2/11/2015 

Legislative News Update

THE ARMY would get a $7 billion increase in its base budget for 2016 under the Obama administration plan submitted to Congress this week.  The increase primarily goes to operations, maintenance and weapons modernization programs.The administration requests $147 billion for the Army in fiscal 2016, $2 billion less than the current budget in a reduction resulting from reduced funding for contingency operations.For fiscal year 2015, the Army received $121 billion in the base budget and $28 billion in operating contingency funds.  For fiscal 2016, the administration proposes boosting the base budget to $127 billion while cutting the contingency budget to $21 billion.The 2016 budget was announced Feb. 2, at a time when the Army has 140,000 soldiers serving in 150 foreign countries, and with nine of the Army’s 10 active divisions having headquarters actively engaged in ongoing operations.The modest boost for the Army is part of a decision by the administration to ask Congress for a 2016 defense budget that is $38 billion over spending caps set in the Budget Control Act, something that will require consent from lawmakers.  While the Army would receive $7 billion more than current spending, the budget would provide a $16 billion increase for the Air Force and an almost $12 billion increase for the Navy, according to Defense Department briefing charts.Forty-five percent of the Army’s base budget goes for personnel costs, with 36 percent for operations and maintenance and 18 percent for weapons programs.  Spending on personnel is flat, even though the Army expects to be smaller in 2016, a result covering the cost of modest increases in pay and benefits.  The budget includes a 1.3 percent basic pay hike, an average 1.2 percent increase in housing allowance and a 3.4 percent increase in subsistence allowance.Active-duty personnel levels would drop from 490,000 today to 475,000 by Oct. 1, 2016, under the plan.  Army National Guard strength, now 350,200, would drop to 342,000.  Army Reserve strength would remain at 198,000.There is $16.1 billion allocated to Army weapons procurement in the budget request, up from $13.9 billion in 2015.  Increases are spread over aircraft, missiles, track vehicle and ammunition programs, but Army officials said a top priority is modernizing Apache, Black Hawk and Chinook helicopter fleets in support of the Aviation Restructuring Initiative, a controversial topic where an independent commission could end up deciding details and timing.Ninety-four Black Hawks, 64 Apaches and 39 Chinooks would be purchased in 2016, an increase from the 87 Black Hawks, 35 Apaches and 32 Chinooks funded in 2015.  Money also is included to buy 450 Joint Light Tactical Vehicles and upgrades for 87 Strykers.FORMER SEN. BOB KERREY, along with other members of the Military Compensation and Retirement Modernization Commission testified before the Senate Armed Services Committee yesterday about the recommendations contained in their report released last week. Kerry said his work on the panel changed his mind that personnel costs were spiraling out of control.  He highlighted Social Security and Medicare as bigger, more expansive entitlements that require changes to address the deficit."That's just crushing all the appropriations accounts," Kerrey said. "It would be unfair to identify military retirement as the big problem, because it isn't.  The big problem is Social Security and Medicare."For that Sen. Kerrey, we give you an AUSA salute.In his opening statement, Committee Chairman Sen. John McCain, R-Ariz., said, “We honor the service and sacrifices of service members and their families – active duty, Guard, and Reserve – and we pledge to keep their well-being foremost in our thoughts as we deliberate the Commission’s recommendations.  But upholding our sacred obligation to them does not mean resisting change at every turn.  We must not shrink from the opportunity before us to create a modern system of compensation and retirement benefits that would provide greater value and choice for those it serves.McCain also said that, “The military’s current compensation and retirement systems are decades old, and in their current form, may be less than suitable for modern-day military members.  Today, we have a nearly 70-year-old military retirement system, and TRICARE, the military’s health program, was implemented in the mid-1990’s.  Both the retirement system and TRICARE were appropriate for their time, but clearly times have changed.  We are here today to learn how the Commission’s recommendations could make compensation and benefits better for the military members and families of our current force and forces of the future.AUSA is still studying the 300 page report to determine the good and bad.  There are some things that look good such as grandfathering the current force, but giving them the option to opt in, financial literacy training to teach Soldiers how to better manage their money, more child care on military installations and an increase in transition assistance are both winners.However, we are continuing to closely examine other recommendations such as those that would dramatically overhaul the current retirement and military health care systems before we weigh in.  We are also eager to see how the Defense Department will respond when they provide their take to Congress in early April. THE SENATE ARMED SERVICES COMMITTEE held a confirmation hearing today for Ashton B. Carter, the Defense secretary nominee.  Conventional wisdom is that Carter will be easily confirmed for the position.  He would be the administration’s fourth defense secretary. The Fiscal Year (FY) 2016 Defense BudgetAnnounced Feb. 2 it includes modest increases in military basic pay and housing allowances that could leave some military families holding on a little tighter to their wallets.For FY 2016, which begins Oct. 1, the Defense Department’s $536 billion budget request includes a $1.7 billion decrease in pay and compensation. Over five years, the cuts would total $18 billion.Savings is the result of continuing to cap basic pay and basic allowance for housing increases. The budget calls for a 1.3 percent basic pay increase, effective Jan. 1, 2016, that is larger than the 1 percent pay raises received in 2014 and 2015, but lower than the 2.3 percent military raise called for under a federal pay formula that links raises to the Employment Cost Index, a measure of private-sector salaries.Additionally, the 2016 Pentagon budget calls for a second year of capping basic allowance for housing rate increases to slightly less than the rise in local housing costs.  With the change, allowance rates adjustments effective Jan. 1, 2016, would be 2 percentage points less than the full cost of rental housing.The benefits plan would have to be approved by Congress.Commissary subsidies would also be reduced by the 2016 budget, which calls for a $100 million reduction in 2016 in what had been $1.3 billion worth of annual taxpayer support. Budget documents say the savings would come from “efficiencies and operating changes that do not require legislative changes.” Military families should expect to see some reductions in operating days and hours.A consolidated Tricare Health Plan has been proposed that will streamline the current Tricare system and provide incentives for wellness and decreases overutilization of services. Active duty members will remain exempt from co-pays or fees and active duty family members will be provided a “no-cost option no matter of their location or availability/access” to a military treatment facility.There is also a proposed enrollment fee for new Tricare for Life beneficiaries, with fees based on a percentage of the beneficiary’s military gross retired pay, and changes in the Tricare pharmacy fees to be phased in over nine years. Beginning in FY 2016, co-pay for retail prescriptions will grow from $8 generic/ $28 brand to $14 generic/ $46 brand in FY 2025.Proposed funding levels for military family support programs will rise from $7.8 billion in FY 2015 to $8 billion in FY 2016, which is good news for families.  Key programs include child care and youth programs, morale, welfare, and recreation programs, warfighter and family services, Department of Defense Education Activity schools as well as continuing support for spouse employment programs and Military OneSource.There is work to do before the proposed budget becomes law. Both the House Armed Services Committee and the Senate Armed Services Committee will hold hearings beginning in early February. AUSA will provide input to military and congressional leaders throughout the process.THE CLAY HUNT SUICIDE PREVENTION FOR AMERICAN VETERANS (SAV) ACT was passed in the Senate yesterday and is headed to the president for signature.  This AUSA-supported legislation will ensure VA’s mental health and suicide prevention efforts receive crucial independent, third party oversight while creating a greater accounting of available services and fostering an enhanced community approach to delivering veterans suicide prevention and mental health care treatment. It is named after Iraq and Afghanistan war veteran Clay Hunt, a Marine sniper who died by suicide in 2011.  Army & Air Force Exchange Service Public AffairsNEWS RELEASE: 15-050                                                         Feb. 3, 2015EXCHANGE MEDIA CONTACT: JULIE MITCHELL – mitchelljul@aafes.com Association of the United States Army Weighs In on Exchange Benefit DALLAS – The Army &Air Force Exchange Service’s Exchange Retiree Advisory Council, including Leroy Bussells, assistant director, Retiree & Veteran Affairs for the Association of the United States Army (AUSA), met this past January in Dallas to review Exchange services with Exchange senior leaders.   Exchange Executive Vice President and Chief Strategy Officer Mike Immler briefed Bussells and other members on the Exchange’s newly updated shopping website, shopmyexchange.com. The brand-new site received its first major overhaul in a decade this past fall. The updated site is designed to offer better navigation, more products and better service.Other Exchange priorities in 2015 include offering more national brands in stores and online. The Exchange also plans to roll out BE FIT Experience Centers at 50 locations. These centers will focus on national-brand athletic clothing and shoes for men and women. In Express locations, the Exchange is focused on healthy options and adding island coolers for grab-and-go convenience items. The Exchange is strengthening the sense of community as it explores the creation of entertainment centers, with multiplex theaters showing first-run movies and casual dining restaurants on many Army posts. These centers are expected to bring active-duty and retired Exchange shoppers back onto their nearest military installation. The Exchange’s first entertainment center at Fort Bragg is in the early planning stages, and other possible locations are being determined. The Exchange Retiree Advisory Council is made up of members from organizations representing military retirees and their families. Members are nominated as official representatives of their groups and selected by the Exchange Director/CEO. As a member, Leroy Bussells advises the Exchange Director/CEO on issues of interest to AUSA. The council’s next meeting is expected to occur in June.The Army & Air Force Exchange Service goes where Soldiers, Airmen and their families go to improve the quality of their lives through goods and services provided. Exchange earnings provide dividends to support military morale, welfare and recreation programs. The Exchange is part of the Department of Defense and is directed by a Board of Directors, responsible to the Secretaries of the Army and Air Force through the Chiefs of Staff. To find out more about the Exchange history and mission or to view recent press releases please visit our Web site at http://www.shopmyexchange.com or follow us on Twitter at https://twitter.com/ExchangePAO.  Department of Defense Authorizes Service Stars on the Global War on Terrorism Expeditionary MedalThe Department of Defense announced today that effective immediately, service members are authorized to wear Service Stars on their Global War on Terrorism Expeditionary Medals (GWOT-EM) to represent deployments in support of approved GWOT operations.Undersecretary of Defense for Personnel and Readiness Jessica Wright signed a memorandum authorizing the new policy change retroactive to Sept. 11, 2001.Only one GWOT-EM is awarded for each approved operation. For example, a service member who was awarded the medal for an Operation Enduring Freedom deployment, and is subsequently authorized a second award for an Operation Inherent Resolve deployment would wear a single Service Star on the GWOT-EM to denote both awards.The five GWOT-EM approved operations are: Operation                                      Inclusive DatesENDURING FREEDOM (OEF)  Sep 11, 2001 TBDIRAQI FREEDOM (OIF)               Mar 19, 2003 Aug 31, 2010NOMAD SHADOW (ONS)          Nov 5, 2007 TBDNEW DAWN (OND)                     Sep 1, 2010 Dec 31, 2011INHERENT RESOLVE (OIR)     June 15, 2014 TBD The list of associated areas of eligibility for each approved GWOT-EM operation is available at: http://prhome.defense.gov/RFM/MPP/OEPM/Functions.This policy change does not adjust criteria for award of the Afghanistan Campaign Medal or the Iraq Campaign Medal (ICM). Full eligibility criteria for the GWOT-EM are contained in Department of Defense Manual 1348.33, Volume 2, Manual of Military Decorations and Awards: DoD Service Awards Campaign, Expeditionary, and Service Medals. Additionally, each military department will prescribe procedures for service members' requests for award of GWOT-EM Service Stars.The Global War on Terrorism Expeditionary Medal is positioned above the Global War on Terrorism Service Medal in precedence, and directly follows the Kosovo Campaign Medal.To learn more, please view the department's memorandum. Shelf Life Extension Program Cuts Drug Costs, Aids Combat ReadinessThrough a cooperative program with the Food and Drug Administration (FDA), the Department of Defense (DoD) is reducing costs by extending the shelf life of selected prescription drugs that are found to be safe and effective beyond the expiration date, maintaining the original quality. The Shelf Life Extension Program (SLEP) keeps needed medications available longer for TRICARE beneficiaries at home and on the battlefields.“Routinely replacing medication stocks is costly to the federal government and taxpayers,” said Brandon Hardin, the Defense Health Agency’s (DHA) business support director. “Through scientific testing we are able to extend those medications that have maintained their quality and save money.”How the program worksThe FDA evaluates selected pharmaceuticals for shelf life extension by testing samples submitted from SLEP participants, which include other federal agencies. If the testing results show the product is safe and effective, the FDA extends the expiration date.  Most common drugs tested are ciprofloxacin (antibiotic), doxycycline, nerve agent antidotes and antivirals for influenza, according to Hardin.In 2014, the DoD’s program extended 449 of the 540 eligible lots tested, saving DoD $163.7 million by not having to replace those medications, he said. “Part of the program’s high success rate is the selection of products known to have a high probability of being extended.”DHA’s medical logistics division manages SLEP and is responsible for coordinating administrative functions between the FDA and 18 federal participants. The SLEP also aids agencies in responding to disease outbreaks and other threats, while reducing the overall costs of stockpile management.Boosting combat readinessBeyond deferring billions in drug replacement costs among the federal partners, the SLEP and DHA’s work supports combat readiness. In 2013, the sole producer of several antidotes for chemical, biological, radiological and nuclear threats had manufacturing difficulties. This reduced the company’s ability to provide protection to the U.S. Armed Forces in case of nerve agent poisoning, said Hardin. “Much of the antidotes’ inventory had expired or would expire within 180 days with no possibility of replacing the dwindling supply.”The DoD identified 43 lots of an antidote near or just past its expiration date. Hardin said, based on scientific data from previous SLEP testing results, the FDA concluded that all of the lots of the antidote submitted could be used for an additional year for the protection of deployed personnel. “Besides reducing overall costs and providing assurance that these critical pharmaceuticals meet stringent quality standards, the SLEP program helps protect those who protect us,” said HardinDramatic Drop in Traumatic Brain InjuryThe number of new cases of traumatic brain injury fell to 92.7 per month in 2014, down from a peak of 588 per month in 2008, according to reports from the Armed Forces Health Surveillance Center. The report counts diagnosis during a medical visit or hospitalization either during a deployment or within 30 days of returning from a deployment.What to watch: The drop is almost entirely the result of having fewer deployed service members in combat, so the risk of concussive injury has fallen. When tracking deployment-related traumatic brain injury began in 2003, there were 51.4 cases per month, the level to be expected in the near future. Defense Releases FY 2016 Budget RequestThe Pentagon on Monday released its $585.3 billion fiscal 2016 budget request with recommendations to continue slowing the growth in military pay and compensation. Most notably, the Defense Department recommends:

• A 1.3% military pay raise, which is slightly better than the past two consecutive 1% requests but still less than the expected CPI increase.
• To cut housing allowances by 4% over the next few years, which continues the Pentagon’s push to lower BAH from the current 99% of average costs to 95%.
• To reduce appropriated funding to commissaries by $300 million, which again continues a push to reduce the current $1.4 billion in annual subsidies to $400 million. This could force some commissaries to reduce their hours and days of operation.
• A new fee to penalize active duty families who are perceived to be abusing or misusing military emergency rooms.
• At minimum, to more than double copays for pharmaceuticals purchased commercially.
• To create new TRICARE-for-Life enrollment fees, but grandfather existing users. The proposed TFL fee begins at a half-percent of gross retired pay in FY 2016, and increases to 2% by FY 2019.
• To consolidate TRICARE Prime, Standard and Extra into one plan, and by FY 2020, raise the average retiree’s out-of-pocket health costs to 10%.

This defense budget request is a good starting point, but said the best request would be for Congress to first end sequestration, which begins again on Oct. 1, and forces the Pentagon to cut almost $1 trillion from its budget over 10 years. That could eliminate quality of life programs for military personnel and their families, and tremendously impact readiness and modernization programs, to the point of jeopardizing the military’s ability to respond when and where needed. Regarding the budget, Stroud said We look to continuing this most important conversation with Congress and the American people about what it means to properly take care of veterans, service members and their families, but all is for naught as long as sequestration remains the law of the land. Congress must end it or replace it, so that the rest of America can begin moving forward.”Clay Hunt Suicide Prevention Bill Clears Congress On Monday, the Senate passed H.R. 203, the Clay Hunt Suicide Prevention for American Veterans (SAV) Act, a bill that the we strongly supported, by a vote of 99-0.  Having already cleared the House, the bill now heads to the President for his signature. This critical legislation begins to address the crisis of veterans’ suicide by allowing VA to hire more psychiatrists, collaborate with local non-profit mental health organizations, and expand its successful peer support networks. Still, we feel that more needs to be done. Dropped provisions from the final bill would have improved mental health partnerships between VA and the Reserve Components, and required DOD to review less-than-honorable discharges that may have been associated with undiagnosed PTSD. We will continue to work with Congress on these critically important issues. Prescription TrackingVA recently implemented a new online tool that allows veterans to track the delivery of their VA prescriptions through My HealtheVet, 24/7. VA reports that more than 57,000 veterans currently use the prescription tracker every day.  Read more at: http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2676.  New TRICARE Prescription Copays in EffectThe FY 2015 National Defense Authorization Act required the military’s TRICARE health program to increase most pharmacy copayments by $3. The increase went into effect Feb. 1, and copays vary depending on the class of drug and where beneficiaries choose to fill their prescriptions. Using military pharmacies to fill prescriptions continues to be free to beneficiaries, as well as generic formulary medications received through TRICARE’s Pharmacy Home Delivery program. Read more at:http://www.tricare.mil/CoveredServices/BenefitUpdates/Archives/02_02_15_RxCopayIncrease.aspx.Pentagon Launches Call to Continued Service CampaignThe Joint Chiefs of Staff signed a 32-star letter Tuesday to urge service members to continue serving their nation and communities after they separate or retire from the military. The Call to Continued Service Campaign expands the successful Marine For Life and Soldier For Life programs so that all are now encouraged to become military and veteran advocates out in their communities, and to help ease transitioning issues for future veterans and their families—which is exactly what the VFW is all about.Three MIAs IdentifiedThe Defense POW/MIA Accounting Agency announced the identification of remains belonging to one airman and two soldiers who had been missing and unaccounted for since World War II and Korea. Returned are:

• U.S. Army Air Forces 1st Lt. James F. Gatlin, 25, of Jacksonville, Fla. On Dec. 23, 1944, Gatlin was copiloting a B-26C Marauder that was shot down while on a bombing mission near Ahrweiler, Germany. Gatlin and four other crew members were reported killed in action. He was assigned to the 575th Bombardment Squadron, 391st Bombardment Group, 9th Air Force, and was buried with full military honors Jan. 30 in Bushnell, Fla.
• Army Sgt. Gilberto L. Sanchez, 19, of New Braunfels, Texas. Sanchez was assigned to Medical Company, 32nd Infantry Regiment, 31st Regimental Combat Team. His unit was deployed east of the Chosin Reservoir in North Korea when it was attacked by overwhelming numbers of Chinese forces. On Dec. 1, 1950, remnants of the 31st RCT, known historically as Task Force Faith, began a fighting withdrawal to more defensible positions south of the reservoir. Sanchez was reported as missing in action on Dec. 2. He was buried Jan. 23 with full military honors in San Antonio.
• Army Cpl. C.G. Bolden, 24, of Van Buren, Ark. Bolden was assigned to Company C, 1st Battalion, 38th Infantry Regiment, 2nd Infantry Division.  He was captured by enemy forces on Jan. 5, 1951, and reportedly died in a North Korean POW Camp on April 30, 1951. He was buried Jan. 27 with full military honors in Clinton, Ark.

'16 DoD Budget Proposal: $585.2 BillionThe Obama administration submitted a $585.2 billion Defense Department budget request for 2016 to Capitol Hill, which it claims would focus on meeting continued threats from the Middle East and Russia. The proposal would help strike "the proper balance between [sic] capacity, capabilities, and current and future readiness," according to the Pentagon's related fact sheet. If approved, the 2016 defense-spending budget would be $24.9 billion higher than levels approved for 2015, and would pay for domestic and overseas contingency operations. The White House also is asking Congress to approve another round of base closure and realignment (BRAC). Total strength would diminish for each service branch, and beneficiaries would see significant changes in housing allowances, commissary services, and health care. (Uniformed service members and their families still would receive free health care.) 1.3-Percent Pay Raise ProposedService members would receive a 1.3-percent pay raise next Jan. 1, under the Obama administration's proposed 2016 defense-spending bill. Limited pay raises would continue through 2020, with increases of 1.3 percent in 2017, 1.5 percent in 2018 and 2019, and 1.8 percent in 2020. Additionally, the White House wants to cap the basic allowance for housing (BAH) so that service members would pay five percent of their off-base housing costs out of pocket. The bill also includes a plan to reduce the subsidy to the commissary system. The change would give the Defense Commissary Agency (DeCA) the flexibility to "operate the commissary system more like a business," according to the Pentagon. Shoppers would notice higher prices on certain goods. The additional revenue from these higher prices would allow the commissary system to maintain lower prices on market basket goods that junior families need. If adopted this year, the change would not take effect until 2017. TRICARE Options Would Be ConsolidatedWhile the administration adheres to the commitment to free health care for active-duty service members, other beneficiaries of military health care could see "modestly higher deductibles and co-pays" under the proposed 2016 defense-spending bill. Retirees, for instance, would see a "modest annual enrollment fee" for TRICARE for Life coverage. Also, the pharmacy co-pay structures would be "adjusted" upward. While active-duty members and their families still would receive free health care, the administration wants to impose fees on family members who "misuse emergency department care." Retirees and their families also would have to make increased co-payments and absorb higher cost shares for health care as well.  CBO: ‘Hire More Heroes' Would Add to DeficitA measure that would remove employers' requirements to include employees who already have coverage through either TRICARE or the Department of Veterans Affairs from legal requirements under the Affordable Care Act would add $858 million to the federal deficit, according to the non-partisan Congressional Budget Office (CBO). The measure, H.R. 22, passed the House on Jan. 6. On Jan. 28, the House Finance Committee ordered the bill – known as the Hire More Heroes Act – to be reported without amendment favorably. Rep. Rodney Davis, R-Ill., introduced the measure. Both CBO and the Joint Committee on Taxation (JCT) believe if H.R. 22 becomes law, it would reduce the number of employers required to make payments for coverage under the Affordable Care Act, known commonly as Obamacare. "As a result, CBO and JCT estimate that enacting H.R. 22 would reducer revenues, and thereby increase budget deficits … over the 2015-2025 period," CBO stated in a Feb. 2 report. VA: 30 Percent of All Federal Employees are VetsThirty percent of all employees of the federal government executive branch are veterans, according to the latest statistics by the Department of Veterans Affairs. The percentage of veterans who work for the federal government has risen annually since fiscal year 2008 (Oct. 1, 2007-Sept. 30, 2008), when the figure was 25.5 percent. The VA cited President Obama's 2009 executive order, which established the Veterans Employment Initiative, as a driver for the increase. As the veteran population in government service rose, overall hiring decreased 32 percent. The Defense (46.8 percent), Transportation (35.9 percent), VA (32.2 percent), and Homeland Security (27.4 percent) departments have the highest veteran representation. The Education (9.7 percent) and Health and Human Services (6.6 percent) department had the lowest. Next Air Force One SelectedThe Air Force has selected the Boeing 747-8 as the next presidential aircraft. The most modern iteration of the venerable 747 was chosen to be the next Air Force One because it would be manufactured in the U.S., and meet mission requirements. The only other four-engine aircraft under consideration was the Airbus A380, which is built in France. The selection does not constitute a contract award to Boeing – not yet, anyway. "We still need to finalize the overall acquisition strategy and conduct risk-reduction activities with Boeing to inform the engineering and manufacturing development contract negotiations that will define the capabilities and cost," said Air Force Col. Amy McCain, the Presidential Aircraft Recapitalization program manager. The new plane would replace the existing fleet of VC-25 aircraft, with an expected 30-year lifespan.  ‘Peeping Tom' Filming Incident Under InvestigationA Navy lieutenant is facing an investigation following allegations that he illegally tried to record on video women while they used the female officers' lavatory on the carrier John C. Stennis, Military Times reported Feb. 2. Stennis was taking part in a training exercise at the time in waters off Southern California at the time. The male officer allegedly was caught aiming video equipment into the lavatory area through a grate. The female officer who caught him alerted authorities, and later identified him to them. Both Stennis' commander, Capt. Mike Wettlaufer, and a spokeswoman for Naval Air Forces Pacific expressed disappointment in the alleged incident and promised to hold the male officer – who is not part of Stennis' crew – accountable for any possible wrongdoing. Report: AF Instructor Imprisoned for RapeAir Force Master Sgt. Michael Silva was sentenced to 20 years in prison for raping two women while he served as a recruit trainer at Lackland Air Force Base, Texas, the San Antonio Express-News reported Jan. 30. One of the women Silva raped was a recruit under his tutelage at Lackland. The crimes took place in 1995 and 2007. Criminal investigators learned of Silva's crimes during a probe of a larger scandal at the Texas base, in which 17 instructors faced accusations of sex-related crimes against as many as 43 female subordinate trainees. The illegal activity was traced back to 2009. Two commanders of the training squadrons involved in the allegations lost their jobs. Draft TMC Position on Each MCRMC RecommendationRecommendation 1: Help more service members save for retirement earlier in their careers, leverage the retention power of traditional Uniformed Services retirement, and give the Services greater flexibility to retain quality people in demanding career fields by implementing a modernized retirement systemTMC initial observations – The TMC needs to do a much more thorough analysis and evaluation, given the potential impact this recommendation could have on the retention of the mid-career officers and non-commissioned officers of the All-Volunteer Force.TMC initial concerns:

• The recommendation provides a dramatic shift in the military culture and moves the burden of responsibility for retirement management from the government on to the individual.
• Makes the assumption that this new retirement recommendation will be successful through the accomplishment of a major education in financial literacy of the force and that government-sponsored financial planners will be available at all locations to provide continued assistance to service members.
• This recommendation, especially under stressed conditions like the past 10 years, provides a greater incentive for service members to leave at critical retention points.
• Provides less of a financial benefit for those service members who stay for twenty years or more than under the current system.
• Shifts some retirement growth/management risk onto service member vice employer (DoD) – shirks current employer responsibility.
• Comparisons to private sector fails to take into consideration the unique conditions of service and the inability to transfer like skill levels back and forth as the private sector can – you must grow the skills in the military you just can’t hire a tank driver or F-22 pilot with 8 years of experience.  
• The defined contribution plan as outlined only provides dollar matching through 20 YOS – this would act as a huge disincentive to serve beyond 20 YOS.

Recommendation 2:Provide more options for service members to protect their pay for their survivors by offering new Survivor Benefit Plan coverage without Dependency and Indemnity Compensation offsetTMC initial observations – TMC cannot support the proposal. TMC initial concerns:

• It does not eliminate the current offset inequity affecting approximately 60,000 survivors.
• The proposed increase in premiums is exceptionally high and could actually reduce the number of retirees taking the coverage.
• The higher cost premium would be attractive to retirees that are the most financially strapped – 100% total and permanent disabled retirees – these disabled retirees are the ones we shouldn’t ask to pay even higher premiums.

Recommendation 3:Promote Service members’ financial literacy by implementing a more robust financial and health benefit training programTMC initial observations – TMC generally supports the principles of the proposal, however see potential problems with implementation. TMC initial concerns:

• Currently some bases may share Personal Financial Managers with other bases, limiting their availability, and “messaging” from leadership already in place for Military Saves Program.
• Any plan to grow a more robust financial and health benefit training program MUST include families.
• Any plan should include education on accessing and using their military benefits to further promote financial stability and should provide greater frequency at key touch points during the military life cycle.

Recommendation 4: Increase efficiency within the Reserve Component by consolidating 30 Reserve Component duty statuses into 6 broader statusesBy-in-large, we should support the recommendation but need more information on some of the categories to make sure they will accomplish the overall goal of simplification while also being fair to reserve component members and giving them the proper credit for their duty. Recommendation 5:Ensure Service members receive the best possible combat casualty care by creating a joint readiness command, new standards for essential medical capabilities, and innovative tools to attract readiness-related medical cases to military hospitalsProposal intent is to focus greater oversight on ensuring joint warfighting readiness

• Significant joint operations experience/improvements gained during 13 years of war, including joint medical operations.
  
  • Fewer battlefield deaths
  • Rapid medical evacuation
• MCRMC concerned this experience will dissipate as war winds down, and services will return to business as usual.
• Proposal envisions establishing 4-star Joint Readiness Command, with responsibility for planning, coordinating and overseeing joint operations ONE ELEMENT OF WHICH IS JOINT MEDICAL Readiness.
• Drawing clear line between military mission requirements for medical support vs. delivery of health benefits coverage to beneficiaries other than military members.
• Readiness focus on:
  
  • Care of service members (vs dependents/retirees/survivors)
  • Care delivered in MTFs (vs civilian facilities)
  • Care delivered by military medical professionals (vs civilian providers)
  • Capability of military medical professionals to maintain professional qualifications needed for wartime ops
• Having MTFs partner with private insurance plans as a kind of preferred provider for military (and potentially nonmilitary beneficiaries who need procedures that contribute to wartime medical readiness/maintenance of medical professional qualifications (e.g., trauma, surgery, etc.).
• DoD to have authority to make annual adjustments up or down for MTF care as needed to sustain MTF target caseload.
• Budget for MTF/service member care under O&M as military readiness expense.

TMC initial observations:

• TMC has long supported the principle of establishing a Joint Medical Command to ensure interservice consistency of policy and budget oversight, appropriate requirements for medical staffing, training and procurement efficiencies and more.
• MCRMC proposal has some similarities to that concept, but is much more far-reaching.
• Entails dramatic changes for delivery of beneficiary care whose impact requires significant study to assess potential adverse consequences for beneficiaries.

TMC initial concerns:

• Joint Command vision does not entail budget authority, but only participation in budget process with service/other players.
• Appears to envision further downsizing of MTF capacity; if so, are MTFs in more remote areas at risk?
• Envisions establishing beneficiary copays in MTFs (TMC strongly opposes).
• Envisions adjusting insurance reimbursements and/or beneficiary copays as financial “sticks” to drive selected beneficiaries into MTFs rather than civilian facilities for certain procedures.
• Proposed elimination of catchment areas could be positive as long as long-distance travel to MTFs is voluntary.
• TMC is concerned that DoD could use propose rate/copay-setting authority to coerce beneficiaries into using distant/inconvenient MTFs by setting stiff copay penalties for non-use (i.e., use of “sticks” vs incentive “carrots”).
• For MTF purposes, effectively subordinates beneficiaries’ needs/desires to MTFs; beneficiary becomes a tool for services to maintain readiness (“operating fodder”).
• Need to assess potential implications of proposal to open MTFs to non-DoD-eligibles as needed to meet trauma/surgical/other professional requirements.
• Formula for allocation of readiness vs beneficiary benefit (O&M vs MilPers) has always been subject of controversy; DoD not willing to provide data in past on cost of readiness vs beneficiary benefit.
• Since MTFs need more than service member care to meet training needs, increases potential to put MTF needs in more direct opposition to dependent/retiree/survivor beneficiary desires.
• Historically, MTFs have wanted older beneficiaries for trauma, surgery, and certain other needs, but has not had capacity to enroll them for routine/specialty care.
• Alternative proposals could be developed to meet MTF combat-related care needs that would be seen as benefiting rather than coercing non-AD beneficiaries (e.g., partner with insurers to establish Military Medicare HMOs that enroll only DoD eligibles and establish the local MTF as the HMO’s provider for certain surgical and other services …this was once proposed by a former AF/SG).

Recommendation 6:Increase access, choice, and value of health care for active-duty family members, Reserve Component members, and retirees by allowing beneficiaries to choose from a selection of commercial insurance plans offered through a Department of Defense health benefit programProposal intent is to eliminate TRICARE program and shift all beneficiaries but AD service members to FEHBP-like insurance plans in response to reported access/referral/contracting/bureaucratic/other problems beneficiaries experience with TRICARE Prime and surveys showing members want a choice of plans.Proposal envisions:

• Administering the program through the Office of Personnel Management that oversees federal civilian FEHBP.
• Eliminating most of the TRICARE administrative overhead.
• Beneficiaries would be offered an array of plan options for each locality (HMO, PPO, fee for service with various options for premiums, deductibles and copays).
• MTFs would be one of the providers under each plan.
• DoD envisioned as having authority to adjust MTF vs civilian reimbursements to insurers and MTF vs. civilian copays as needed to meet MTF requirements.
• TRICARE pharmacy program would remain as is.
• TRICARE For Life would remain as is.
• Different premium costs shares would be established for different beneficiary categories:
  
  • 28% for active duty dependents but with a new nontaxable Basic Allowance for Healthcare would be established to fully cover
  • 20% for retirees and family members under 65 that would be phased in over 15 years at +1%/year based on assertion that retirees cost share is now 5%
  • 5% for survivors and TRICARE-eligible former spouses (proposal is to leave them at “current [5%] level”
• Premiums would be reset each year at 50% of the median cost experienced by beneficiaries at each location during the previous year.
• Budget for AD dependent/retiree/survivor care under MilPers account (vs. current O&M).
• Include cost of care for these beneficiaries under the Medicare-Eligible Retiree Health Care Trust Fund along with cost of TFL care.

TMC initial observations

• The Commission’s description of problems with TRICARE Prime are on the mark however instead of fixing the TRICARE program the answer is to eliminate it and have beneficiaries pay more for the fix.
• But the proposed change is an extremely radical one that could have far-reaching implications now and in the future.
• Such a dramatic change in the entire philosophy of delivering military health coverage requires extensive and thorough review to ensure it meets beneficiary needs without changing fundamental benefit value or leading to significant unintended consequences.
• We agree that coverage should be improved for the Guard/Reserve community.

TMC initial concerns:

• TMC opposes funding care for non-TFL-eligibles through the MERHC or other health care trust fund
  
  • This would add significantly more funds to the “mandatory spending” category Congress has sought to reduce.
  • It also would impose major administrative roadblocks to any program enhancements or correcting unforeseen inequities that may prove needed in the future.
• The proposal says the TRICARE Pharmacy program would be retained, but most civilian health plans such as those envisioned to be administered through OPM entail some level of Rx coverage.
  
  • To the extent the plan selected includes such coverage, it would render the TRICARE pharmacy program (and especially the lower-cost mail-order program) virtually unusable for the beneficiary
  • Does the plan envision that the OPM-administered plans for DoD beneficiaries would not include Rx coverage?
• To the extent premiums and copays vary by locality, this would be a dramatic and unwelcome departure from what has been a uniform program, regardless of locality.
• Putting this major military health benefit under the administration of OPM appears to be a significant step toward treating military beneficiaries like federal civilians for health care purposes. 
  
  • Military beneficiaries incur unique and  extraordinary sacrifices that are unlike the service conditions of any civilian, and their health benefits have been intended to be significantly better than civilian programs
• To what extent would this proposal have to be approved by congressional committees that oversee federal civilian/OPM issues?  What is the likelihood of agreement/disagreement from that quarter?
• TMC is concerned that the Commission states overtly that its intent is to raise beneficiary costs as a means of retarding DoD beneficiaries’ health care usage, which has exceeded civilian usage.
  
  • But this ignores that there are many reasons for the usage statistics differential (e.g.,  military system has not been proactive in providing ways to meet beneficiary needs for such things as off-hours care, or in publicizing those that exist)
• TMC has never accepted assertions that implementation of TRICARE in the 1990s entailed covering 27% of DoD costs.
  
  • In TMC’s negotiations with DoD in setting payment rates for that initial program, no percentage of costs was ever discussed
  • TMC has made numerous requests for the data on how that calculation was made, but it has never been provided by DoD
  • TMC does not believe beneficiaries’ costs should be based on DoD costs, because that forces beneficiaries to subsidize DoD inefficiencies and oversight failures
• TMC believes the envisioned 20% premium cost share for retirees is substantially too high, regardless of any phase-in period, and that such a standard devalues the in-kind premiums contributed through decades of arduous service and sacrifice that were acknowledged in previous cost-share setting.
• Fundamental issue here is “what is the premium value of decades of service and sacrifice in uniform?”
  
  • This needs to be formally recognized in the cost-sharing determination
  • In the past, this has been implicit:  zero cash premium for TRICARE Standard, and a modest cash premium (a minor fraction of FEHBP premiums) and very low copays in TRICARE Prime
  • Commission confirms there should still be zero cash premium for TFL supplement to Medicare
  • Whatever military people are asked to pay in any new plan should be consistent with that history of premium-setting
  • Service in recent decades of continuous war has to be at least as valuable as service rendered in previous decades
• There are other significant inequities in the proposed premiums, such as the proposal to set former spouses’ cost share (5%) at one-fourth of the retired member’s (20% ultimately).
• The proposal does not address the unique circumstances of severely disabled service members once they are retired from service.
• The proposal does not address what would be available to retired members/families/survivors who reside overseas and currently have access to TRICARE.
• The proposal to set annual premiums and health care allowance levels at the median expense experienced by beneficiaries in the previous year could have the potential to depress rates over time based on the depressive effect of those who chose for budgetary or other reasons to elect lower-tier coverage.
• The proposal would set the health care allowance at the amount necessary to cover the average plan in each locality… but isn’t military-provided coverage, by definition, supposed to be significantly better than average?
• No mention is made of what level of catastrophic cap would be placed on annual out-of-pocket healthcare expenses for active duty and retired members/families.
• How did the Commission develop/calculate data on beneficiaries’ perceived value of program changes (increased access, etc.)?
• To the extent that beneficiaries would be shifted to private insurance plans and right-sizing of MTFs, the assumption seems to be that some level of care would be shifted to civilian providers.  But there already is considerable concern about the adequacy of civilian capacity in coming years, especially with many doctors retiring and millions of newly covered ACA beneficiaries competing for access.
• While TMC shares Commission’s concern about problems experienced with TRICARE Prime, the main question is whether it takes such a radical change to address those problems. 
  
  • e.g., for internal TMC consideration only, you could switch to all TRICARE Standard and use a share of the (huge) resultant savings to provide additional resources to help beneficiaries find participating providers, provide 24-hour nurse hot lines, provide extra assistance services to special-needs families, pediatric care, etc.
• In the end, the main beneficiary concerns come down to (a) access to quality care, (b) cost to the beneficiary, and (c) preservation of DoD’s unique employer responsibility to provide its career service members and families a top-tier health program to help incentivize decades of service in the face of extraordinary (including wartime) hardships.
• Military beneficiaries deserve to get the needed access without incurring the kind of significant cost increases associated with the proposed plan.
  
  • Major cost increases effectively devalue TRICARE beneficiaries’ past and future service and sacrifice

Recommendation 7: Health Care Issues for Uniformed Services Special-Needs Family MembersProposal intent is to improve support for special-needs family members by aligning services offered under the Extended Care Health Option to those of state Medicare waiver programs.Proposal envisions:

• Increasing services covered through ECHO (subject to the ECHO benefit cap of $36,000) to include, but not limited to:
  
  • Consumer-directed care
  • Expanded respite care hours
  • Allowing families to access respite care hours without receiving another ECHO benefit in the same month as the  respite care
  • Providing custodial care
  • Providing adult diapers where necessary and appropriate

TMC initial observations – supports the Commission proposal.  We applaud the commission addressing the unique challenges faced by our military special needs families.  However, we believe it will be important to examine a transitional benefit for those who have depended on this program and will find themselves at the bottom of the state Medicaid lists upon separation/retirement.TMC initial concerns – The critical benefit must capture members of all seven of the uniformed services and we are concerned that Guard and Reserve families may have a difficult time transitioning in and out of the ECHO program. Finally, it is important to consider a transitional benefit (1-3 years) for these vulnerable families as they leave active duty service.Recommendation 8: Improve DoD/VA Collaboration on Issues of Transitioning Service membersProposal intent is to ensure improved oversight and execution of long-established goals for DoD/VA collaboration.Proposal envisions:

• Granting the DoD-VA Joint Executive Committee (JEC) additional authorities and responsibilities to standardize and  enforce D0D/VA collaboration, including:
  
  • Defining common services that will be jointly conducted throughout DoD and VA healthcare systems
  • Creating standard terms for resource sharing agreements (RSAs) on common services that can quickly and efficiently be implemented by local commanders
  • Monitoring planned expenditures for common services by both DoD and VA, comparing them to the JEC strategic plan, and certifying consistency with the plan
  • Approving in advance any new capital assets acquisition, or asset sustainment/ restoration/modernization of either DoD or VA medical components
  • Reporting quarterly to Congress on DoD and VA expenditures and consistency
  • Overseeing Electronic Health Record (EHR) compliance with applicable technology standards across DoD and VA, ensuring data can be quickly and  easily shared between departments
  • Ensuring DoD and VA immediately begin process of establishing a health  care record within the VA EHR system for all current service members, including all who complete Service-specific enlisted and officer accession programs
  • Monitoring and reporting on the percentage of the military force represented with a health care record in both DoD and VA HER systems
  • Creating a uniform formulary to include all the drugs identified as critical for transition beginning immediately with pain and psychiatric drugs; JEC should review list of critical drugs periodically
  • JEC must mandate, oversee and report to Congress on use of all joint procurement options.
  • Establishing a standard methodology for DoD and VA reimbursement for services to each other, on real time, automated basis; JEC should establish policies under which DoD and VA don’t consider reimbursement rates when deciding where to send patients.

TMC initial observations – generally concurs with the Commission proposal with some concerns.TMC initial concerns:

• From our perspective, a single Uniform Formulary would be beneficial only if the formulary is larger, e.g., adopt the DoD formulary in order to make sure service members who transition from DoD to VA can maintain their prescription meds and to make sure other veterans have access to whatever medications they may need.
• How do we ensure access to National Guard medical records which are the property of the respective states and are extremely difficult to obtain?
• If the Reserve Component is transitioned to TRICARE Choice, then how will DoD/VA interface with private providers to make sure military records are up-to-date and accurate?
• Would contractors like Logistics Health Incorporated (LHI) continue to be the clearinghouse between DoD and private providers?

Recommendation 9:Protect both access to and savings at Department of Defense commissaries and exchanges by consolidating these activities into a single defense resale organizationTMC initial observations – TMC is grateful that the commission discovered the true value of the commissary and exchange and recognizes that families really do rely on the savings. TMC does not support the recommendation because of several concerns. TMC initial concerns:

• The proposal includes restructuring that puts the very existence of the two organizations and their related benefit in savings, revenues for programs, and jobs for military families at risk. Efficiencies may be found at the top levels, but a full-scale consolidation will doom two programs that currently work and have tremendous value to military families and puts the savings, revenues, and jobs at risk. 
• This recommendation does nothing to aid the quality of life for military families rather it disproportionately impacts the very families that need the benefit most.

Recommendation 10:Improve access to child care on military installations by ensuring the Department of Defense has the information and budgeting tools to provide child care within 90 days of needTMC initial observations – TMC supports the Commission’s proposal and are grateful for recognizing the importance of child care for military families and appreciate that there will be greater visibility on waiting lists and the scope of this issue, however we have some concerns and recommendations.TMC initial concerns

• DoD has to continue to pursue innovative solutions to meet this need beyond just building more brick and mortar CDCs. Other issues for consideration when addressing the challenges of finding and securing affordable childcare include: wait list prioritization and realignment of existing programs to meet the shift back to a garrison based force (24 hour and weekend care for duty, 7 day a week operation, extended day options).
• DoD should use this opportunity for collecting data to find a way forward that determines the prioritization of military families on the waiting list.

Recommendation 11: Safeguard education benefits for service members by reducing redundancy and ensuring the fiscal sustainability of education programsTMC initial observations – TMC generally supports much of the recommendation, including closing the Reserve Education Assistance Program and transitioning eligible reservists to the Post 9/11 GI Bill, however we have some concerns and recommendations.TMC initial concerns:

• DoD should refund the entire $1,200 to all service members who paid into the MGIB but were eligible for Post 9/11 benefits.
• Who will decide which educational programs qualify for Tuition Assistance as related to professional development?
• Service members who have signed Post 9/11 GI Bill contracts, including transferability, under the current rules should be grandfathered e.g., no farther active duty service commitment required.  These individuals should not have to meet a new threshold of ten years of service plus an additional commitment of two years.
• Some TMC organization may have concerns with the proposed termination of the housing stipend for dependents but this action may the price to preserve transferability.
• We should not treat service members differently from all other Americans when it comes to eligibility for unemployment insurance.
• Need to consider whether MGIB-SR (SELRES) enrollees will be sunset and if future reservists added to Post 9/11 GI Bill.

Recommendation 12: Better prepare service members for transition to civilian life by expanding education and granting states more flexibility to administer the jobs for veterans state grants programTMC initial observations – TMC generally supports the recommendation with two caveats:  Mandatory participation in Transition GPS and similar programs should occur at key milestones throughout a service member’s career (i.e., upon second enlistment, at 10 year mark, within 2 years of retirement, not just a one-time event.  Also, additional accommodations should be made for families.Recommendation 13:Ensure Service members receive financial assistance to cover nutritional needs by providing them cost-effective supplemental benefits.TMC initial observations – TMC supports the recommendation.  This proposal will help more families in need to access nutritional and financial support and helps shine light on SNAP program and WIC overseas – essential programs for military families, which rely on a viable commissary benefit. Financial education is key and further data collection will be needed.Recommendation 14:Expand Space-Available travel to more dependents of Service members by allowing travel by dependents of Service members deployed for 30 days or more.TMC initial observations – TMC supports the recommendation.  Recommendation 15:Measure how the challenges of military life affect children’s school work by implementing a national military dependent student identifier.TMC initial observations – TMC supports the recommendation.  One item that remains unclear is whether or not information will be collected on children of AD parents/guardians of all of the Uniformed Services or just the Armed Forces. President’s Defense Department Budget Request for FY 2016• Basic Pay Raises– The FY 2016 President’s budget proposes a 1.3 percent increase in military basic pay. This is less than the 2.3 percent increase under the formula in current law, which calls for a military pay raise to equal the annual increase in the wages and salaries of private industry employees as measured by the ECI. The FY 2016 proposed increased is 0.3 percent above the FY 2015 military pay increase of 1.0 percent. – In addition, outyear pay raise planning factors currently assume limited pay raises will continue through FY 2020, with increases of 1.3 percent in FY 2017, 1.5 percent in FY 2018 and FY 2019, and 1.8 percent in FY 2020.• Slow BAH Growth to Achieve a 5 percent out-of-Pocket Cost –Building on the 1 percent out-of-pocket adjustment authorized in the FY 2015 National Defense Authorization Act, the FY 2016 proposal gradually slows the annual BAH increases by an additional 4 percent over the next 2 to 3 years until rates cover 95 percent of housing rental and utilities costs. Overall, this change results in an out-of-pocket cost of 5 percent on average, which is far less than the 20 percent out-of-pocket experienced in the 1990s. - In areas where average rates increase, DoD will slow the growth of that increase until the 5 percent target is reached. The actual percentage will vary by area, because it would be unfair to those who live in high rental cost areas to make this change on a strict percentage basis. Rather, service members in the same pay grade but living in different areas should see the same dollar amount of out-of-pocket cost. This is done so the individual member will know the amount they will contribute toward housing and can make informed trades in their own budgets. - The rate protection feature will also remain in effect. In other words, no one who is currently living in a particular area will see their BAH decrease. If the survey data in an area indicates that the BAH rate should decrease, only members moving into the area will receive the lower rate, consistent with the current rules. - The Department expects that the out-of-pocket target of 5 percent will take several years to achieve because the Department is just slowing the growth of future increases.• Reduce Commissary Subsidy –The Defense Commissary Agency (DeCA) operates 241 stores around the world, including 178 domestic locations, providing groceries at cost plus a 5 percent surcharge to service members and retirees. The surcharge generally covers the cost of commissary facility sustainment, modernization, and store equipment. The Department subsidizes DeCA’s operations with appropriated funds to pay overhead and employee wage expenses. The FY 2014 subsidy was $1.4 billion. The FY 2016 DeCA budget request reflects a reduction to the operating cost subsidy.The FY 2016 budget proposes subsidy savings that will largely come from efficiencies and operating changes that do not require legislative changes. The most visible impact to Commissary patrons will be a reduction in operating days and hours with most stores remaining open 5 or more days a week.The FY 2016 budget also proposes additional savings that will require legislative changes to enable second destination transportation charges to be included in the cost of goods and to allow the cost of supplies and materials to be funded through the current 5 percent surcharge revenues rather than the operating cost subsidy.The Department is committed to further reducing the subsidy provided to the commissaries in subsequent years by seeking legislative changes to allow the Department the flexibility to operate the commissary system more like a business. These legislative changes will include initiatives to expand the types of goods that can be bought and sold by the commissaries and allow the variable pricing of goods. This will allow goods to be priced above cost to increase revenues on certain items, while providing more savings to a market basket of goods that affect junior members with families the most. While these legislative changes will be requested in the FY 2016 legislative package, they are not intended to go into effect until FY 2017.• Consolidated TRICARE Health Plan– Proposal will streamline the current TRICARE managed care and fee-for-service options (Prime, Standard, and Extra) into a simplified structure of Military Treatment Facility (MTF), in-network and out-of-network cost sharing that provides incentives for wellness, decreases overutilization of services, and provides beneficiaries with open access to providers. Through modestly higher deductibles and co-pays, this simplified structure is designed to encourage members to use more affordable means of care. – Active duty members will remain exempt from co-pays or fees. – One modification made to the FY 2015 proposal was to ensure that active duty family members have a “no cost” option for care no matter of their location or availability/access to an MTF. Under the previous proposal, Active Duty Family Members (ADFM) unable to use an MTF would have been required to pay network co-pays and deductibles for care. This would apply to situations where there was a lack of appointment availability or a specific type of care at an MTF, or for those living in remote locations without access to an MTF. The FY 2016 proposal addresses this complaint and provides ADFMs a “no cost” care option in all locations. – In an effort to encourage beneficiaries to seek care in the most appropriate setting and improve the overall continuity of care, the FY 2016 proposal includes fees for ADFMs that misuse emergency department care. – When fully implemented, the Consolidated TRICARE Health Plan will remain a generous benefits package. By FY 2020, the average retiree family will pay about 10 percent of total health care costs – well below the original 27 percent when the program was established in the mid-1990s.• Implement Enrollment Fee for New Tricare-for-Life Beneficiaries and Increase Pharmacy Co-Pays− In conjunction with the Consolidated Plan changes, the Department again seeks to adjust pharmacy co-pay structures and establish a modest annual enrollment fee for the TRICARE-for-Life coverage for Medicare-eligible retirees.President’s FY 2016 Budget Request for the Department of Veterans AffairsThe President has requested $168.8 billion budget for the Department of Veterans Affairs (VA) in fiscal year 2016. The budget includes:

• $73.5 billion in discretionary funding, largely for healthcare
• $95.3 billion for mandatory benefit programs such as disability compensation and pensions.

VA is suggesting that they will need more resources to ensure that VA can provide timely, high quality health care into the future. VA says that they are hearing directly from Veterans and their representatives that they would prefer to get their care in VA facilities from the medical professionals they know and with whom they have relationships. In the coming months, the Administration will submit legislation to allow the Department to reallocate a portion of unused funding from the Veterans Choice Program to support essential investments in VA system priorities in a fiscally responsible, budget-neutral manner. This flexibility will allow the Department to serve Veterans the way they want and deserve to be served. Here are highlights from the President’s 2016 budget request for VA:Health CareTotal medical care budget of $63.2 billion, including collections - Major spending categories within the health care budget are:• $7.5 billion for mental health;• $2.8 billion for prosthetics;• $556 million for spinal cord injuries;• $232 million for traumatic brain injuries;• $243 million for readjustment counseling; and• $7.5 billion for long-term care.Expanding AccessAmong the programs that will expand access under the proposed budget are: • $1.2 billion in telehealth funding, which helps patients monitor chronic health care conditions and increases access to care, especially in rural and remote locations; • $446 million for health care services specifically designed for women, an increase of 8.3 percent over the present level;• $598 million for the activation of new and enhanced health care facilities; • $1.1 billion for major construction projects; • $86.6 million for improved customer service applications for online self-service portals and call center agent-assisted inquiries; and • $5.9 million to bring into full operation two new national cemeteries opening in 2015, and to activate one new national cemetery and one rural National Veterans Burial Ground in 2016Improving the Efficiency of Claims ProcessingThe President’s Budget provides for full implementation of the Veterans Benefits Administration’s (VBA) plan to process all disability compensation claims within 125 days. Major claims transformation initiatives in the budget invest $431 million to bring leading-edge technology to claims processing, including:• $290 million ($253 million in Information Technology and $37 million in VBA) to support the electronic claims processing system – the Veterans Benefits Management System (VBMS); and • $141 million for Veterans Claims Intake Program (VCIP) to continue conversion of paper records, such as medical records, into electronic images and data in VBMS;In addition, the President’s Budget supports rightsizing VBA’s workforce to address staffing needs so it can continue to improve the delivery of benefits to Veterans. As VBA continues to receive and complete more disability compensation rating claims, the volume of appeals, non-rating claims, and fiduciary field examinations correspondingly increases. The request for $85 million for 770 additional full-time equivalent employees (FTE) will allow VBA to provide more timely actions on appeals and non-rating claims, and will ensure strong fiduciary oversight.Eliminating Veterans HomelessnessThe Administration has made the elimination of Veteran homelessness a national priority. The budget request targets $1.4 billion for programs to prevent or reduce homelessness, including: • $300 million for Supportive Services for Veteran Families (SSVF) to promote housing stability; • $374 million for the HUD-VASH program wherein VA provides case management services for at-risk Veterans and their families and HUD provides permanent housing through its Housing Choice Voucher program; and • $201 million in grant and per diem payments that support temporary housing provided by community-based organizations.Other Key Services for Veterans :• $266 million to administer the VA-run system of 133 national cemeteries;• $4.1 billion for information technology (IT), including investments to modernize Veterans’ electronic health records, improve Veterans’ access to benefits, and IT infrastructure; and • $1.7 billion in construction, cemetery grants, and extended care grants to include nine VHA major construction projects and four gravesite expansion projects.  Online Prescription Tracker Gives Veterans 24/7 Online Access to StatusRecommendation Made by VA Employee, 2013 SAVE Award WinnerVeterans can now track the status of most of their prescriptions online, thanks to an innovative idea by a Department of Veterans Affairs’ (VA) employee. The new 24/7 service allows online tracking for most prescriptions mailed from the VA Mail Order Pharmacy.The Prescription Tracker was recommended by VA employee Kenneth Siehr, a winner of the President’s 2013 Securing Americans Value and Efficiency (SAVE) Award. Siehr’s idea focused on the use of technology as a way to save money and improve the services VA provides to its patients.“Our nation’s Veterans deserve a first-class pharmacy and quality customer service as a part of the exceptional health care available from VA,” said Siehr, the National Director for Consolidated Mail Outpatient Pharmacies. “It is an honor to be part of serving Veterans and to have been recognized for an idea that enhances our services to them.” More than 57,000 Veterans are currently using the service through My HealtheVet, an online feature that allows Veterans to partner with their health care team. The number is expected to grow as VA starts to educate Veterans about the new feature.  Later this month, the tracking feature will include images of the medication that dispensed. Over the next year, a secure messaging alert will be added so that Veterans know when a medication was placed in the mail. “VA prescription refill online is an excellent example of how one employee looked at the process of VA prescription tracking through the eyes of our Veterans and came up with an idea that better serves Veterans,” said Interim Under Secretary for Health, Carolyn M. Clancy. “This idea is both innovative and transformative, and it is certainly one, when put into action, improves customer service for America’s Veterans.” Care and Benefits for Veterans Strengthened by $169 Billion VA BudgetWASHINGTON – The President has proposed a $168.8 billion budget for the Department of Veterans Affairs (VA) in fiscal year 2016. The proposed budget will support VA goals to expand access to timely, high quality health care and benefits, continue the transformation of VA into a Veteran-centric department and end homelessness among Veterans. “VA has before it one of the greatest opportunities in its history to enhance care for Veterans and build a more efficient and effective system.  This budget will allow us to continue important progress to better serve Veterans, their families and their survivors,” said Secretary of Veterans Affairs Robert A. McDonald. “We are listening to what Veterans, Congress, employees, Veterans Service Organizations (VSOs), and other stakeholders are telling us.  We aspire to make VA a model agency that is held up as an example for other government agencies to follow with respect to customer experience, efficient and effective operations, and taxpayer stewardship.”The budget includes $73.5 billion in discretionary funding, largely for healthcare, and $95.3 billion for mandatory benefit programs such as disability compensation and pensions.  The $73.5 billion total in discretionary spending, including over $3.2 billion in medical care collections from health insurers and Veteran copayments, is $5.2 billion and 7.5 percent above the 2015 enacted level.  The budget also requests $66.6 billion, including collections, for the 2017 advance appropriations for medical care, an increase of $3.4 billion and 5.4 percent above the 2016 medical care budget request.  As a first-time request for advance appropriations for 2017 for Compensation and Pensions, Readjustment Benefits, and Veterans Insurance and Indemnities, within our mandatory benefits programs in the Veteran’s Benefits Administration, $104 billion is requested for 2017.“We remain committed to providing Veterans the opportunity to pursue their education, find meaningful employment and access high-quality health care and earned benefits,” Secretary McDonald added.  “From the men and women of ‘the greatest generation’ to the Veterans who have returned from our most recent conflicts in Iraq and Afghanistan, every Veteran deserves to have a seamless, integrated, and responsive VA customer service experience every time.”However, more resources will be required to ensure that VA can provide timely, high-quality health care into the future.  VA is hearing directly from Veterans and their representatives that they would prefer to get their care in VA facilities from the medical professionals they know and with whom they have relationships.  In the coming months, the Administration will submit legislation to allow the Department to reallocate a portion of unused funding from the Veterans Choice Program to support essential investments in VA system priorities in a fiscally responsible, budget-neutral manner.  This flexibility will allow the Department to serve Veterans the way they want and deserve to be served.VA operates one of the largest integrated health care systems in the country with approximately 9.4 million enrollees; the tenth largest life insurance program; monthly disability compensation, pensions and survivors benefits to more than 5.2 million beneficiaries; educational assistance or vocational rehabilitation benefits and services to 1.2 million students; mortgage guaranties to over 2 million homeowners; and the largest cemetery system in the nation.Here are highlights from the President’s 2016 budget request for VA. Health Care With a medical care budget of $63.2 billion, including collections, VA is positioned to serve approximately 9.4 million Veteran patients enrolled to receive care in the fiscal year beginning Oct. 1.  The enrollee total includes over 1.4 million Veterans who served in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New DawnMajor spending categories within the health care budget are:·         $7.5 billion for mental health;·         $2.8 billion for prosthetics;·         $556 million for spinal cord injuries;·         $232 million for traumatic brain injuries;·         $243 million for readjustment counseling; and·         $7.5 billion for long-term care. Expanding Access The President’s Budget would ensure that care and other benefits are available to Veterans when and where they need them.  Among the programs that will expand access under the proposed budget are:·         $1.2 billion in telehealth funding, which helps patients monitor chronic health care conditions and increases access to care, especially in rural and remote locations;·         $446 million for health care services specifically designed for women, an increase of 8.3 percent over the present level;·         $598 million for the activation of new and enhanced health care facilities;·         $1.1 billion for major construction projects;·         $86.6 million for improved customer service applications for online self-service portals and call center agent-assisted inquiries; and·         $5.9 million to bring into full operation two new national cemeteries opening in 2015, and to activate one new national cemetery and one rural National Veterans Burial Ground in 2016. Improving the Efficiency of Claims ProcessingThe President’s Budget provides for full implementation of the Veterans Benefits Administration’s (VBA) robust Transformation Plan -- a series of people, process, and technology initiatives -- in 2016.  This plan will continue to systematically improve the quality and efficiency of claims processing and assist the Department in processing all disability compensation claims within 125 days.Major claims transformation initiatives in the budget invest $431 million to bring leading-edge technology to claims processing, including:·         $290 million ($253 million in Information Technology and $37 million in VBA) to support the electronic claims processing system – the Veterans Benefits Management System (VBMS); and·         $141 million for Veterans Claims Intake Program (VCIP) to continue conversion of paper records, such as medical records, into electronic images and data in VBMS.In addition, the President’s Budget supports rightsizing VBA’s workforce to address staffing needs so it can continue to improve the delivery of benefits to Veterans.  As VBA continues to receive and complete more disability compensation rating claims, the volume of appeals, non-rating claims, and fiduciary field examinations correspondingly increases.  The request for $85 million for 770 additional full-time equivalent employees (FTE) will allow VBA to provide more timely actions on appeals and non-rating claims, and will ensure strong fiduciary oversight.Eliminating Veterans HomelessnessThe Administration has made the elimination of Veteran homelessness a national priority.  The budget request targets $1.4 billion for programs to prevent or reduce homelessness, including:·         $300 million for Supportive Services for Veteran Families (SSVF) to promote housing stability;·         $374 million for the HUD-VASH program wherein VA provides case management services for at-risk Veterans and their families and HUD provides permanent housing through its Housing Choice Voucher program; and·         $201 million in grant and per diem payments that support temporary housing provided by community-based organizations.MyVAIn 2014, Secretary McDonald introduced the MyVA initiative, an effort to reorient the Department around the needs of Veterans and make VA a more customer-centric organization.  This will ultimately be the largest department-wide transformation in VA’s history and will measure success based on Veteran outcomes and satisfaction.  The 2016 budget supports MyVA implementation, which will create a VA that is organized for success from the perspective of Veterans – combining functions, simplifying operations, and proving Veterans the care and services they have earned and deserve.  Veterans Choice ActThe Veterans Choice Act provided $5 billion in mandatory funding to increase Veterans' access to health care by hiring more physicians and staff and improving the VA’s physical infrastructure.  It also provided $10 billion in mandatory funding through 2017 to establish a temporary program (the Veterans Choice Program) improving Veterans’ access to health care by allowing eligible Veterans who meet certain wait-time or distance standards to use eligible health care providers outside of the VA system. The Veterans Choice Program may provide a measure of short-term relief from the pressure of escalating health care needs as current patients in the VA system elect to receive their care through the program. These investments, together with the 2016 Budget, will provide the authorities, funding, and other tools to enhance services to Veterans in the short-term while strengthening the underlying VA system to better serve Veterans in the future.  However more resources in certain areas will be required to ensure that the VA system can provide timely, high-quality health care into the future. In the coming months, the Administration will submit legislation to allow the VA Secretary to best meet Veteran needs. This will allow the Secretary to make essential investments in VA system priorities in a fiscally-responsible, budget-neutral manner.Other Key Services for Veterans ·         $266 million to administer the VA-run system of 133 national cemeteries;·         $4.1 billion for information technology (IT), including investments to modernize Veterans’ electronic health records, improve Veterans’ access to benefits, and IT infrastructure; and·         $1.7 billion in construction, cemetery grants, and extended care grants to include nine VHA major construction projects and four gravesite expansion projects.Veterans: Are You at Risk for Heart Disease?VA is doing wonderful things for Veterans with heart problems.It’s American Heart Month and here comes that list again of things you know you should be doing. But first, let’s tell you the story of Army Veteran Edward Baker.“I was having bad shortness of breath. I couldn’t walk further than the front of the VA building to the lab. That’s how I knew that something was wrong,” says Baker.When he told his Primary Care doctor of his shortness of breath, he was immediately referred to Cardiology where he was told about a condition called mitral regurgitation.“I wanted to live, that is what I wanted to do, I wanted to live” says Baker who today has much to be thankful for. He was the first Veteran to undergo MitraClip surgery at VA North Texas.The MitraClip Percutaneous Mitral Valve Repair System is the first device available to safely perform percutaneous mitral valve repair.“The procedure was a tremendous success. The pressures in his heart immediately decreased and the patient symptoms immediately improved,” says Dr. Emmanouil Brilakis, Baker’s cardiologist.

First VA in Nation to Perform MitraClip Surgery

Dr. Brilakis was extremely proud that the VA North Texas Cardiologist team was the first to perform this specialized procedure. “This was a technically challenging procedure but was accomplished with the assistance of the OR and cardiology personnel in addition to the administrative support from our Administrative Officer, Pamela Alexander,” said Brilakis.“We provide world-class care at VA North Texas, and this clinical advancement is another example of our commitment to improve the health and well-being of our North Texas Veterans,” said Jeff Milligan, Director of VA North Texas.Mitral regurgitation (MR) is a condition in which the heart’s mitral valve leaflets do not close tightly. When this happens, blood flows backward from the heart’s left ventricle into the left atrium. The heart must then work harder to push blood through the body, which can cause fatigue, shortness of breath and worsening heart failure. MR is the most common type of heart valve insufficiency in the United States, and approximately 50,000 patients require surgery each year.

Vietnam Veteran No Longer Needs the Meds

If you think you can’t do it, read this story about Vietnam Veteran Dennis Rigatti and think again. At the age of 66, Rigatti joined VA New York Harbor Healthcare System’s MOVE! ® Telephone Lifestyle Coaching Program. With his determination to maintain a balanced nutrition and exercise regimen, he lost 31 pounds. After taking medication to control his blood pressure for over 40 years, he is proud to report that his doctor has discontinued it and he is maintaining a normal blood pressure with a healthy lifestyle.While it’s great to know lifesaving options are available at VA Medical Centers, it’s even smarter to take care of your heart and avoid the need for surgery.

Here’s What You Can Do

Cardiovascular disease (CVD) — including heart disease, stroke, and high blood pressure — is the number one killer of women and men in the United States.You can control a number of risk factors for CVD, including:·         Diet·         Physical activity·         Tobacco use·         Obesity·         High blood pressure·         High blood cholesterol·         DiabetesAs you begin your journey to better heart health that can last a lifetime, here are some suggestions from the Center for Disease Control to keep in mind:·         Try not to become overwhelmed. Every step brings you closer to a healthier heart, and every healthy choice makes a difference!·         Partner up. The journey is more fun — and often more successful — when you have company. Ask friends and family to join you.·         Don’t get discouraged. You may not be able to take all of the steps at one time. Get a good night’s sleep — also important for a healthy heart — and do what you can tomorrow.·         Reward yourself. Find fun things to do to decrease your stress. Round up some colleagues for a lunchtime walk, join a singing group, or have a healthy dinner with your family or friends.

Plan for Prevention

Try out these strategies for better heart health. You’ll be surprised how many of them can become lifelong habits.·         Work with your health care team.·         Monitor your blood pressure·         Get your cholesterol checked.·         Eat a healthy diet.·         Maintain a healthy weight.·         Exercise regularly.·         Don’t smoke.·         Limit alcohol use.·         Manage your diabetes.·         Take your medicine.Together, we all can prevent and manage heart disease, one step at a time.