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

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3 dead and thousands evacuated as Northern California fires explode

A building at the Meadowood Napa Valley luxury resort burns after the Glass Fire moved through the area on September 28, 2020 in St. Helena, California. Photo: by Justin Sullivan/Getty Images

Three people have died in a wildfire in Northern California and tens of thousands were evacuated across the state, as firefighters contended with strong winds and dry conditions that saw blazes explode across the state on Monday.

Driving the news: Shasta County Sheriff Eric Magrini confirmed the deaths occurred as the Zogg Fire spread across 15,000 acres, forcing the evacuation of 1,200 people. More than for 5o,000 people, per AP.

Updated 20 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 9 p.m. ET: 33,273,720 — Total deaths: 1,000,555 — Total recoveries: 23,056,480Map.
  2. U.S.: Total confirmed cases as of 9 p.m. ET: 7,147,241 — Total deaths: 205,031 — Total recoveries: 2,794,608 — Total tests: 102,342,416Map.
  3. Business: Companies are still holding back earnings guidance.
  4. Health: Trump announces plan to distribute 150 million rapid tests —The childless vaccine.
  5. Media: Fauci: Some of what Fox News reports about COVID-19 is "outlandish"
  6. States: Cuomo extends New York moratorium on evictions until 2021.
  7. World: More than 1 million people have now died from coronavirus — India the second country after U.S. to hit 6 million cases.
Dave Lawler, author of World
38 mins ago - World

Global coronavirus death toll crosses 1 million

Data: Our World in Data; Chart: Sara Wise/Axios

The global toll of confirmed deaths from COVID-19 crossed 1 million on Monday, according to data from Johns Hopkins.

By the numbers: More than half of those deaths have come in four countries: the U.S. (204,762), Brazil (141,741), India (95,542) and Mexico (76,430). The true global death toll is likely far higher.