Shereef Elnahal, MD, MBA, VA undersecretary for health
WASHINGTON, DC — The Senate voted to confirm Shereef Elnahal, MD, MBA, as the next VA undersecretary for health, making him the first Senate-confirmed person in that role since 2017.
That occurred shortly before the Senate’s recess in July. Elnahal’s confirmation had been delayed since May, when an attempt to fast-track his appointment was blocked by a single senator over his disapproval of President Joe Biden’s nominations as a whole.
Meanwhile, Biden’s nominee for VA undersecretary for benefits withdrew his nomination after Republican concerns about allegations made during his time in the Department of Labor. This forces the administration to go back to the drawing board in its search for a top VBA official.
Elnahal received a dual MD-MBA from Harvard University in 2012, and in 2015 was appointed by President Barack Obama to the White House Fellows program, which is designed to give young professionals first-hand experience with the workings of the federal government. He then served as VA’s assistant secretary for health for quality, safety and value from 2016 to 2018. In that role, he was responsible for the quality of care at VA facilities.
In 2018, he was nominated to join the cabinet of New Jersey governor Phil Murphy as the state health commissioner, where he served for one year before becoming president/CEO of University Hospital in Newark.
“Before I arrived, the hospital was under the oversight of a state monitor for failures in care quality, patient safety, financial performance and poor community trust,” Elhnahal explained during his confirmation hearing in April. “Together with my workforce, I turned that hospital around by investing in a culture of respect and accountability.”
Asked what lessons he would bring from his experience at University Hospital into VA, Elnahal said, “As a leader, I quickly had to not only understand but act upon the principle that my purpose for being there during the crisis was to support our front-line clinicians who were seeing our patients during the worst of the crisis. That was my agenda. It led me to the right decisions, including hazard pay for my workforce when I didn’t know if I’d be able to afford it. When we didn’t know if the provider relief funds were coming. … But it was the right decision.”
Just prior to resigning from the governor’s cabinet, Elnahal garnered national attention by authorizing New Jersey’s paramedics to administer buprenorphine in the field to treat acute withdrawal symptoms after the administration of naloxone. During his tenure as commissioner, he also worked to significantly expand the state’s medical marijuana program, increasing the number of dispensaries, physicians and patients served.
This garnered little controversy during the confirmation process, with Sen. Dan Sullivan (R-AL) even voicing hope that Elnahal would spur the department to take further steps into researching the medical use of cannabis.
“This issue is very complex from the national standpoint and the federal government standpoint. As you know, it remains a Schedule 1 drug,” Elnahal said. “But you have my commitment to have these discussions with leadership across the administration, but also with this committee, and try to come to a right set of next steps.”
It was not any particular aspect of Elnahal’s resume that led to such a long delay in his confirmation, but rather one senator’s discontent with President Biden and his nominees as a whole. When Sen. Joe Tester (D-MT), chair of the Senate VA Committee, attempted to expedite Elhanal’s confirmation in May, Sen. Rick Scott (R-FL) objected, blocking the fast-track appointment.
“Throughout his presidency, Joe Biden’s administration has shown an inability to place qualified and competent people in many places of power throughout the federal government,” said Scott. “We’ve had crisis after crisis, due to the failed leadership of President Biden and his appointees. This nominee, who will be in charge of critical healthcare programs at the Department of Veterans Affairs, is no different.”
Asked by Tester about specific objections to Elnahal, Scott refused to respond, leading to a rare outburst from Tester on the Senate floor.
“I hope the senator doesn’t walk into Memorial Day services and talk about what a great friend to veterans he is, because he is not,” Tester declared. “This obstruction stops our veterans from getting the healthcare they need. You want to talk about why the American people think the Senate is dysfunctional? The senator from Florida could look in the mirror.”
Lawmakers in July voted 66-23 to confirm Elnahal, making him the first permanent undersecretary for health since 2017, when David Shulkin, MD, stepped down from the position to take over as VA secretary. The last five years have seen four acting undersecretaries in the role, the most recent being Steven Lieberman, MD, MBA.
Biden’s undersecretary for benefits nominee, Raymond Jefferson, faced a similar confirmation delay, though for more specific reasons.
During Jefferson’s confirmation hearing—held jointly with Elnahal’s—he faced questions from several Republicans about an incident that occurred during his time as assistant secretary at the Department of Labor from 2009 to 2011. Jefferson was accused by subordinates of helping a personal friend get a government contract and was eventually forced to resign. Jefferson fought the allegations, spending a considerable amount of his own money to do so. In 2019, the Department of Labor’s Office of the Inspector General reversed their findings, stating that the accusations could not be substantiated and that Jefferson should not have been forced out of the post.
Several Republicans on the committee remained concerned, however, noting that, while the OIG’s findings failed to prove guilt, they were not necessarily proof of innocence.
Jefferson’s nomination stalled in the Senate, and he withdrew his name from consideration in July. Shortly afterward, VA established a commission to identify potential candidates. In the meantime, Joshua Jacobs, a senior adviser to the VA secretary, will continue performing the duties of the VBA Secretary.