MOAA’s efforts to raise concerns on Capitol Hill regarding military treatment facility (MTF) restructuring and medical billet cuts continue to pay off.

The full House Appropriations Committee report for the FY 2021 House Defense Appropriations bill, released last week, denies DoD’s request for funding to replace uniformed medical providers with civilians/contractors. It also restores funding to support MTFs that had been proposed for downsizing and incorporates additional reporting requirements and congressional oversight into the process.

The appropriations bill is separate from the National Defense Authorization Act (NDAA). It funds DoD, including operations and maintenance, readiness activities, research and development, equipment modernization, and health and quality of life programs for military members and their families.

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

MTF Restructuring

The report from the full House Appropriations Committee expressed concerns about DoD’s approach to MTF restructuring outlined in the February 2020 Section 703 report to Congress:

The Committee questions several of the assumptions made about the quality and accessibility of private sector care, the cost of changing the venue of care, and the relationship to other restructuring efforts, such as reducing the number of military medical billets.

The report also directs DoD to brief the congressional defense committees on the implementation plan to close or “descope” any MTFs including an update to the market analysis conducted, cost implications, timeline, impact on providers, and benefits or risks to the served population.

Medical Billet Cuts

The administration’s FY 2020 budget request included a proposal to decrease medical billets for the services to allow an increase in the number of operational billets needed for lethality, a request that was repeated this year. The committee report expresses concern about the ramifications of these cuts and DoD’s inadequate responses to questions about beneficiary and readiness impacts:

Reductions would have major ramifications throughout the military health system, yet leaders across the Department of Defense have been ill-prepared to articulate the consequences of these reductions.

Despite requests for additional information, the Committee still has not been provided with a detailed mitigation plan for beneficiary care or medical readiness. Serious questions remain about the quality and availability of care for beneficiaries, as well as the negative impact on readiness that may be caused by an unnecessary reduction of military medical providers.

In addition to denying DoD’s request to fund civilian care transitioned away from uniformed providers, the committee directed DoD to re-evaluate the number of military medical personnel required to respond to all operational requirements, including in support of homeland defense missions, in light of lessons learned about the capacity and capability of both military and civilian medical care during the novel coronavirus pandemic.

What’s Next in the Defense Appropriations Process?  

The committee report underscores MOAA’s concerns about MTF restructuring and billet reductions, and addresses our requests for additional DoD reporting and congressional oversight.

We have not yet seen defense funding bill marks from the Senate Appropriations Committee, and we don’t yet know whether House provisions will make it into the final bill -- once both chambers have completed initial consideration of their versions, differences between them will be reconciled by the Appropriations Committees. 

MOAA’s Next Steps With the FY 2021 NDAA

MOAA members were critical in building House support for halting MTF restructuring and medical billet cuts, resulting in two provisions in the House Armed Services Committee (HASC) mark of the NDAA: Modification to Limitation on the Realignment or Reduction of Military Medical Manning End Strength (Section 715) and Modifications to Implementation Plan for Restructure or Realignment of Military Medical Treatment Facilities (Section 716).

The Senate Armed Services Committee (SASC) mark did not include similar provisions, so it is critical to build support for these sections of the House bill among Senate offices as the NDAA process moves forward.

We are conducting outreach to Armed Services Committee staff in both chambers, as well as to key member offices, to explain why these sections must be included in the final NDAA to protect military medical readiness and beneficiary access to care. We are also developing plans to activate MOAA’s membership to build support for HASC provisions across all Senate offices, a critical step as the FY 2021 NDAA moves toward conference. You can reach out to your senator on the issue using this link.