Military Medical Leaders Express Concerns Over Health Care Reform

By Terri Moon Cronk

DoD News, Defense Media Activity

WASHINGTON, June 12, 2015 – Senior Defense Department medical leaders addressed health care reform on Capitol Hill yesterday, expressing concern over potential impacts on military medical readiness and overall readiness.

Appearing before the House Armed Services Committee’s military personnel subcommittee were Dr. Jonathan Woodson, assistant secretary of defense for health affairs, and top medical officials from the services: Army Lt. Gen. Patricia D. Horoho, Air Force Lt. Gen. (Dr.) Mark A. Ediger and Navy deputy surgeon general Rear Adm. (Dr.) C. Forrest Faison III.

Military health care reform was examined as part of the overall Military Compensation and Retirement Modernization Commission, which sent its recommendations to President Barack Obama in January.

“We agree with [the commission’s] findings of overarching challenges facing military medicine and concur with many recommendations,” Woodson said, adding that some of its recommendations are now in place.

Strategies Now in Place

Woodson described strategies that are now in place to make the military health care system “better, stronger and more relevant for the future,” and stressed the critical nature of military readiness, ensuring quality health care and using money wisely in the Military Health System.

“We’ve undertaken a comprehensive review of our medical infrastructure and resources,” he said, “and [we’ve] presented a modernization plan that proposes to place our most-skilled professionals in the military communities where they are likely to keep those skills sharpest.”

The Military Health System has reformed governance and stood up the Defense Health Agency to enhance collaborative work affordably among the three medical services, Woodson told the panel. “We’re making it easier to access care in the system by focusing on quality, safety and making performance data more transparent,” he said.

Woodson said he agrees with commission’s recommendation to reform the TERICARE military health plan, and told the panel that work is already underway.

Surgeons General Share Concerns

The surgeons general said that while they support the objectives of the commission’s findings, they have concerns about elements that threaten readiness and military medical skills.

“[Fewer than] one of five service members evacuated from Iraq and were injured in battle,” Horoho noted. “During Operation United Assistance, the major threat to soldiers was endemic infectious diseases. The Army already uses joint infrastructures … [for] medical readiness. The Army does not support establishing a four-star readiness command,” a commission recommendation and a point echoed by Ediger and Faison.

Though the surgeons general support affordable health care and increased choices for patients, “to establish TRICARE choice would negatively impact the readiness of our entire health care team and present financial challenges for active-duty families and retirees” Horoho said.

“To put [military treatment facilities] in competition with the private sector would drive up administrative costs and significantly detract from the operational mission of our medical facilities,” Ediger agreed.

The Air Force surgeon general said requiring airmen and their families to “navigate a complex system of insurance marketplace on a recurring basis” could increase their stress.

“[The Military Health System] is working hard to recapture its [patient] workload into the direct-care system,” Faison said, adding that offering commercial insurance to military patients would compete with that goal.

“Nonactive-duty beneficiaries comprise 67 percent of our total beneficiary population, 83 percent of our inpatient care and 79 percent of our high-acuity workload,” Horoho emphasized.

Military Medical Training Would Be Affected

“These patients are vital to sustain our graduate medical and health professionals’ education programs,” she said. “The loss of these inpatients from our direct health-care system would pose tremendous risk to our training and negatively impact our medical forces readiness posture.”

Ediger and Faison agreed that the lack of military patients would harm medical training and affect overall readiness.

“We believe resilient families with excellent health care support greatly enhances the resilience of all of our airmen,” Ediger said. “Significant progress in the [Military Health System], as Dr. Woodson pointed out, has occurred. And we are a progressive system of health and readiness as a result.”

“We need to recognize what sets us apart from civilian medicine: that we are a rapidly deployable, fully integrated medical system,” Faison said. “This allows us to support combat casualty care with unprecedented battlefield survival rates.”

“The Army needs a medically ready force,” Horoho said, with Ediger and Faison in agreement. “Commanders need to know … soldiers will be ready to deploy,” she added.

“When wounded soldiers hear the rotor blades of a medevac helicopter, they need to continue to have confidence that our providers are trained and ready,” Horoho said. “Any radical departure presents significant risk to a system that has produced record levels of both combat casualty survival and readiness.”