform, which included strengthening accountability measures and giving veterans options to seek private care on the government’s dime

“I will ensure that every vet has the choice to seek care at the VA, or seek private medical care paid for by our government,” Trump said. On accountability, Trump vowed to use his signature phrase on “incompetent” VA executives: “They’re fired.” He also promised to reward, not punish, employees who expose inefficiencies.

Sam Clovis, who served as Trump’s chief policy adviser during the campaign, said in May if ensuring quality care for veterans “means we have some form of privatization or some form of Medicare, we don’t see anything wrong with that.”

Selnick, who is now reporting to VA to work with its career employees and outgoing political officials to prepare the next administration, recently wrapped up his service on the congressionally chartered Commission on Care. The commission issued its final report and recommendations earlier this year, but Selnick was one of three commissioners out of the 15 on the panel who declined to sign off. Selnick helped to author a “dissenting view,” which found the primary report represented a “lost opportunity for transformation.”

Selnick, a special assistant to the VA secretary during the George W. Bush administration, said the commission’s plan would leave in place the Veterans Health Administration’s “failing” operating model and was too friendly toward veterans service organizations and the department’s “bureaucracy.” He said unless VA unions were stripped of their influence and employees of their right to appeal negative personnel actions to the Merit Systems Protection Board, the workforce would avoid accountability.

Selnick and CVA have supported a proposal from Rep. Cathy McMorris Rodgers, R-Wash., to move VHA into a government-chartered nonprofit corporation. The third-highest ranking House member put forward draft legislation in June to task one part of the new nonprofit with managing VA’s brick and mortar facilities and the other to manage insurance programs, creating two separate entities to handle payer and provider functions.

The discussion draft would expand choice for veterans by creating a “premium support” model to receive care from non-VA sources. Critics contend that premium support is a voucher system that cuts benefits and leaves veterans on their own to receive care. Veterans would be able to choose either the VetsCare Federal program -- allowing them to continue receiving care exclusively though the traditional VA system -- or VetsCare Choice -- which would provide them with subsidized private care. Those choosing the latter option could still opt to go to facilities run by the corporation to receive care for service-related injuries.

A group of more than two dozen veterans service organizations -- including Disabled Veterans of America, the American Legion and Veterans of Foreign Wars -- sent a letter to McMorris Rodgers, who chairs the House Republican Conference, and other members of House leadership, to voice “grave concerns” with the draft. The VSOs said the bill was built upon false premises, ignored the improving circumstances at the department since 2014 and would inflict “immediate and permanent negative consequences for millions of veterans” if enacted.

That measure, and the reforms proposed by groups like CVA, was always likely a non-starter under President Obama. The White House rejected even the commission’s proposal to create more integrated care, which reformers like Selnick said was far too mild.

The commission’s plan, Obama said in September, would force “untenable resource tradeoffs that would limit the ability of VA to carry out other parts of its mission on behalf of veterans.”

Another commission-backed recommendation that failed to gain traction would create a VA equivalent of the Pentagon’s Base Realignment and Closure process so the department could divest itself from unneeded buildings.

Under a Trump administration, those proposals would likely face a much friendlier reception -- especially if the meetings he has taken and appointments he has made are any indication.

Trump is “very serious about making substantial reforms at VA,” Caldwell said. Hegseth and Selnick, he added, “can provide a lot of insight in new and unique ways.”

Another member of Trump’s VA landing team, former House Veterans' Affairs Committee Chairman Rep. Steve Buyer, R-Ind., has also voiced his support for easing the firing of VA employees, saying in 1999 VA’s punishment resembled Club Med. The current chairman of that committee, Rep. Jeff Miller, R-Fla., helped Trump craft his VA reform plan. Miller is set to retire in January and has expressed interest in becoming the next VA secretary, but has yet to meet with Trump since his election.

Caldwell pointed to Miller’s VA Accountability Act, which cleared the House last year, as an example of the type of reform Trump could sign into law as president.