Should the National Guard Get Free Health Care? Gen. Hokanson Is Trying to Make it Happen

Chief of the National Guard Bureau, Army Gen. Daniel R. Hokanson.
The chief of the National Guard Bureau, Army Gen. Daniel R. Hokanson, delivers remarks at the annual POW/MIA recognition ceremony at the Pentagon, hosted by Secretary of Defense Lloyd J. Austin III, Washington, D.C., Sept. 16, 2022. (DoD photo by Lisa Ferdinando)

Gen. Daniel Hokanson, the chief of the National Guard Bureau, has two years left on the job to accomplish one of his biggest priorities -- and biggest challenges.

At the top of Hokanson's to-do list as he quickly approaches retirement is securing free universal health care for the National Guard. Unlike their active-duty counterparts, part-time Guard troops aren't entitled to health care when they are off orders.

But the change is a heavy lift because of its high price tag: $719 million per year. The cost is giving lawmakers cold feet, and Hokanson's effort has gained little momentum despite his pleas to Congress at public committee hearings and behind the scenes.

Read Next: Air Force Gets Its Own Combat Dive Badge After Using the Navy's for Years

"When we bring people on orders, they gotta be medically ready," Hokanson told in an interview at the annual Association of the United States Army conference this month in Washington, D.C. "I don't want a soldier that can't afford health Insurance and then therefore can't help his neighbors because they're not medically ready."

Hokanson estimates some 60,000 Guardsmen do not have health care.

All part-time troops are eligible for Tricare Reserve Select, which costs $46.70 per month for an individual and $229.99 for a family. But those costs can take up the bulk of a Guardsman's military pay. A specialist in the Army National Guard, the service component's most common rank, will earn roughly $351 per month.

Governors are increasingly relying on those part-timers, who must juggle civilian careers with military service, and the system of how Guardsmen are paid and deployed gets complicated fast.

Domestic missions are typically conducted on state orders issued by governors. In those cases, troops are effectively not in the federal military and instead can function somewhat like state contractors in camouflage, such as soldiers deployed to Texas' Operation Lone Star border mission.

Soldiers and airmen earn no benefits associated with active-duty operations and are not entitled to free health care while on those state missions.

When Guardsmen are off orders -- how they spend most of their time -- they do not have access to free health care.

However, if a state mission is deemed a national emergency by the president, as was the case with the pandemic and response to the Jan. 6, 2021, U.S. Capitol riot, Guardsmen are entitled to all the pay and benefits of active-duty service members, including health care, if the orders go beyond 30 days.

The Guard has seen an uptick in domestic mobilizations recently in response to natural disasters, civil unrest, and even teacher and civil servant shortages, Eric Evans, the CEO of Friendly Forces, an advocacy group for part-time troops that created a database of employer policies, told in a statement.

"However, state orders do not provide an equivalent level of financial remuneration and insurance coverage as federal orders," Evans said. "If you want to have a ready force that is rapidly deployable domestically and abroad, you have to take care of them, both on and off orders."

Last year, a bill was introduced by Reps. Andy Kim, D-N.J., and Trent Kelly, R-Miss., which would have secured free health care for Guardsmen, but the legislation went nowhere despite widespread endorsements from the military community, including the National Guard Association of the United States, the Wounded Warrior Project and the Elizabeth Dole Foundation. But it's unclear how much those groups lobbied behind the scenes.

Most of the energy on Capitol Hill for military benefits reform went toward the landmark toxic exposure package signed by President Joe Biden in April. That bill opened up health care to millions of veterans exposed to burn pits and other toxic conditions and is estimated to cost $300 billion over the next decade.

Health care for the Guard would cost roughly $7.1 billion over the same time period, assuming all uninsured troops enrolled in Tricare.

Hokanson said he makes it a point to bring up health care in calls with lawmakers. While military leaders sometimes advocate for quality-of-life improvements for their troops, it's relatively rare for one to throw their weight behind specific legislation.

Some lawmakers mistakenly assume Guardsmen already have access to free health care, while others are skittish over the cost, Hokanson said.

"I would say the skeptics, when you explain to them, they're all in," he said. "There are some that are just, 'Hey, that's a big bill.'"

The Guard is in the midst of a crisis keeping its ranks filled with soldiers and recruiting new talent. The service component failed to meet its retention goals by about 14%, or roughly 4,800 soldiers during the last fiscal year, which ended Sept. 30.

It is also struggling to recruit, falling short by 14,500 new soldiers, according to internal data reviewed by That's in addition to roughly 30,000 Army Guardsmen who have not been vaccinated against COVID-19 and may face separation.

Education benefits are seen as the service component's most valuable tool to get applicants in the door. But health care may be a top influence when troops decide whether to continue their service.

"Getting an 18- to 20-year-old person excited about health care is difficult to do," Maj. Gen. John Harris, the adjutant general of the Ohio National Guard, said at an AUSA press conference Oct. 11. "But by the time they're ready to reenlist, they now have their spouses and family established in benefits. It certainly is an important retention tool."

-- Steve Beynon can be reached at Follow him on Twitter @StevenBeynon.

Related: The National Guard Is Having a Nightmarish Time Keeping Soldiers and Recruiting New Ones

Story Continues