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Ronny Jackson withrew his nomination to be VA Secretary last week. (Photo: Tom Williams / CQ Roll Call)

The most obvious problem at the Veterans Affairs Department is that it doesn’t have a secretary. But that leadership vacuum only compounds the deeper issues the VA has spent years trying to overcome.

The big picture: The VA is the second-largest federal agency, with a huge annual budget, and it’s also at the center of a heated political debate. But advocates generally agree about what its needs are.

These are all multi-year problems that did not manifest themselves overnight. At the same time, the VA does not have the continuity of leadership and vision necessary to solve these kind of persistent problems
— John Hoellwarth, communications director of AMVETS

Vacancies: There are around 33,600 job openings at the VA — but that’s a lot better than the 49,300 employees the agency was seeking in May of last year.

  • “The lack of a secretary is just the tip of the iceberg, and it’s representative of a lack of not only leadership but also personnel at the department," said Lou Celli, director of veterans affairs and rehabilitation at the American Legion.

Mental health: "Reducing Veteran suicide is VA’s top clinical priority, and under President Trump, the department is increasing suicide prevention and mental health care efforts," VA spokesman Curt Cashour said.

  • Of the statistical 20 veterans per day who die by suicide, only six are engaged with the VA.
  • Experts and advocates are generally happy with the work the VA has done to address the problem. They say getting more veterans into the system is the next key; the VA has submitted a plan along those lines to the White House.
  • "They've done a Herculean job with the crisis hotline," Celli said. "It is effective and it does work, but I think that the goal is to try to reach these veterans before they reach the level of crisis."'

Electronic medical records: It’s been over year since the VA got started on the contract for a new system that would allow veterans’ health records to seamlessly from the Defense Department to the VA.

  • A final decision is expected “in the coming weeks," Cashour said.

A decision about private care: This issue is by far the most politically explosive.

  • The Obama administration expanded access to non-VA care in the wake of the 2014 VA scandal, allowing veterans to use their benefits with other local providers if they have to wait too long to see a VA doctor.
  • The next secretary will quickly be thrust into a fierce political debate about whether to further privatize veterans’ care.
  • The VA is "kind of like looking at Obamacare or Medicare and throwing war in the middle of it, because it's got this political element and it’s got a lot of money,” said Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America

Go deeper

Updated 4 hours ago - World

U.S. airstrike kills senior al-Qaeda leader in Syria, DOD says

A displacement camp near the village of Qah in Syria's northwestern Idlib province. Photo: Ahmad Al-Atrash/AFP via Getty Images

A U.S. airstrike in northwest Syria on Friday killed senior al-Qaeda leader Abdul Hamid al-Matar, U.S. Central Command said in a statement.

Why it matters: Syria serves as a "safe haven" for the extremist group to plan external operations, according to U.S. Army Maj. John Rigsbee.

Updated 10 hours ago - Politics & Policy

Giuliani associate Lev Parnas convicted of campaign finance crimes

Lev Parnas, a former associate of then-President Donald Trump’s personal lawyer Rudy Giuliani. Photo: Stefani Reynolds/Bloomberg via Getty Images

Florida businessman Lev Parnas was convicted Friday on charges of conspiracy to make foreign contributions to political campaigns, according to multiple outlets.

Why it matters: Prosecutors said Parnas, then an associate of former President Donald Trump's personal lawyer Rudy Giuliani, funneled over $150,000 from a Russian businessman into U.S. campaigns as part of an effort to land licenses in the U.S.'s legal cannabis industry.

Supreme Court agrees to hear challenges to Texas abortion law

Photo: Saul Loeb/AFP via Getty Images

The Supreme Court on Friday agreed to hear two cases challenging Texas' abortion law, which bans the procedure as soon as six weeks into pregnancy, but left the law in place in the meantime.

Why it matters: The court is moving extraordinarily fast on the Texas cases, compressing into just a few days a process that normally takes months. And that schedule means the court will take up Texas' ban a month before it hears another major abortion case — a challenge to Mississippi's own 2018 ban on abortions after 15 weeks.