Can the NDAA Stop Planned Cuts to Military Medicine? MOAA Answers Your Questions

Can the NDAA Stop Planned Cuts to Military Medicine? MOAA Answers Your Questions
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The changes coming to military medicine as part of proposed reforms may involve 18,000 billet cuts and a reorganization of dozens of facilities affecting hundreds of thousands of beneficiaries.


MOAA's Summer Storm 2020 seeks legislation in the FY 2021 National Defense Authorization Act (NDAA) to officially stop these efforts to downsize military medical capacity and require additional DoD analysis and mitigation planning, together with increased congressional oversight. Specifically, MOAA wants to secure Senate support for two House provisions that do just that.


We believe all cuts should be reconsidered in light of lessons learned from the whole of government response to the coronavirus emergency and recent Government Accountability Office (GAO) report findings highlighting DoD shortfalls in its plan to restructure MTFs that put access to care for military families at risk.


[TAKE ACTION: Urge Your Senators to Support Legislation Stopping Cuts to Military Medicine]


Here are some answers to frequently asked questions about the planned cuts, about the NDAA process, and about other related news items of interest. Not finding what you’re seeking? Email with your concerns.


Q. Could the cuts be stopped via the NDAA?


A. That’s our goal. MOAA wants language in the FY 2021 NDAA that officially stops military treatment facility (MTF) downsizing and medical billet reductions, and increases DoD reporting requirements and congressional oversight. The House version of the NDAA includes such language.


Our ask goes beyond delaying the military health system cuts and plants the seed for a re-evaluation of military medical readiness requirements based on an assessment of the national COVID-19 response and implications for DoD’s future role in pandemic prevention and response. Section 715 of the House NDAA ensures medical manpower requirements account for all national defense strategy scenarios, including “both the homeland defense mission and pandemic influenza.”  


Q. Why is MOAA focusing on the Senate?


A. The NDAA process is complex, even by legislative standards. Here’s the short version:

  • The House bill includes two provisions that would halt the planned cuts, thanks in part to your efforts in a successful Virtual Storming the Hill – click here to read more about them.
  • The Senate bill does not include these provisions.
  • Now that both bills have been passed by their respective chambers, members of the House and Senate meet in a conference committee to resolve any differences. Your interaction with senators – especially those who are chosen to take part in that committee -- will help ensure the House language remains in the bill.


Q. What if I’m meeting with a member of the House of Representatives? How should I shape my message?


A. If you meet with a House office, please express appreciation for Sections 715 and 716 in the House version of the NDAA. Use information in MOAA’s issue paper to emphasize how important it is that these provisions make it through conference and into the final legislation.


Q. Are these cuts the same as those in recent media reports? And didn’t the president say he would stop them?


A. It’s not clear whether some or all of the $2.2 billion DoD health care budget cut reported by Politico was the result of previous Pentagon reviews. It is clear, from the report and from previous reform measures, that DoD is relying heavily on the civilian medical sector to cover the needs of beneficiaries as part of their planned MHS changes. Analysis on the availability of civilian care done to date has been insufficient and MOAA members are concerned, even reporting a lack of access to care in the civilian networks in some areas.


We must secure legislation to increase DoD reporting requirements and congressional oversight of MTF restructuring and proposed medical billet cuts to ensure continued beneficiary access to high quality care. 


Q. Where do the services stand on these changes? What about their letter to Defense Secretary Mark Esper asking him to halt all transfers of military treatment facilities to the Defense Health Agency (DHA)?


A. While the request would halt MTF restructuring, there’s no indication the secretary will agree to the changes. And lawmakers from both parties have suggested there are no plans to alter course on the overall reform effort. So securing NDAA language requiring a delay to the cuts and a re-evaluation of future reforms remains key.


Lt. Gen. R. Scott Dingle, USA, the Army’s surgeon general and head of Army Medical Command, made it clear at a July 29 event that the needs of the beneficiary population are in line with those of the Army and other services under the DHA umbrella.


“Health care delivery and readiness cannot be separated,” Dingle said. “These are health readiness platforms. These are the venues that our health care workers must work to ... provide care to the beneficiary population at your post, camp, or station, yet also to be ready to be called upon to execute the Army’s mission of to deploy, fight, and win, and then right along with them is the medical community deploying. … It was an understanding or an epiphany that hit everyone that we were separating health care delivery and readiness, and we need to stop and get this right.”


MOAA understands and appreciates the concerns outlined by the Army surgeon general. We must ensure our military medical system can meet medical readiness requirements while also ensuring beneficiary access to essential medical care. The House NDAA language provides the best way forward, as it would allow for an approach that considers both the realities of COVID-19 and improved decision-making metrics (as outlined in the GAO report).


Q. What kind of "lessons learned" should DoD get from this pandemic and its response?


A. Our nation has implemented a whole-of-government interagency response to COVID-19. The “lessons learned” will go across the entire government and the civilian medical and emergency response systems.


For DoD, MOAA believes the lessons learned are likely to focus on the level of uniformed medical reserve capacity needed to effectively surge military medical resources to areas of need while still delivering essential medical care to military beneficiaries who rely on uniformed medical providers for their care. The lessons learned also should address DoD’s role in medical research and development and pandemic prevention efforts.


[DONATE: MOAA’s COVID-19 Relief Fund]


Q. My MTF is on the list of facilities being downsized. What should I do?


A. Chances are your elected officials are aware of these efforts and the potential impact on military hospitals and clinics in their district/state, but it can’t hurt to make sure they understand your MTF is impacted. If your MTF is on the list, be sure to add a personal perspective to your discussion by talking about how the proposed changes could impact your family.


Q. My MTF isn't on that list. Will these reforms still affect me? How?


A. While the Section 703 report listed 48 MTFs slated for potential downsizing and infrastructure reductions, MOAA has almost no visibility on details related to the 18,000 medical billet cuts – we do not know which medical specialties or MTFs will be impacted. It is fair to say all MTF patients should be concerned about how billet cuts may impact them.


Because DoD’s plan is to shift care to the civilian medical system, you may want to share what you know about limitations to civilian medical care in your local area that could impact your ability to find care if you are affected by billet cuts. For example:

  • Do you live in a fast-growing area where medical systems are having a hard time keeping up with demand?
  • Many rural hospitals are struggling. Has your local civilian hospital been downsized or closed?
  • Is there a new employer headed to your area that will bring increased demand for care?


[RELATED: What Will Civilian Health Care Cuts Mean for TRICARE Beneficiaries?]


Q. The Defense Health Agency assured us that all MTF restructuring is conditions-based and has asked for a delay in MHS reform implementation timing – why is this not enough?


A. Legislation is critical to ensure DoD conducts rigorous analysis and mitigation planning before making military medical cuts that cannot be easily reversed. House provisions will also ensure much-needed transparency and congressional oversight to the MTF restructuring and medical billet cut process.


Additionally, the COVID-19 pandemic will yield many lessons learned for the entire medical system, including DoD. It would not make sense to simply pause billet reductions and MTF restructuring only to return to a pre-coronavirus reform strategy after the crisis has passed. The COVID-19 pandemic demands all plans to downsize military medical capacity be reconsidered.


Q. Didn’t we get a halt to billet reductions in last year’s NDAA?


A. Yes. Section 719 of the FY 2020 NDAA -- Limitation on the Realignment or Reduction of Military Medical End Strength -- halted billet reductions until DoD and the services demonstrate they have addressed all readiness and beneficiary care impacts via reviews, analyses, mitigation plans, and beneficiary outreach. This report was due in June, but DHA has requested an extension due to COVID-19. The report is still critical, but it will be incomplete without a larger analysis around the national response to COVID-19.


Given the shortfalls GAO found with DoD’s Section 703 report on MTF restructuring, we have also asked Congress to require a GAO evaluation of DoD’s Section 719 report on proposed medical billet cuts.


Editor's note: A version of this FAQ was first published May 13.


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