Donald Trump's top two picks to become the next Veterans Affairs secretary abruptly withdrew their names over the weekend, leaving a shrinking list of candidates for the Cabinet post and a host of uncertainty surrounding the next administration's ambitious reform plans.

On Saturday, Florida businessman Luis Quinonez announced he would not pursue the job due to health issues. Within hours, Cleveland Clinic CEO Toby Cosgrove also removed himself from consideration, marking the second time in three years the well-known health care executive has turned down such an offer.

Both men had met with the president-elect several times about overseeing the agency, which employs about 365,000 people and has an annual budget nearing $180 billion. Trump announced nominees to lead nearly every other major government department before the end of last year. 

The president-elect has described the current department as broken and vowed to massively expand private care options for veterans, root out waste within veterans programs and restore public confidence in a department still reeling from the 2014 wait times scandal.

He also promised to enact many of those changes within his first 100 days in office. Transition teams have been laying the groundwork for those reforms for weeks, but it’s unclear how far that work can progress without a new VA secretary.

It’s also increasingly unlikely that a new secretary will be in place by the end of January, since the Senate confirmation process typically takes several weeks even for non-controversial candidates.

Veterans groups have expressed frustration with the pace of transition, and requested meetings with Trump to voice their desires for the department's future.

Multiple groups have publicly supported the idea of keeping current VA Secretary Bob McDonald in place, but Trump officials have dismissed the idea.

The leading remaining candidates include Fox News host Pete Hegseth, former president of the conservative advocacy group Concerned Veterans for America, and former Massachusetts Sen. Scott Brown. Both have met with Trump multiple times in recent weeks.

Hegseth’s past with CVA has proven controversial within the veterans community, and the appointment of either Brown or Hegseth would raise questions about why Trump continued to seek alternative candidates after interviewing both men weeks ago.

Trump has also discussed the position with Navy Adm. Michelle Howard, the first African-American woman to command a ship, and retired Army Gen. Ann Dunwoody, the service’s first female four-star general. But both are considered long-shot candidates within Trump’s camp.

Former Coast Guard Commandant Adm. Thad Allen also met with Trump about the post. House Veterans’ Affairs Committee Chairman Jeff Miller, R-Fla., was considered a leading contender early in the process, but has not had formal talks with Trump about the job in recent weeks.

Transition officials are expected to brief the media on the ongoing search on Tuesday.

Leo Shane III covers Congress, Veterans Affairs and the White House for Military Times. He can be reached at lshane@militarytimes.com.

Leo covers Congress, Veterans Affairs and the White House for Military Times. He has covered Washington, D.C. since 2004, focusing on military personnel and veterans policies. His work has earned numerous honors, including a 2009 Polk award, a 2010 National Headliner Award, the IAVA Leadership in Journalism award and the VFW News Media award.

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