The Senate Veterans Affairs Committee cleared the way Tuesday for Robert Wilkie to become the next secretary of the Department of Veterans Affairs in a vote that pointed up the challenges he will face in implementing a massive reform bill aimed at expanding private health care options.

By a voice vote, the committee moved to send Wilkie's nomination to the full Senate with a recommendation for approval in a floor vote that could come as early as next week.

The lone "No" vote in the committee was cast by Sen. Bernie Sanders, I-Vermont, who told reporters he was voting "less against Mr. Wilkie than against President [Donald] Trump."

Sanders said he fears that Wilkie, with Trump's backing, would "move to privatization" of health care at the VA under the recently passed VA Mission Act, which calls for extending the VA Choice Program on community-care options for one year while consolidating and reforming the way it is administered.

The VA Mission Act also includes significant changes to the VA's caregivers program for severely disabled veterans. The caregivers program had been limited to post-9/11 veterans, but the changes would extend caregivers benefits to veterans of all eras over four years.

Major veterans service organizations (VSOs) initially balked at supporting the VA Mission Act over their own concerns about privatization.

The VSOs eventually backed the bill after receiving assurances from the Trump administration and bipartisan members of the Senate Veterans Affairs Committee that the VA would remain the gatekeeper on health care and that private care would be an option when it is in the best interests of the veteran.

Wilkie, 55, of North Carolina, a Republican who previously served in several staff positions on Capitol Hill and at the White House, was not Trump's first choice to replace ousted VA Secretary Dr. David Shulkin, who was either fired by Trump or resigned in March.

His path to the nomination also was marked by several detours.

Wilkie had been undersecretary of defense for personnel and readiness and was moved over to the VA as acting secretary while Trump pressed for the nomination of Rear Adm. Ronny Jackson, his personal physician and head of the White House medical unit.

Jackson withdrew his name from consideration after allegations emerged questioning his personal behavior and administration of the medical unit. To date, these allegations have not been proven.

Once Trump settled on Wilkie, a bureaucratic problem arose under the U.S. Code, which bars an acting secretary from succeeding to the permanent job as head of a government agency.

Wilkie had to step down as acting secretary. Peter O'Rourke, who had been chief of staff at the VA, moved into the acting secretary's position pending Wilkie's confirmation.

At Wilkie's confirmation hearing last month, Sen. Johnny Isakson, R-Georgia, chairman of the Senate Veterans Affairs Committee, warned him that he would face a major morale problem at a department riven by political infighting and lingering concerns over the scope and direction of private health care options.

In addition, Congress has yet to identify the funding sources for the VA Mission Act. The bill signed by President Trump allotted $5.2 billion to extend the VA Choice Program for one year, but the projected cost of the VA Mission Act is $55 billion over five years.

At the confirmation hearing, Wilkie said he favors private and community care when the VA cannot meet the needs of the veteran, but "I am opposed to privatization" and would keep the Veterans Health Administration fully funded.

-- Richard Sisk can be reached at Richard.Sisk@Military.com.