VA to Get First Permanent Official for Top Health Job Since 2017

by Rebecca Kheel

The Veterans Health Administration will have a Senate-confirmed leader for the first time in more than five years after President Joe Biden’s nominee for the role received approval from the upper chamber.

The Senate voted 66-23 on Thursday afternoon to confirm Shereef Elnahal as the Department of Veterans Affairs under secretary for health.

The vote fills the VA’s top health job with someone other than an acting official for the first time since early 2017, when David Shulkin stepped down to be the VA secretary for the Trump administration. Neither administration had moved forward with a nominee in the interim, leaving in limbo a position that’s critical to overseeing care for millions of veterans.

As under secretary for health, Elnahal will oversee the Veterans Health Administration, with responsibility for a $60 billion-plus budget and 9 million patients. He comes into the job at a time when the department has struggled with launching a new electronic health records program and continues to make changes to comply with the 2018 Mission Act, which requires the department to ensure timely access to care and allows more veterans to go to private doctors.

“Now more than ever, the Department of Veterans Affairs needs a steady hand to guide the Veterans Health Administration,” Senate Veterans Affairs Committee Chairman Jon Tester, D-Mont., said on the Senate floor ahead of the vote. “It is no secret that VHA and health care systems or providers are going through a challenging time. The VA continues to battle the impacts of the COVID-19 pandemic with veterans cases and hospitalizations and deaths on the rise again. And VA staff are dealing with burnout and increased turnover.”

Tester also praised Elnahal’s “impressive record,” saying it shows he is “committed to caring for our more than 9 million veterans in VA’s care.”

Elnahal has been the president and CEO of University Hospital in Newark, New Jersey, since 2019; prior to that, he was New Jersey’s health commissioner. From 2016 to 2018, he served at the VA as the assistant deputy under secretary for health for quality, safety and value.

During his confirmation hearing, Elnahal pledged to instill a “culture of respect and accountability” at the VHA, as he said he’s done at his current job.

He also vowed to be more transparent with appointment wait time data, improve oversight of physician credentials, improve access to mental health treatment and address problems with the department’s new electronic health records system.

Elnahal, who as New Jersey health commissioner expanded access to medical marijuana to veterans and other patients with certain conditions, also said he would work within the bounds of federal law to discuss advancing research on cannabis for certain health conditions at the VA.

“I did serve as an advocate for the program across the board for all patients who are eligible for specific conditions,” Elnahal said. “But the intersection with federal law was not something I had to contend with, so that would be a layer of issues I would have to address if confirmed.”

Elnahal was quickly advanced by the Senate Veterans Affairs Committee after his confirmation hearing in April. But his confirmation stalled for a couple months after Sen. Rick Scott, R-Fla., objected to fast-tracking full Senate approval, arguing Biden’s nominees haven’t been qualified but not offering any specific criticism of Elnahal or his qualifications.

While the health role is now filled, the VA continues to wait for a benefits administrator. Biden nominated Ray Jefferson to be the VA’s under secretary of benefits the same day he nominated Elnahal, and the two nominees shared a confirmation hearing in April. But Jefferson has withdrawn from consideration amid GOP concerns about his work leading the Veterans Employment and Training Service at the Department of Labor during the Obama administration.

The Labor Department’s inspector general in 2011 substantiated allegations Jefferson violated federal contracting and ethics rules, but the watchdog reversed its ruling eight years later and said the allegations should not have been substantiated and that Jefferson should not have been asked to resign.

The VA announced Tuesday it was launching a new search for an under secretary of benefits.