According to The Associated Press, which obtained an advance copy of Shulkin's forthcoming book "It Shouldn't Be This Hard to Serve Your Country," Trump raised the matter with Shulkin during a March 2017 conversation in the Oval Office.
Trump was fresh off his 2016 campaign in which privatizing VA had become a political hot button after he pledged to steer more veterans to private-sector doctors outside the VA. He had said the VA was the "the most corrupt" and "probably the most incompetently run" Cabinet department.
During the meeting, Shulkin says Trump asked whether “we should begin to close the VAs,” referring to government-run medical centers that he viewed as poorly performing. Federal law prohibited such measures, so Shulkin answered that the VA was working with Congress to set up a system-wide review to address underperforming facilities, whether by fixing or closing.
“But this takes time,” Shulkin said.
Trump exclaimed, “So let’s just do an executive order!”
“This is a legislative issue,” Shulkin said.
Trump then offered, “Can’t we just declare a national emergency?”
At that point, the president's son-in-law and White House adviser, Jared Kushner, said: "Yes. We're still in a war, so we could."
Shulkin told the AP that ultimately he dissuaded Trump from pursuing that route, persuading him to sign executive orders for changes with wider support, such as expanded telehealth options for veterans.
"Much of my narrative deals with the factions pushing me to simply close the VA or at least large parts of it that weren't working well," Shulkin writes in the book, due out Oct. 22. "But I didn't see how shutting down a system specifically designed to care for veterans could be in the veterans' best interests."
Legislation that Trump signed last year gives veterans more freedom to see doctors outside the VA in an effort to cut wait times, paving the way for new rules that Shulkin says will "lead to the rapid dismantling of the current VA system." Recent studies have actually found that veterans got into a VA facility for an appointment faster on average and received better care than if they went to a private facility, raising questions about the value of steering veterans to the private sector if it results in inferior care.
The legislation expanding the Choice program includes a provision for a presidentially appointed commission to be set up in 2021, after voters elected the next president, to compile a list of VA facilities nationwide to be closed or reconfigured. If the president approves, closures would then begin unless Congress voted down the entire list, giving lawmakers no input on individual facilities to be added or removed.
Shulkin was fired in March 2018 amid investigations into alleged spending abuses and reports of internal dissension at the VA. The agency's internal watchdog had found that Shulkin had improperly accepted Wimbledon tennis tickets and his then-chief of staff had doctored emails to justify his wife traveling to Europe with him at taxpayer expense. Shulkin agreed to reimburse the government more than $4,000 in that case.
“As many of you know, I am a physician, not a politician,” Shulkin wrote in a New York Times op-ed published after his firing. “I came to government with an understanding that Washington can be ugly, but I assumed that I could avoid all of the ugliness by staying true to my values.”
The Associated Press contributed to this report.