As this issue of AUSA News goes to press, lawmakers from the House and Senate Armed Services Committees continue to work on a final National Defense Authorization Act (NDAA) for fiscal 2019.

AUSA has weighed in on two provisions we believe would have a detrimental effect on military health care.

In a July 13 letter to the committee leadership, retired Gen. Carter F. Ham, AUSA president and CEO, outlined our concern with sections 711 and 712 of the Senate NDAA.

The 2017 defense policy bill moved the military treatment facilities (MTFs) from the services to under the control of the Defense Health Agency (DHA).

Since that time, DHA has worked with each of the services and produced a plan for implementation. However, as Ham states, Senate sections 711 and 712 refute that effort.

“These two provisions would disestablish the Service Medical Commands, require the services to establish an operational medical force readiness organization, but remove the services authorities required to execute them,” Ham wrote.

Adding, “In addition, the language adds another layer of change and risk on the plan to execute NDAA-directed healthcare reform.”

Ham said the “Secretary of Defense and the secretaries of the military departments should retain flexibility to determine command authority for any medical readiness organizations, consistent with the authority of the Secretary of the Army under 10 USC § 3074 to organize the Army and designate commands.”

Further, Ham asserts, the two provisions “strip authority from the services and consolidate power in the Defense Health Agency without adding the ability and expertise to enhance operational medical force readiness and total force readiness.”

Ham said that consolidation of power is contrary to the House effort to scale back DoD’s “Fourth Estate,” the 28 civilian agencies which support the Defense Department but are not part of the armed services.

The Fourth Estate employs over 200,000 civilian personnel and nearly 600,000 contractors and has grown from 7 percent of the DoD budget in 1990 to 18 percent today.

Finally, he urges the lawmakers to “hear directly from the Service Chiefs on this matter before you finalize the FY2019 NDAA.

The Office of the Secretary of Defense, DHA, and the surgeons general all have their views, but it is the service chiefs who bear the legal responsibility and the ethical requirement to man, train and equip forces to the very best of their ability.”

AUSA, coalition partners: More pay, more troops

AUSA also outlined our position on other provisions contained in the House and Senate authorization bills.

Along with our partners in The Military Coalition, AUSA told House and Senate Armed Services committees in a July 10 letter that we appreciate the 2.6 percent basic pay and drill pay increase endorsed by the House and Senate in their separate versions of the defense bill.

The modest increase would keep pace with private-sector salary growth and would also be the biggest pay increase in nine years. The 2018 raise was 2.4 percent.

The letter also endorses increases in troop levels. “We also strongly support your commitment to increase military personnel end strengths in both the active and reserve components of the services in order to meet national security strategy requirements and dwell-time needs as our forces prepare for and respond to security challenges around the globe,” says the letter.

The House and Senate bills each propose continued increases in Army troop strength, with one slight difference. The House approved the Pentagon’s request to increase the Regular Army by 4,000 to a new end strength of 487,500 on the way to a 500,000 goal.

The Senate bill approves an increase of 2,241, and reduces Navy and Air Force manpower requests.

One area of concern raised in the letter is a provision of the Senate’s bill that would end up raising TRICARE fees for retirees who in 2017 had been grandfathered from increases.

Coalition members say this change, which the Senate says corrects an inequity in fees, “disregards the intent” of the 2017 defense policy bill that protected those who retired before Jan. 1, 2018.

The effect is to impose “yet another round of significant healthcare cost increases on those who served a full career in uniform and have already endured cost increases following the Defense Health Agency’s unilateral decision last year to implement changes to the fee table,” the letter says.

Adding, “The cumulative impact of higher copays, enrollment fees, higher catastrophic caps and a new non-network deductible would significantly erode the value of the health care benefit earned over many years of service and sacrifice.”

The Senate bill also “does nothing to address the steep copays for physical, speech and occupational therapies, as well as mental health visits, a critical flaw in the new TRICARE copay construct.

Beneficiaries continue to have negative experiences with the managed care support contract transitions which makes this increase even more egregious.

It is apparent to us additional fees collected are not being used to maintain or improve the military health care system, but are instead being used to fund readiness or other unspecified priorities.”