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It is no secret to anyone in the U.S. military, whether active-duty members or in the reserve components, that many activated National Guardsmen and reservists with pre-existing medical conditions have received mobilization orders.
Some of this is a direct result of the fact that these part-time warriors
are often older than their active-duty brethren and as such, are more
prone to illness and the various medical conditions that begin to
plague us as we begin to age. Another less-discussed issue is the
fact that many members of the Guard and reserve work for small or
family-owned businesses where medical benefits may not exist or if
they do, are minimal at best.
In the case of mobilized reservists and Guardsmen who do have employer-provided
medical benefits, current federal law does not require employers to
keep the military member on
the payroll or on benefits while on active service. There are
those companies that do, but in reality, few do so and the smaller
"mom and pop" businesses almost always cannot afford to do so. So,
as the member of the Guard or reserve faces activation and the concurrent
loss of civilian income and benefits, he or she must also worry about
providing medical care for dependents.
Over the last several months, DefenseWatch has posted numerous articles
about mobilized reserve members being placed on medical hold or deployed
even after being found to have medical problems that should have been
notated on their record(s) prior to deployment. Some have actually
been sent home because they lacked medication previously prescribed
by a civilian physician and not provided by the military prior to
leaving the point of embarkation. This type of evacuation is not as
uncommon as you would think.
Pre-deployment guidelines stipulate that military members arrive in-theater with a 120-day supply of any medications they were taking prior to mobilization. For many reserve component members, complying with this requirement can be an onerous and expensive tasking as more and more civilian medical plans reduce drug prescription benefits to a supply of 30 days. To meet the military's more stringent 120-day requirement means that reserve component members must then procure the balance of a 90-day supply at their own expense.
In addition to providing for one's own prescription drug supply, Guardsmen
and reservists are now faced with the added financial burden of providing
proof of dental care on an annual basis. This requirement is the direct
result of findings by both the Army
and the Air
Force that far too many mobilized reservists were showing up at
mobilization points in need of dental care. In the case of the Army
National Guard and Army reserve, components that activate entire units,
the loss of too many individuals needing dental care can cause serious
delays and impact mission capability.
Leaders in both the Air National Guard and the Air Force Reserve Command
have issued directions that members provide their unit dental officers
with proof that their individual dental situation does not preclude
them from world-wide deployability. In the ANG and AFRC, if a member
is found to need dental care prior to deploying, they are instructed
to see their civilian dentist to have the problem fixed or they will
be removed from the deployment package.
This is somewhat easier to do in the ANG and AFRC because the Air Force tends to send aviation packages comprised of people in specific career fields rather than entire units. Should an individual be found to be unqualified due to a dental or medical hold, the unit deployment manager then finds another member with the needed Air Force Specialty Code (AFSC) to fill that vacancy.
During defense appropriations deliberations earlier this spring, the
administration announced that President Bush would veto any legislation
that provided full (read equal) Tricare
coverage for reserve component members prior to receipt of mobilization
orders. The Department of Defense previously stated that it was opposed
to providing access to Tricare for reservists and Guardsmen based
on their belief that a majority of these citizen-soldiers had medical
coverage through civilian employers up to the date of activation.
While estimates of cost to the government are inconclusive at present, it appears that the burden would be small since service members would actually be paying the premiums.
While this may be the case for members who work for larger companies or agencies of local, state and federal governments, it still fails to include those activated reserve component members who come from smaller employers lacking benefits. It also fails to recognize the needs of those members who are self-employed and who don't benefit from the benefits packages offered by larger employers.
Recent evacuation figures from Iraq indicate statistics that contradict
the administration's previous assumptions where the reserve components
are concerned. As of last week, 709 members of the military (all branches)
had been either killed in action or died of wounds. More than 4,000
soldiers, sailors, airmen and Marines
had been evacuated as a result of wounds received during hostile action.
Total evacuations from Iraq now stand at more than 15,000.
The additional 11,000 evacuees include those injured in theater, those with illnesses contracted since deployment and those found to have medical conditions that preclude them from performing their normal duties or even remaining in less than optimum environmental conditions. This last number is indeed a shocking one because it deprives the theater and unit-level commanders of valuable personnel who are needed. When looked at from another standpoint, the 11,000 personnel evacuated for medical reasons not caused by combat amounts to the equivalent of a small division.
Unforeseen medical evacuations, which have received scant mention in the mainstream news media, create added complications for the military and the government. These members, who were previously counted in force totals for Operation Iraqi Freedom, are now denied to the commanders and units that need them the most. In some cases, these evacuations could have been prevented if the member's medical record had been properly scrutinized before leaving CONUS to insure that the medical history was complete, accurate and contained no hidden surprises. Of the 11,000 non-combat related evacuations (many of them for members of the ARNG and USAR), it is quite probable that many, if not most, could have been prevented if the member had had access to Tricare prior to deployment.
Another fact also rears its head in the discussions of Tricare for activated members of the reserve component. When a member is activated and loses access to his or her existing medical care and then enrolls his family in Tricare, he/she often belatedly finds out that many physicians do not accept Tricare.
This places an added burden on the stay-behind family members to find medical professionals who will accept Tricare. This can often mean that the spouse and children then have to drive unreasonable distances to a Tricare provider to obtain medical care. In some cases, the only other alternative is to head for the nearest military installation in the hope that they will provide care. This isn't always possible as military medical care is now primarily focused on uniformed members with the expectation that their dependents will be seen by civilian providers.
The Bush administration previously decried the proposed addition of non-activated reserve component members to Tricare as a cost that was prohibitive and which would prevent modernization of equipment and other resources. But the fact remains that the one service most heavily burdened by the wars on terror and in Iraq is also the one which has seen the largest percentage of personnel evacuated for non-combat related medical and dental conditions.
The Army, which has had to rely on increased call-ups of members of the National Guard and reserve is also the service least prepared to deal with personnel on medical holds.
Given that the average Guard or reserve unit costs a mere 20 percent of the cost of an equivalent active-duty unit of the same size and mission, it would make sound financial sense to allow members of the reserve components to at least enroll themselves (even when not activated) to insure that they have complete medical coverage prior to any contingency activation or mobilization. Members of Congress have made this suggestion on several occasions, only to be refuted by the Pentagon and administration.
The congressional suggestions are sound ones because they offer full Tricare benefits on a co-pay basis where costs are shared by the government and the individual. The member is given the option of enrolling just himself or herself and paying those premiums while reserving the right and ability to add dependents at time of activation.
If the Pentagon were really interested in being able to use its "force in reserve," it needs to know that the vast majority of the reserve components are staffed with people who are in the best possible medical condition. All the training in the world, all the common core tasks being well performed are lost, if the soldier, sailor, airman or Marine cannot deploy because of cavities or allergies that require medication.
It is penny-wise and pound foolish to deny reserve component personnel access to Tricare. It is oftentimes too late when a military doctor finds out someone has a problem and they are standing before you in a clinic in Najaf, Tikrit or Fallujah, when they could have been more easily treated before leaving home.