Leaders of the House and Senate Armed Services Committees have reaffirmed their commitment to reform of the military health system despite calls from the service chiefs for adjustments.
Responding to a memo sent by service leaders Aug. 5 to Defense Secretary Mark Esper asking that the services retain authority over their military hospitals and clinics, lawmakers said they understand the challenges they face but said reforms are still needed.
Texas Rep. Mac Thornberry, the senior Republican on the House Armed Services Committee who chaired the panel during development of the reforms, said the factors that led to the measures "have not changed."
"Service-based health care systems remain frustrating and inefficient for the service member and taxpayer alike. ... If the services have technical challenges on the path to consolidation, Congress is ready to work together to overcome them," Thornberry told Military.com.
A spokesperson for Democrats on the House Armed Services Committee also said the transformation should continue moving forward.
"More than four years after the law required the department to transform the military health system, the services are trying to further delay change and are using the COVID-19 pandemic as the reason for delay,” said the staff member, who spoke on the condition of anonymity because they were not authorized to discuss the issue publicly. “The DoD's medical response to the pandemic has provided lessons, which should be used to inform the plan moving forward, not grind implementation to a halt."
In their memo, the secretaries of the Army, Navy and Air Force, along with the branch chiefs of the Army, Navy, Air Force, Marine Corps and Space Force, said efforts to convey the services' hospitals and clinics to the Defense Health Agency were "not viable."
They asked that the domestic military hospitals and clinics already transferred to DHA be returned and planned upcoming personnel or resource changes be suspended.
On Oct. 1, 2019, more than 280 military hospitals and clinics were transferred to the DHA, with the remaining 64 facilities overseas expected to move in October 2021.
Under the new construct, the DHA became responsible for the facilities without having the manpower or system to run them, so the services provided a "direct support relationship" during the transition period.
But the concept is problematic and onerous, the service chiefs said, and the pandemic has shown that the changes introduce "unnecessary complexity and increased inefficiency and cost" to the system.
"The proposed DHA end-state represents unsustainable growth with a disparate intermediate structure that hinders coordination of service medical response to contingencies such as a pandemic," they wrote.
In December, Army Secretary Ryan McCarthy asked for a temporary halt of the transfers, saying the DHA lacked the appropriate planning or performance to assume management of the facilities.
In March, the service surgeons general told House Appropriations Defense Subcommittee members that the DHA wasn't ready for the changes.
"In order to get it right, the focus should be on the [military treatment facility] transitions, which starts with the step to stand up that headquarters. The headquarters is not up and operational and running," said Army Surgeon General Lt. Gen. Scott Dingle. "After you get that headquarters stood up, then you can start the transition of the military medical treatment facilities."
Proponents say they understand the services’ hesitancy, but the promised reforms will eliminate systemwide redundancies and improve the quality of health care.
"The task to integrate has been daunting, but DoD, to its credit, is making it happen," said Thomas Spoehr, director of the Center for National Defense at the Heritage Foundation's Davis Institute. "The potential advantages of such a consolidation are obvious: Medical professionals can be managed with greater geographic opportunities for assignments, better buying power will allow DoD to compete on an even basis for medical supplies with even the largest hospital systems, existing service headquarters can be downsized, and workloads rationalized for beneficiaries."
But critics fear it will erode the medical benefit provided to beneficiaries as military facilities close or downsize and more patients are moved to Tricare.
"Access to base medical care has been a huge incentive for military recruitment. However, veterans are seeing this incentive disappearing. ... Why should we recommend our children and grandchildren serve years of hardship and separation from family members and then end up with fewer medical benefits at retirement?" asked retired Navy Cmdr. Robert Edwards, whose sons-in-law are both career Air Force officers.
Lawmakers agreed that there are lessons to be learned from the pandemic and the services as they respond to the crisis and care for beneficiaries. They pledged to work with the DoD and the services to ensure that the system provides quality care while containing costs.
"My number one goal of oversight with military health care is to ensure our troops and their families have the best care money can buy," said Senate Armed Services Committee Chairman Sen. Jim Inhofe, R-Okla. "We are always looking for improvements to make, and the 2017 and 2019 NDAAs proposed some big adjustments and we are making good progress. ... We must keep working together."