Fox News Channel contributor Pete Hegseth arrives at Trump Tower on Nov. 29. He is still in the running for head of the Department of Veterans Affairs. (Spencer Platt/Getty Images)

With confirmation hearings for Donald Trump’s Cabinet set to start this week, the president-elect still has not chosen a leader for the Department of Veterans Affairs, an agency he vowed on the campaign trail to significantly shake up.

It is not for lack of trying.

Trump has met with or considered about a dozen candidates to run the second-largest federal department. But none seems to have made the cut.

[To keep promises to veterans, Trump taps Koch-backed group]

Of all the day-to-day operations of government that Trump railed against during his campaign, VA, an agency reeling from scandal, came under special scrutiny. Its management challenges are vast, and the president-elect’s promises to veterans to remake it daunting.

Finding the right person for the job — and someone who actually wants it — remains one of Trump’s biggest challenges less than two weeks before his inauguration. VA is one of only two Cabinet positions — the other is the Agriculture Department — without a nominee for secretary.

In recent weeks, Trump has met with retired military leaders, politicians and health-care executives, some of whom would help diversify a Cabinet he is under pressure from some on his team to make more inclusive. He has met with some candidates multiple times and extended preliminary offers to others. Yet several qualified contenders have turned him down.

Reince Priebus, Trump’s incoming chief of staff, has urged the president-elect to expand the VA search to more women and minorities, according to a source close to the transition who spoke on the condition of anonymity because the person was not authorized to discuss internal discussions publicly.

[Trump under pressure to keep Obama’s VA secretary]

Trump met last week with Leo MacKay Jr., a senior vice president at Lockheed Martin who was a deputy VA secretary under President George W. Bush. But MacKay, who is black, is reluctant to leave the private sector, the source said. In December, Trump officials approached Navy Adm. Michelle Howard, the first woman and African American to become a four-star admiral. But she declined to pursue the post.

VA, with 360,000 employees, an $180 billion budget, and a sprawling system of 1,700 medical centers and benefits, has proven one of the toughest corners of the government to run — and run well. Its daily operations are tested by the burdens of 15 years of war in Iraq and Afghanistan and increasing medical demands from older veterans who fought in Vietman, Korea and World War II.

President Obama’s first secretary, Eric Shinseki, a decorated former Army general, was forced out amid a widening scandal that exposed long delays for medical appointments and orders from managers to fudge wait times to cover the delays up.

Trump has made it clear that he wants big reforms to fix what he has called a “broken” system that treats illegal immigrants “better than our vets.” 

At the top of the list: a significant expansion of private health care outside VA for those who want it, an easier path to firing incompetent employees and less waste in agency programs.

These ideas are opposed by powerful, old-line veterans of service groups in Washington, who tried to persuade Trump to keep Obama’s current secretary, Republican Robert McDonald, on the job, but apparently have come up short.

The tensions underscore another hurdle for the incoming president, say veterans’ advocates: He must walk a fine line between ideology and constituencies, pushing for changes he wants without alienating large groups such as the American Legion and the Veterans of Foreign Wars, which have members in every small town in the nation.

“Who in their right mind wants to go in and take on what seems to be insurmountable problems?” said Susan Lukas, a former high-ranking VA budget official who is now legislative director at the Reserve Officers Association. “There’s an extremely high level of oversight.”

The job comes with other hurdles. Long waits persist for medical appointments in some parts of the system. VA runs the country’s largest health-care system at a time when government-run health care is under fire. Its massive benefits program runs huge backlogs. Its leader must answer to otherwise divided lawmakers who unite for veterans to demand accountability.

Unlike most other federal agencies, VA serves veterans directly. And when it fails, a well-organized constituency that has always been sacred to Americans and its politicians makes it known.

The delays in finding a new secretary have worried veterans groups, which say the changes Trump pledged in his first 100 days in office could lose momentum. Nominations for the agency’s health and benefits chiefs must be vetted by a special commission, adding months to the confirmation process.

“We appreciate that a lot of thought is going into picking the next VA Secretary,” Dan Caldwell, policy director for Concerned Veterans for America, a conservative group backed by the billionaire brothers Charles and David Koch, said in an email. “But we don’t want to see a delay in the nomination affect the Department’s transition between administrations or impede the president-elect’s VA reform agenda for 2017.”

One potential candidate, retired House Veterans Affairs Committee Chairman Jeff Miller (R-Fla.), fell from serious consideration because he is not a veteran. Another, Luis Quinonez, a Florida businessman and prominent Latino who had risen to the top of the list, withdrew before the new year, citing health issues. Quinonez also is battling Virginia officials over back child support, the Military Times reported, an issue that could have clouded his confirmation.

At the same time, Cleveland Clinic chief executive and cardiac surgeon Delos “Toby” Cosgrove, considered the front-runner because of his extensive health-care background, also pulled out. He told transition officials that he could not extract himself from his commitments in Cleveland.

Trump also has met with former senator Scott Brown (R-Mass.), an early supporter, and former Coast Guard commandant Thad Allen.

The leading candidate left appears to be Pete Hegseth, 36, a Fox News Channel contributor and Iraq War veteran. Hegseth is a former president and chief executive of the conservative Concerned Veterans for America. The group, founded just four years ago, has an influential role in the Trump transition. From his perch at Fox News, Hegseth has been a harsh critic of McDonald’s leadership.

But some of Trump’s advisers think that Hegseth, while aligned with Trump ideologically, does not have enough experience to lead such a massive agency, according to the source close to the transition team. Hegseth also has alienated traditional veteran service organizations by vowing to fire under-performing employees and turn over more of the system to private doctors, a change they warn would privatize the safety net for those who served.

But Hegseth was told by Trump aides last week that he is still in the running, the source said.

Sean Spicer, the incoming White House press secretary, said last week that there is “nothing to announce at this time” on a VA secretary nominee. He declined further comment.

”There may be 50 or 100 people in America who have the bona fide qualifications to run VA, ” said Philip Carter, an Iraq War veteran and senior fellow at the Center for a New American Security, focusing on veterans. ”Most of them don’t want the challenge or don’t want to be asked because they don’t align with Trump politically. If you pick badly, it will blow up in your face.”