Democratic senators who have met with White House physician Ronny Jackson, the President's pick to lead the Department of Veterans Affairs, have made clear that privatization of veterans' medical care is a red line for them.
If Jackson, a rear admiral in the Navy, supports privatization, they won't back his nomination. So far, they say, Jackson has signaled emphatically that he doesn't support it.
As of yet, no Democrats have publicly thrown their support -- or opposition -- behind Jackson, saying they still have unanswered questions and want to see Jackson show his spine and rebuff the White House on one of the President's central campaign promises.
Senate Veterans Committee top Democrat, Jon Tester of Montana, told reporters on Capitol Hill this week that Jackson said "all the right things" when it comes to privatization, but that he hadn't had a conversation with the President about his position. Tester said he told Jackson that he needs to do that "and then come back and tell me what the President says about you."
Ohio Sen. Sherrod Brown, another Democrat who sits on the committee, told CNN this week that Jackson "assured" him in their roughly 20-minute meeting that he would oppose privatizing the agency, but that he wanted him to tell the President that, and speak out publicly against any effort to make that shift to veterans' health care. Jackson was convincing enough "for now," he said, but added he wanted to see Jackson stand up to the administration and conservative interests that would push for privatization.
"And maybe he loses his job after fighting the administration for a period of months," Brown told CNN. "But I want to see him do that because I know hardly a veteran anywhere I've ever met who thinks that a privatized VA is better than the Veterans Administration that has served this country. I will fight like hell to make sure that stays."
Washington Democratic Sen. Patty Murray, who also met with Jackson, said she still wanted to know more about how Jackson "will stand up to ideological opponents of VA," even though he spoke "strongly" against privatizing VA.
The lengthy fight over privatization
The fight over how to best care for the nation's 20 million veterans has been long simmering and contentious, and has pitted nearly every traditional veterans group against the conservative advocacy group Concerned Veterans of America, which is funded by the billionaire Koch Brothers.
Jackson's predecessor at the department, David Shulkin, said that restructuring care for veterans in that manner would not work and favored a more moderate approach that involved investments in the VA health care system while offering veterans more, though not unlimited, access to private doctors.
But then-candidate Trump made improving care for veterans a central campaign promise, and said he wanted to allow more access to private doctors. And as recently as last month, he said veterans should be able to "run to a private doctor" if they wanted, a statement that revived concerns that drastically expanding private care was the goal when Trump decided to oust Shulkin and replace him with Jackson.
Asked whether the White House supported a drastic expansion of private care, White House spokesman Raj Shah told CNN that there have been "no discussions" about privatizing veterans' care. And acting VA Secretary Robert Wilkie, who has also been making the rounds on Capitol Hill in recent days, has also spoken out, saying he doesn't support privatization, but that he wants to see the sprawling VA system modernize to care better for veterans.
Multiple sources -- on Capitol Hill and in leadership at major veterans groups -- tell CNN that they think this is a bit of a semantics game, and privatization means different things depending on who you ask.
About one third of veterans' appointments are already made with doctors and offices outside of the VA's health system, including in cases in which wait times are too long, the department didn't offer the right mix of services or it's determined that veterans would be better cared for in the private sector.
Democrats and veterans group have warned that shifting even more care (and money) for veterans outside of VA and into the private sector could weaken the department's services and lead to the health system's collapse.
Traditional veterans groups have argued, almost uniformly, that they want to see Congress and the administration fix the holes in VA's health system, including aging infrastructure, long wait times and accessibility issues, rather than just pushing care for veterans out into the private sector. They see community care as part of the solution, but not the end-all, be-all.
The VA has pushed back on the notion that shifting more care for veterans is equal to privatization.
"The fact is that demand for veterans' health care is outpacing VA's ability to supply it wholly in-house," the VA said in a statement earlier in the month. "And with America facing a looming doctor shortage, VA has to be able to share health care resources with the private sector through an effective community care program. There is just no other option."
Jackson told lawmakers that he has yet to tell Trump where he stands on privatization, despite telling multiple senators that he opposes it.
When Shulkin was confirmed in February 2017, he openly stated that he wouldn't privatize the agency, calling VA a "unique national resource that is worth saving."
"There will be far greater accountability, dramatically improved access, responsiveness and expanded care options, but the Department of Veterans Affairs will not be privatized under my watch," he said.
A little more than a year later, he found himself out of a job.
Privatization is not the only issue
The questions about Jackson are not limited to his policy views. Lawmakers have also raised questions about whether or not he is qualified to lead the sprawling agency that is at a critical juncture.
Sen. Mike Rounds of South Dakota, a Republican member of the Veterans Committee, told CNN that "anyone coming into VA would face the challenge with working with the sprawling agency's more than 360,000 staff, but that Jackson's challenge "will be greater than most coming into that."
Kansas Sen. Jerry Moran, a committee Republican who is meeting with Jackson next week told reporters that there's no list of things Jackson needs to do to get his support, but that "ultimately, I need to reach the conclusion that I have confidence in this person to lead a huge organization that desperately needs strong leadership."
"He doesn't have the experience that you traditionally would think would be required at the VA, but that doesn't preclude me from reaching the conclusion that he could be a good secretary," he added. "But I need to be assured that despite the experience, he has other qualifications, capabilities, characteristics, that make him the person that should be the secretary."
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